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Family history and premature coronary heart disease
C B Eaton1, A G Bostom, L Yanek
1Department of Family Medicine, Brown University School of Medicine, Memorial Hospital of Rhode Island, Pawtucket 02860, USA.
Insights
A family history of coronary heart disease (CHD) is a significant independent risk factor for developing premature CHD. This genetic predisposition indicates high risk, even when other traditional and nontraditional risk factors are absent.
Area of Science:
- Cardiology
- Genetics
- Preventive Medicine
Background:
- Investigating the persistent role of family history in coronary heart disease (CHD).
- Assessing family history as a risk factor for premature CHD after accounting for other known risk factors.
Purpose of the Study:
- To determine if a family history of coronary heart disease (CHD) remains a significant predictor of premature CHD.
- To evaluate the independent contribution of family history to premature CHD risk.
Main Methods:
- Compared 95 patients with premature CHD to 95 controls.
- Assessed numerous risk factors including family history, hypertension, diabetes, lifestyle, and lipid profiles.
Main Results:
- A positive family history significantly increased premature CHD risk (OR=3.9).
- Risk varied by family history strength, with strong history showing OR=6.1.
- Individuals with a positive family history rarely lacked other risk factors.
Conclusions:
- Family history is a critical, independent risk factor for premature CHD.
- It should not be viewed as a simple binary risk, but as a marker of high susceptibility.
- Positive family history necessitates careful risk assessment beyond traditional factors.
Background:
We were interested in studying whether a family history of coronary heart disease (CHD) persisted as a significant risk factor for premature coronary heart disease after adjusting for traditional and nontraditional risk factors.
Methods:
Ninety-five case patients with documented premature CHD (occurring in a person less than 60 years old and with greater than 50 percent occlusion of a major epicardial vessel or a documented myocardial infarction) and 95 community-based control patients were examined for risk factors including family history, hypertension, diabetes mellitus, sedentary lifestyle, smoking, body mass index, total cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, lipoprotein(a), homocysteine, and fibrinogen.
Results:
The risk of premature CHD for a positive family history ranged from an odds ratio (OR) of 3.25 for a standard family history of CHD in a first-degree relative, 5.9 for family history of early CHD in a first-degree relative before the age of 45 years, and 6.1 for a strong family history of CHD defined as CHD in at least two first-degree relatives. Family history persisted as a significant risk factor for premature CHD (OR = 3.9, 95 percent confidence interval [CI] 1.8-8.7) in multiple variable models that included traditional and nontraditional risk factors. It was rare, however, for a person with a positive family history not to have at least two other traditional or nontraditional risk factors.
Conclusions:
Family history of CHD should not be considered a simple binary risk factor for premature CHD, and a positive family history of CHD indicates that a person is at high risk for premature CHD independent of traditional and nontraditional risk factors.