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Familial occurrence of coronary heart disease: effect of age at diagnosis
Insights
Family history of early myocardial infarction (MI) significantly increases coronary heart disease (CHD) risk. Familial hyperlipidemia and hypertension are key drivers, suggesting early identification and treatment can mitigate risk.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Public Health
Background:
- Coronary heart disease (CHD) poses a significant public health challenge.
- Family history is a known, yet often underutilized, predictor of CHD risk.
- Early onset of myocardial infarction (MI) suggests a strong genetic predisposition.
Purpose of the Study:
- To assess the occurrence of CHD and its risk factors in first-degree relatives of men with and without MI.
- To investigate the relationship between the age of MI diagnosis in patients and the prevalence of CHD in their families.
- To identify specific familial risk factors contributing to early-onset CHD.
Main Methods:
- A case-control study involving 309 men (203 with MI, 106 healthy controls) under 56 years old from South and East Finland.
- Assessment of CHD occurrence and major risk factors (hypertension, hyperlipidemia) in first-degree relatives.
- Analysis of CHD risk based on the age of MI diagnosis in the index patient.
Main Results:
- Younger age at first MI diagnosis was strongly associated with higher CHD prevalence in parents and siblings.
- Brothers of patients diagnosed with MI before age 46 had substantially higher CHD risk compared to controls.
- Familial hyperlipidemia and hypertension were most prevalent in relatives of the youngest MI patients, indicating their role in early-onset CHD.
Conclusions:
- A strong familial component underlies early-onset CHD, primarily mediated by inherited hyperlipidemia and hypertension.
- Utilizing family history information can identify high-risk individuals for early intervention.
- Proper management of modifiable risk factors in genetically predisposed individuals may largely eliminate the risk of premature CHD.
Abstract:
The occurrence of coronary heart disease and its main risk factors were assessed among the first degree relatives of 309 men from South and East Finland, including 203 men with fatal or nonfatal myocardial infarction and 106 healthy reference men under age 56 years. The younger the patient at the diagnosis of a first myocardial infarction, the more common was coronary heart disease in his parents and siblings. The risk of having coronary heart disease by age 55 was, respectively, 11.4, 8.3 and 1.3 times greater in the South and 6.7, 3.6 and 1.8 times greater in the East for the brothers of patients than for the brothers of reference subjects depending on whether the diagnosis of myocardial infarction in the patient had first been established before the age of 46 years of age 46 to 50 years or at age 51 to 55 years. Hypertension and hyperlipidemia, but none of the other risk factors studied, were most common among the relatives of the youngest patients and diminished in frequency with advancing age of the patient. Most of the strong familial component in coronary heart disease of early onset thus appears to be mediated by familial hyperlipidemias and hypertension. It is suggested that the risk of premature coronary heart disease in the persons at highest risk could be largely eliminated if information about family history were used to identify such persons at an early stage and if they were treated properly for their correctable risk factors.