Coronary Artery Disease in Monozygotic Twins

Two patients (monozygotic twin brothers) with premature coronary artery disease were reported so as to emphasize and review the importance of known and unknown hereditary risk factors. There were two risk factors (family history and smoking) in both patients. HDL cholesterol and apolipoprotein A levels were borderline low and apo B borderline high. One of them had undergone coronary bypass surgery two years after myocardial infarction, and the other had become symptomatic with a similar location of the lesion on LAD artery. Elective, successful PTCA procedure resulted in early (15th day) restenosis whereupon elective revascularisation was performed. These cases, along with the 12 pairs of twins with CAD reported previously, suggest that the asymptomatic twin should be carefully followed-up when the co-twin has documented coronary artery disease.