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Family history as a risk factor for early onset myocardial infarction in young women
Y Friedlander1, P Arbogast, S M Schwartz
1The Department of Social Medicine, The Hebrew University-Hadassah School of Public Health, PO Box 12272, Jerusalem 91120, Israel. yfried@vms.huji.ac.il
Insights
A family history of myocardial infarction (MI) increases early MI risk in women. Sibling history is a significant factor, only partially explained by known risk factors, unlike parental history.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Epidemiology
Background:
- Family history of heart attack risk in young women is understudied.
- The role of known and novel coronary heart disease (CHD) risk factors in familial aggregation of early myocardial infarction (MI) is unclear.
Purpose of the Study:
- To investigate the association between family history of MI and early MI in young women.
- To determine if known and novel CHD risk factors explain familial aggregation of early MI.
Main Methods:
- Population-based case-control study of women aged 18-44 years.
- Structured interviews collected family history of MI and other risk factors.
- Biochemical measurements and genetic polymorphisms were analyzed.
Main Results:
- Women with a family history of MI had double the rate of MI compared to controls (RR, 1.96).
- Sibling history of MI, but not parental history, remained associated with MI after controlling for established CHD risk factors.
- Adjusting for lipids, lipoproteins, and genetic factors partially reduced the association with sibling MI history (OR, 3.97).
Conclusions:
- Family history of MI is a significant risk factor for early MI in women.
- Parental MI history's association is explained by shared risk factors.
- Sibling MI history's association with early-onset MI is only partially explained by established and novel risk factors.
Background:
The relation between a family history of heart attack and the occurrence of early myocardial infarction (MI) has not been studied extensively in women. In addition, whether recognized and newly-identified coronary heart disease (CHD) risk factors account for the familial aggregation of these events remains unknown. We therefore examined these questions in a population-based case-control study among female 18- to 44-year-old residents of western Washington State.
Methods And Results:
The patients consisted of 107 women with first acute MI, and the control subjects comprised 526 women similar in age identified from the community and without a history of recognized clinical coronary heart disease or stroke. Trained interviewers used a structured questionnaire to elicit a detailed history of heart attack in first-degree relatives. Information about other known MI risk factors was collected and biochemical measurements performed, and common polymorphisms in various candidate genes were determined. The rate of MI among first-degree relatives of MI cases was twice as high as among first-degree relatives of controls (relative risk, 1.96; 95% confidence interval (CI), 1.46-2.48); this association was present for each familial relationship. Sibling history of MI but not parental history was associated with MI, after controlling for established CHD risk factors. In a subsample of subjects with blood measurements, further adjustment for lipids, lipoproteins and specific genetic risk factors slightly reduced the association with sibling MI history (from odds ratio (OR), 5.17; 95% CI, 1.93-13.85 to OR, 3.97; 95% CI, 0.92-17.17).
Conclusion:
Family history of MI is positively associated with the risk of early MI in women. While the association with parental history of MI is mediated through the clustering of other common risk factors, the association of sibling history of MI with early-onset MI in young women is only partially explained by the clustering of established and newly-identified risk factors.
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