Familial risk assessment for early-onset coronary heart disease
Maren T Scheuner1, William C Whitworth, Henraya McGruder
1RAND Corporation, Santa Monica, CA 90407-2138, USA.
Insights
Familial risk assessment effectively identifies individuals at higher risk for early-onset coronary heart disease and related conditions. This method aids in targeted interventions for preventing cardiovascular disease.
Area of Science:
- Cardiovascular epidemiology
- Genetic risk factors
- Preventive cardiology
Background:
- Early-onset coronary heart disease (CHD) poses a significant public health challenge.
- Familial history is a known, yet often underutilized, predictor of cardiovascular risk.
- Effective risk stratification is crucial for timely preventive strategies.
Purpose of the Study:
- To evaluate a familial risk assessment method for stratifying risk of early-onset coronary heart disease (CHD).
- To examine associations between familial risk and other cardiovascular risk factors including diabetes, hypercholesterolemia, hypertension, and obesity.
- To determine the optimal risk assessment model for predicting early-onset CHD.
Main Methods:
- Utilized data from the HealthStyles 2003 survey (N=4,035).
- Assessed associations between familial risk factors and early-onset CHD, diabetes, hypercholesterolemia, hypertension, and obesity.
- Employed area under the curve (AUC) statistics to evaluate model discriminatory ability.
Main Results:
- Strong and moderate familial risk were significantly associated with increased odds of early-onset CHD after demographic adjustment.
- Strong familial risk remained significantly associated with diabetes, hypercholesterolemia, hypertension, and obesity, even after adjusting for personal cardiovascular disease history.
- A comprehensive risk assessment model incorporating familial risk, demographics, and personal health history achieved an optimal AUC of 87.2%.
Conclusions:
- Familial risk assessment is a viable tool for stratifying risk in early-onset coronary heart disease.
- Identifying individuals with increased familial risk allows for targeted interventions for preventable conditions.
- These findings underscore the importance of integrating familial risk into clinical assessment and preventive strategies for cardiovascular disease.
Purpose:
We examined the performance of a familial risk assessment method that stratifies risk for early-onset coronary heart disease by considering the number of relatives with coronary disease, degree of relationship, lineage, and age at diagnosis.
Methods:
By using data from the HealthStyles 2003 survey, we assessed the associations between familial risk and early-onset coronary heart disease, diabetes, hypercholesterolemia, hypertension, and obesity. By using area under the curve statistics, we evaluated the discriminatory ability of various risk assessment models.
Results:
Of 4,035 respondents, 60% were female and 72% were white, with a mean age of 48.8 years. After adjustment for demographics, strong and moderate risk were significantly associated with approximately a five- and twofold risk of early-onset coronary disease, respectively. After adjustment for demographics and personal history of cardiovascular disease, strong familial risk was also significantly associated with diabetes, hypercholesterolemia, hypertension, and obesity. A risk assessment model that included familial risk, demographics, and personal history of diabetes, hypercholesterolemia, hypertension, and obesity was most optimal with an area under the curve statistic of 87.2%
Conclusions:
Familial risk assessment can stratify risk for early-onset coronary heart disease. Several conditions associated with increased familial risk can be prevented. These results have important implications for risk assessment and risk-reducing interventions.
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