Study of risk factors and its correlation with constraint induced movement therapy for atherosclerosis in patients of coronary artery disease and their offspring


  • Venugopal Margekar Department of Medicine,GRMC, Gwalior, Madhya Pradesh, India
  • Shweta Thakur Department of Radiodiagnosis, GRMC, Gwalior, Madhya Pradesh, India
  • O. P. Jatav Department of Medicine,GRMC, Gwalior, Madhya Pradesh, India
  • Pankaj Yadav Department of Radiodiagnosis, GRMC, Gwalior, Madhya Pradesh, India



Atherosclerosis, Cardiovascular events, Constraint induced movement therapy, Ultrasonography, Smoking


Background: A significant percent of cardiovascular event occurs without well-known modifiable risk. A new tool for early identification for atherosclerosis is required for early intervention. Aims and objectives of the study was to study the risk factors for CAD and its correlation with CIMT.

Methods: One hundred and forty subjects were studied for the risk factors of CAD in Department of Medicine of G.R. Medical College, Gwalior from 2012 to 2013. Out of 140 subjects, 100 were patients having CAD and 40 age matched subjects were included as control group. Data was also recorded from their offspring. High resolution B mode ultrasonography was performed to assess CIMT of carotid arteries. The maximum CIMT of any one side of carotid artery was taken for study.

Results: CAD was more prevalent among males (78%). Majority of the offspring of cases had age between 28-42 years and majority were male (73%). Most common risk factors for CAD was dyslipidemia (48%), hypertension (24%), diabetes (12%) and smoking (21%), whereas in offspring’s of CAD patients, dyslipidemia was seen in 28%, hypertension in 3%, diabetes and tobacco smoking in 12% and 24% respectively. The CIMT of CAD patients was significantly increased with increasing the number of risk factors and the same pattern was also seen in controls.  The CIMT of asymptomatic offspring’s having positive family history was significantly more than the asymptomatic offspring without positive family history of CAD.

Conclusions: CIMT measurements can be used as a surrogate marker of atherosclerosis as it has showed a direct link with number of risk factors of CAD. 


Weber C, Noels H. Atherosclerosis: current pathogenesis and therapeutic options. Nature Med. 2011 Nov;17(11):1410.

Singh RB, Mengi SA, Xu YJ, Arneja AS, Dhalla NS. Pathogenesis of atherosclerosis: A multifactorial process. Exper Clin Cardiol. 2002;7(1):40.

Berenson GS. Cardiovascular risk begins in childhood: a time for action. Am J Preven Med. 2009 Jul 1;37(1):S1-2.

Pac-Kozuchowska E, Krawiec P, Grywalska E. Selected risk factors for atherosclerosis in children and their parents with positive family history of premature cardiovascular diseases: a prospective study. BMC Pediatr. 2018 Dec 1;18(1):123.

Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardio. 1976 Jul 1;38(1):46-51.

Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, et al. Prevalence of conventional risk factors in patients with coronary heart disease. Jama. 2003 Aug 20;290(7):898-904.

Pourebrahim R, Fakhrzadeh H, Bandarian F, Tabatabaie O, Noori M, Djalilpour F, et al. Household cardiovascular screening of high-risk families: a school-based study. Eur J Cardi Preven Rehabil. 2006 Apr;13(2):229-35.

Jaquith BC, Harris MA, Penprase B. Cardiovascular disease risk in children and adolescents. J Pediatr Nurs. 2013;28:258-66.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.

Gupta M, Singh N, Warsi M, Reiter M, Ali K. Canadian South Asians have more severe angiographic coronary disease than European Canadians despite having fewer risk factors. Can J Cardiol. 2001;17(Suppl C):226C.

Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease-six-year follow-up experience: the Framingham Study. Annal Inter Med. 1961 Jul 1;55(1):33-50.

Shankar SR, Jaishankar S, Raghu K. Risk and biochemical profile of acute myocardial infarction in a young population. Ind Heart J. 2002;54:541.

Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, et al. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet. 2006 Aug 19;368(9536):647-58.

Tewari S, Kumar S, Kapoor A, Singh U, Agarwal A, Bharti BB, et al. Premature coronary artery disease in North India: an angiography study of 1971 patients. Ind Heart J. 2005;57:289-94.

Zimmerman FH, Cameron A, Fisher LD, Grace NG. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995 Sep 1;26(3):654-61.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.

Isser HS, Puri VK, Narain VS, Saran RK, Dwivedi SK, Singh S. Lipoprotein (a) and lipid levels in young patients with myocardial infarction and their first-degree relatives. Ind Heart J. 2001;53(4):463-6.

Goel PK, Bharti BB, Pandey CM, Singh U, Tewari S, Kapoor A, et al. A tertiary care hospital-based study of conventional risk factors including lipid profile in proven coronary artery disease. Ind Heart J. 2003;55(3):234-40.

Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Ind Heart J. 1996;48:343-53.

Karthikeyan G, Teo KK, Islam S, McQueen MJ, Pais P, Wang X, et al. Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians: an analysis from the INTERHEART Study. J Am Coll Cardiol. 2009 Jan 20;53(3):244-53.

Kuo P. Dyslipidemia and Coronary Artery Disease. Clin. Cardiol. 2017;5(19):527-32.

Holland Z, Ntyintyane L, Gill G, Raal F. Carotid intima–media thickness is a predictor of coronary artery disease in South African black patients. Cardio J Afri . 2009;20(4):1-8.

Andresdottir MB, Sigurdsson G, Sigvaldason H, Gudnason V. Fifteen percent of myocardial infarctions and coronary revascularizations explained by family history unrelated to conventional risk factors. The Reykjavik Cohort Study. Eur Heart J. 2002 Nov 1;23(21):1655-63.

Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH. Prevention conference V: beyond secondary prevention, identifying the high-risk patient for primary prevention, noninvasive tests of atherosclerotic burden, writing group III. Circulation. 2000;101:E16-22.

Chang CC, Chang ML, Huang CH, Chou PC, Ong ET, Chin CH. Carotid intima-media thickness and plaque occurrence in predicting stable angiographic coronary artery disease. Clin Inter Aging. 2013;8:1283.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006 May 27;367(9524):1747-57.

Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001 Dec 4;104(23):2855-64.






Original Research Articles