Family history of coronary heart disease: evidence-based applications

Clinicians sometimes consider family history of CHD when evaluating CHD risk and deciding whether to prescribe a lipid medication. Most clinicians who take family history of CHD into account do so by categorically adjusting the aggressiveness of patient education and preventive medication recommendations (eg, from a low-key informational mode to a more direct influential or persuasive mode). Quantitative methods exist for taking into account any family history of CHD in parents and siblings, when estimating an individual's 10-year risk for a CHD event; at present, these methods are not readily available. For those individuals who have a positive family history of CHD, using family history-adjusted risk estimates could help clinicians more accurately target high-risk individuals who are the most appropriate candidates for therapeutic lifestyle changes and dyslipidemia drug therapy. Electronic health records (EHR) that now include CHD risk estimation as a decision support feature exclude family history from the calculation. Unless family CHD history is included in EHR decision support modules, family history of CHD will be increasingly discounted or ignored, as clinicians come to rely more and more on computerized decision support aids.