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Family history of heart attack: a modifiable risk factor?
Insights
A family history of heart attack significantly increases cardiovascular risk, especially in younger men. Modifiable factors like smoking interact with this history, highlighting preventable risks.
Area of Science:
- Cardiovascular epidemiology
- Genetics and lifestyle interactions
Background:
- Family history of heart attack is an independent predictor of cardiovascular death in men.
- Men under 60 with a family history had a fivefold increased risk in the Rancho Bernardo Study.
Purpose of the Study:
- To investigate the differential effect of modifiable risk factors on cardiovascular risk in individuals with and without a family history of heart attack.
- To assess the interaction between family history and modifiable factors like smoking.
Main Methods:
- Analysis of 9-year follow-up data from 4014 adults (40-79 years old) in the Rancho Bernardo Study.
- Examined the influence of blood pressure, plasma cholesterol, obesity, and cigarette smoking on cardiovascular risk.
- Stratified analysis based on family history of heart attack and smoking status.
Main Results:
- Cigarette smoking was a stronger predictor of cardiovascular disease in individuals with a family history of heart attack for both sexes.
- In men, the increased cardiovascular mortality risk associated with a family history was primarily observed in smokers.
- An estimated 68% of excess deaths in men with a family history were attributable to the interaction between family history and smoking.
Conclusions:
- Modifiable behaviors, particularly smoking, profoundly impact cardiovascular disease risk in individuals with an inherited predisposition.
- The interaction between family history of heart attack and smoking represents a significant, potentially avoidable cause of excess cardiovascular mortality.
- Lifestyle modifications can mitigate the heightened cardiovascular risk associated with a family history of heart attack.
Abstract:
A family history of heart attack is reported to be an independent predictor of cardiovascular death in men. In a 9 year follow-up of 4014 adults from 40 to 79 years old in the Rancho Bernardo Study, men under 60 years of age with a family history of heart attack were at fivefold increased risk. In this study, we sought to determine whether modifiable risk factors, i.e., blood pressure, plasma cholesterol, obesity, and cigarette smoking, have a differential effect on cardiovascular risk in those with and without a family history of heart attack. For both sexes, cigarette smoking was a stronger predictor of cardiovascular disease in those with a family history of heart attack (relative risk of smokers vs nonsmokers was 2.5 for men and 4.0 for women) than in those with no such family history (relative risk of smokers vs nonsmokers was 1.1 for men and 1.7 for women). Conversely, an increased risk of cardiovascular mortality in men with a family history of heart attack was present predominantly in smokers (relative risk related to positive family history was 1.2 in nonsmokers, and 3.3 in smokers). An estimated 68% of the excess deaths in men with a family history of heart attack were attributable solely to the interaction of family history with smoking habit and were therefore potentially avoidable. The risk of cardiovascular disease associated with an apparently inherited predisposition appears to be profoundly affected by modifiable behavior.