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#119 Can I exchange my family because they all have heart attacks?


CLINICAL QUESTION
QUESTION CLINIQUE
What risks do different family histories of cardiovascular disease (CVD) carry?


BOTTOM LINE
RÉSULTAT FINAL
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 riskConsistent definitions of premature CVD would allow a better estimate of the true attributable risk.  



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EVIDENCE
DONNÉES PROBANTES
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 <65and risk of future CVD.1 
      • After eight years of follow up, CVD increased 75% for paternal and ~60% for maternal history of premature CVD. 
  • 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 yearsthose with a family history of premature CHD (age <50) had 44% increased risk of CVD mortality.   
  • 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 factorsacross socio-economic status of household or country and for maternal or paternal MI history. 
Context:  
  • 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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Author(s)
Auteur(s)
  • Cathy Scrimshaw MD CCFP
  • Michael R Kolber BSc MD CCFP MSc

1. Lloyd-Jones DM, Nam BH, D’Agostino RB Sr, et al. Parental Cardiovascular Disease as a Risk Factor for Cardiovascular Disease in Middle-aged Adults A Prospective Study of Parents and Offspring. JAMA. 2004; 291:2204-11.

2. Murabito JM, Pencina MJ, Nam BH, et al. Sibling Cardiovascular Disease as a Risk Factor for Cardiovascular Disease in Middle-aged Adults. JAMA. 2005; 294:3117-23.

3. Marenberg ME, Risch N, Berkman LF, et al. Genetic Susceptibility to Death from Coronary Heart Disease in a Study of Twins. NEJM. 1994; 330:1041-6.

4. Bachmann JM, Willis BL, Ayers CR, et al. Association Between Family History and Coronary Heart Disease Death Across Long-Term Follow-Up in Men: The Cooper Center Longitudinal Study. Circulation. 2012; 125:3092-8.

5. Chow CK, Islam S, Bautista L, et al. Parental History and Myocardial Infarction Risk Across the World. The INTERHEART Study. J Am Coll Cardiol. 2011; 57(5):619-27.

6. Anderson TJ, Grégoire J, Hegele RA, et al. 2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can Journal Cardiol. 2013; 29:151–67.

7. Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014; 129(25 Suppl 2):S49-73.

8. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal. 2011; 32:1769-1818.

9. National Institute for Health and Care Excellence. Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. July 2014. Available at http://www.nice.org.uk/Guidance/CG181. Accessed May 25, 2014.

Authors have no conflicts to disclose.