Concomitant Coronary Artery Disease in Identical Twins: Case Report and Systematic Literature Review

Author:

Kamzolas Odysseas1,Papazoglou Andreas2ORCID,Gemousakakis Eleftherios1,Moysidis Dimitrios3ORCID,Kyriakoulis Kοnstantinos2ORCID,Brilakis Emmanouil4,Milkas Anastasios2

Affiliation:

1. 401 General Military Hospital of Athens, 11525 Athens, Greece

2. Athens Naval Hospital, 11521 Athens, Greece

3. 424 General Military Hospital of Thessaloniki, 56429 Thessaloniki, Greece

4. Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN 55407, USA

Abstract

Coronary artery disease (CAD) is multifactorial and strongly affected by genetic, epigenetic and environmental factors. Several studies have reported development of concomitant CAD in identical twins. We report a case in which a pair of Caucasian male monozygotic twins presented almost concomitantly with acute coronary syndrome (ACS) and had concordant coronary anatomy and identical site of occlusion. We performed a systematic literature review of PubMed, Web Of Science and Scopus databases from inception until 28 February 2023 of case reports/case series reporting the concomitant development of CAD in monozygotic twins. We found 25 eligible case reports with a total of 31 monozygotic twin pairs (including the case from our center) suffering from CAD and presenting (most of them simultaneously) with ACS (mean age of presentation: 45 ± 12 years, males: 81%). Coronary angiograms demonstrated lesion and anatomy concordance in 77% and 79% of the twin pairs, respectively. Screening for disease-related genetic mutations was performed in six twin pairs leading to the identification of five CAD-related genetic polymorphisms. This is the first systematic literature review of studies reporting identical twin pairs suffering from CAD. In summary, there is high concordance of coronary anatomy and clinical presentation between monozygotic twins. Future monozygotic twin studies—unbiased by age effects—can provide insights into CAD heritability being able to disentangle the traditional dyad of genetic and environmental factors and investigate the within-pair epigenetic drift.

Publisher

MDPI AG

Subject

General Medicine

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