#119 Can I exchange my family because they all have heart attacks?
CLINICAL QUESTION
What risks do different family histories of cardiovascular disease (CVD) carry?
BOTTOM LINE
Family history of CVD modifies future CV risk depending on the number and age of affected first-degree relatives. Siblings of patients with CVD have a ~40% risk increase, while offspring of parents with premature CVD have a 60-75% increased risk. Consistent definitions of premature CVD would allow a better estimate of the true attributable risk.
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EVIDENCE
When possible, odds ratios (OR) were converted to relative risks.
- Parental History:
- 2,302 Framingham male and female offspring were analyzed for parental history of premature CVD (father <55 years, mother <65) and risk of future CVD.1
- After eight years of follow up, CVD increased 75% for paternal and ~60% for maternal history of premature CVD.
- 2,302 Framingham male and female offspring were analyzed for parental history of premature CVD (father <55 years, mother <65) and risk of future CVD.1
- Sibling History:
- Using the same cohort over eight years, CVD increased ~40% in those with CVD in their siblings.2
- In identical (or monozygotic) twins, the hazard ratio of death from coronary heart disease (CHD) increased by 3.8-15 times if an identical sibling died of CHD before age 75.3
- Three times higher risk for identical than non-identical twins.
- Greater risk the earlier the other twin died.3
- Extended Family History:
- >49,000 US primarily white males were analyzed for CHD in extended family member (sibling, aunt/uncle, parent, or grandparent) and the risk of future CVD.4
- After 16 years, those with a family history of premature CHD (age <50) had 44% increased risk of CVD mortality.
- >49,000 US primarily white males were analyzed for CHD in extended family member (sibling, aunt/uncle, parent, or grandparent) and the risk of future CVD.4
- Large international case-controlled study5 found statistically significant increased risk of Myocardial Infarction (MI) if:
- One parent had MI, OR=1.67.
- One parent had MI at age <50, OR=2.36.
- Both parents had MI, OR=2.90.
- Both parents had MI at age <50, OR=6.56.
- Results similar when adjusted for CVD risk factors, across socio-economic status of household or country and for maternal or paternal MI history.
- Current guidelines use different definitions of and adjustments for family history of premature CVD.6-9
- Many middle aged patients with first degree relative(s) with premature CVD will have their calculated CV risk increased to level where statin therapy should be considered.
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