Screening Strategies and Primary Prevention Interventions in Relatives of People With Coronary Artery Disease: A Systematic Review and Meta-analysis.
BACKGROUND
Relatives of people with coronary artery disease are at high risk of cardiovascular (CV) disease, but the effect of focused screening and treatment of this population is uncertain.


METHODS
We searched the Cochrane Library, Medline, and Embase from inception until June 30, 2014 for articles that described screening strategies and primary prevention interventions targeting family members of patients with coronary artery disease to reduce CV risk. Results were pooled using a random-effects meta-analysis.


RESULTS
We identified 18 studies that reported screening strategies and 15 reporting interventions to reduce CV risk. Proband willingness to refer relatives for screening was high (n = 6 studies, pooled rate = 87%; 95% confidence interval [CI], 80%-95%). Studies using a screening strategy in which the relative was contacted by health care professionals reported a pooled participation rate of 88% (95% CI, 78%-99%). The quality of interventional studies was highly variable. Random-effects meta-analysis of the highest quality randomized studies (n = 6) consisting of a specialized risk factor intervention compared with usual care was consistent with modest improvements in low-density lipoprotein cholesterol control (-0.18 mmol/L low-density lipoprotein cholesterol, 95% CI, -0.35 to -0.001; P = 0.048). Improvements in diet, smoking rates, exercise, and blood pressure were also observed with active intervention; however, reported outcomes were heterogeneous precluding a formal meta-analysis.


CONCLUSIONS
Screening strategies that target family members, particularly when led by a health care professional, achieve a high participation rate. Although the available evidence is of variable quality, interventions that target individuals with a family history of coronary artery disease appear to be feasible and might be effective in improving certain risk factors or health behaviours but their long-term CV benefits remain uncertain.
Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada; Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada.
Michael
M
Goldfarb
Department of Medicine, Division of Internal Medicine, McGill University Health Centre, Montreal, Québec, Canada.
Douglas
D
Slobod
Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada; The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada.
Line
L
Dufresne
Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada.
James M
JM
Brophy
Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada; Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada; The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada.
Allan
A
Sniderman
Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada; Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada; The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: george.thanassoulis@mcgill.ca.
George
G
Thanassoulis
D002170:Canada; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D004198:Disease Susceptibility / Q000175:diagnosis* / Q000453:epidemiology; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012308:Risk Management / Q000379:methods; D012680:Sensitivity and Specificity