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Medical researchers say the same genes that cause one killer — aneurysms — may protect against the biggest killer of Americans — coronary artery disease. It could be an important clue to two different life-threatening heart problems.
Yale University heart surgeons have operated on thousands of people with aortic aneurysms — dangerous enlargements of the heart's main artery that can suddenly burst. Over the years they noticed that these patients tended to have particularly clean coronary arteries, with little or no plaque buildup and hardening. Hardening of the arteries, or arteriosclerosis, is the main cause of heart attacks and strokes.
"Unfortunately American men develop arteriosclerosis beginning at a very early age," explains John Elefteriades, professor and chief of cardiothoracic surgery at Yale University and Yale-New Haven Hospital. "But our team, we noticed in the process of operating on patients, oftentimes males, middle-age or beyond, who came in with aortic dissections — we couldn't find any lipid, we couldn't find a single fatty streak, we couldn't find any deposits of arteriosclerosis," he says, "And we started to wonder, does the same mutation that makes these patients vulnerable to aortic dissection, does it in some manner protect them from arteriosclerosis?"
Hardening of the arteries, or arteriosclerosis, is the main cause of heart attacks and strokes. image: American Heart Association
Elefteriades and his colleagues have been working for more than a decade to understand anyeurisms. They compiled a database containing the complete records of all their patients with thoracic aortic aneurysms.
"What we did was to establish a computerized database including every patient who was treated… at Yale University for a thoracic aortic aneurysm or dissection," Elefteriades says. "We're now on about patient number 3,000."
To assess the connection between these aneurysms and clean arteries, the Yale research team, collaborating with John Rizzo's group at State University of New York at Stony Brook compared the chest cat scans of 64 aneurysm patients to other patients of similar age and sex. "When you have an advanced deposit of arteriosclerosis, calcium becomes deposited in there, the mineral calcium that makes up our bone, and that can be measured very easily on the cat scan," explains Elefteriades.
They found that the aneurysm group did have significantly less hardening of the arteries than the control group. "If you have enlargement of your ascending aorta, you are much less likely to suffer from arteriosclerosis," he says.
Elefteriades and his colleagues think the most likely explanation is genetic. "It is just possible that these observations may allow us to get a back-door insight into the causation of arteriosclerosis," he says. "We intend to find the gene that causes these aneurysms and perhaps we'll also discover that that gene is involved in protecting a patient against arteriosclerosis.
The researchers had previously discovered that all aneurysms are likely genetic, and say they are already narrowing down which genes may predispose people to aneurysms.
This study was published in the September 12, 2005 issue of the journal Chest, and was funded by the Berkus Fund, the Fariola Fund and the American Heart Association.
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