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Family-centered approaches to understanding and preventing coronary heart disease
Sharon L R Kardia1, Stephen M Modell, Patricia A Peyser
1Department of Epidemiology, University of Michigan, 109 Observatory Street, Room 3047, Ann Arbor, MI 48109-2029, USA. skardia@umich.edu
Insights
A family history of coronary heart disease (CHD) significantly predicts individual risk, even beyond personal risk factors. Focusing on family history offers a better understanding of complex genetic and environmental interactions for disease prevention.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Public Health
Background:
- Family history integrates genomic and ecologic factors influencing health.
- A family history of coronary heart disease (CHD) is a known predictor of individual CHD risk.
- Familial aggregation of CHD is attributed to shared genetic and environmental factors.
Purpose of the Study:
- To highlight the significance of family history in predicting disease risk.
- To emphasize the multifactorial nature of familial disease aggregation.
- To advocate for the family as a unit of inference and prevention target.
Main Methods:
- Review of existing literature on family history and CHD risk.
- Analysis of the predictive value of family history versus individual risk factors.
- Examination of family-centered intervention studies.
Main Results:
- Family history is a significant predictor of CHD risk, independent of individual risk factors.
- Family history may better capture complex gene-environment interactions than individual factors alone.
- Family-centered approaches show advantages in disease prevention.
Conclusions:
- Further research is needed to standardize the assessment and application of family history in clinical practice.
- Incorporating family history can enhance the primary prevention of CHD.
- Viewing the family as a unit of inference and intervention is crucial for advancing CHD prevention.
Abstract:
Family history represents the contributions and interactions of unique genomic and ecologic factors that affect the metabolic profile and life course of a family and its members. It is well known that a family history of coronary heart disease (CHD) is a significant predictor of an individual's risk for CHD even after adjusting for an individual's own established risk factors, such as hypertension, smoking, and abnormal lipoprotein levels. The explanation for the observed familial disease aggregation is not well understood except for the general knowledge that genetic and environmental factors predisposing to CHD also aggregate in families. Given the multifactorial nature of an individual's risk, it can be argued that an individual's familial risk of disease may, in fact, be a better indicator of the many complex interactions among predisposing genetic and environmental factors than can be captured by an individual's own risk factors. Issues of how to assess, quantitate, and apply family history information in clinical settings still need to be resolved. Some clinical risk indicators, such as the National Cholesterol Education Program III guidelines, take into account family history, while others, such as the Framingham Risk Score, do not. Moreover, several family-centered intervention studies have demonstrated the particular advantages of focusing on families rather than just individuals. Although there has been tremendous progress in primary prevention of CHD over the last 20 years, substantial advancements may still be achieved by focusing on the family as its own unit of inference and as a specific target for disease prevention.