Elsevier

Mayo Clinic Proceedings

Volume 93, Issue 9, September 2018, Pages 1213-1223
Mayo Clinic Proceedings

Original article
Basic vs More Complex Definitions of Family History in the Prediction of Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis

https://doi.org/10.1016/j.mayocp.2018.01.014Get rights and content

Abstract

Objective

To determine whether family history of coronary heart disease (FH) definitions differ in their association with atherosclerotic cardiovascular disease (ASCVD) events.

Patients and Methods

Participants who provided FH data from July 17, 2000, through February 24, 2004, were identified. Definitions of FH were any, premature, and Familial Risk Assessment (FRA). Outcomes included coronary heart disease (CHD), stroke, peripheral artery disease, angina, and congestive heart failure. Multivariable-adjusted Cox models examined the association of FH definitions with events. C statistics and the net reclassification index examined the incremental prognostic contribution of each definition.

Results

In 6200 participants, the proportions of any FH and premature FH were 36% and 16%, respectively, and of weak, moderate, and strong familial risk were 20%, 16%, and 20%, respectively. Over median follow-up of 10.1 years (range, 0.02-11.5 years), 741 participants experienced a composite event. Compared with no FH, any FH was associated with incident CHD, angina, and composite ASCVD (hazard ratios [95% CIs]: 1.4 [1.1-1.8], 1.6 [1.2-2.1], and 1.3 [1.1-1.5], respectively). Similar results were obtained for premature FH compared with no FH and for strong compared with weak FRA for these 3 outcomes. There was no association between the FH definitions and noncoronary cardiovascular events. Compared with traditional risk factors (C statistic = 0.740), any FH, premature FH, and FRA all improved discrimination of composite ASCVD (all P < .01); however, the differences in C statistics among any FH (0.743), premature FH (0.742), and FRA (0.744) were numerically small, as were differences in the net reclassification index.

Conclusion

A single question regarding the presence of FH in any first-degree relative performs just as well as more complicated assessments in predicting CHD.

Trial Registration

clinicaltrials.gov Identifier: NCT00005487.

Section snippets

Study Population and Data Collection

The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 participants between 2000 and 2002 across 6 field centers, with full details previously published.16 Participants were aged 45 to 84 years; identified their race/ethnicity as white, black, Hispanic, or Chinese American; and were free of clinical ASCVD at baseline. Data pertaining to FH were obtained at the baseline visit (July 17, 2000, through September 5, 2002) and at visit 2 (September 9, 2002, through February 24, 2004). As

Results

The study population consisted of 6200 individuals (mean ± SD age, 62 ± 10 years; 48% men and 40% white race). Overall, 36% (n = 2211) and 16% (n = 983) of MESA participants reported any FH or premature FH, respectively. The corresponding proportions for weak, moderate, and strong FRA were 20%, 16%, and 20%, respectively (Supplemental Table 1, available online at http://www.mayoclinicproceedings.org). Compared with no FH, the any FH group had a higher percentage of individuals who were of white

Discussion

In this contemporary, multiethnic cohort, FH definitions of differing complexity were all demonstrated to be independent risk factors for ASCVD events. Interestingly, the magnitude of these associations was similar for each FH definition. Although statistically significant, the incremental prognostic contribution to the C statistic for ASCVD was qualitatively similar for each FH definition. The association of FH and events was limited to CHD and angina, and other noncoronary cardiovascular

Conclusion

Various definitions of FH can add significant prognostic information to traditional risk factors in the prediction of CHD events. Current prevention guidelines endorse the assessment of premature FH to guide ASCVD risk prevention, particularly when therapeutic uncertainty exists. Our MESA data would suggest that in aggregate and when other traditional risk factors are already known, a simple and single-question assessment of family history in a first-degree relative of any age may be more

Acknowledgments

We thank the staff and participants of the MESA for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

References (42)

  • S. Yusuf et al.

    Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study

    Lancet

    (2004)
  • H. Hecht et al.

    Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography

    J Cardiovasc Comput Tomogr

    (2017)
  • M.S. Safarova et al.

    Association of a family history of coronary heart disease with initiation of statin therapy in individuals at intermediate rIsk: post hoc analysis of a randomized clinical trial

    JAMA Cardiol

    (2016)
  • P. Dhiman et al.

    Availability and quality of coronary heart disease family history in primary care medical records: implications for cardiovascular risk assessment

    PLoS One

    (2015)
  • H.D. Sesso et al.

    Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women

    Circulation

    (2001)
  • D.M. Lloyd-Jones 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)
  • S. Sivapalaratnam et al.

    Family history of premature coronary heart disease and risk prediction in the EPIC-Norfolk prospective population study

    Heart

    (2010)
  • J.M. Bachmann 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)
  • R. Li et al.

    Family risk score of coronary heart disease (CHD) as a predictor of CHD: the Atherosclerosis Risk in Communities (ARIC) study and the NHLBI family heart study

    Genet Epidemiol

    (2000)
  • J.M. Murabito et al.

    Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults

    JAMA

    (2005)
  • K. Leander et al.

    Family history of coronary heart disease, a strong risk factor for myocardial infarction interacting with other cardiovascular risk factors: results from the Stockholm Heart Epidemiology Program (SHEEP)

    Epidemiology

    (2001)
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    For editorial comment, see page 1167

    Grant Support: The Multi-Ethnic Study of Atherosclerosis was supported by contracts HHSN268201500003I and N01-HC-95159/60/61/62/63/64/65/66/67/69 from the National Heart, Lung, and Blood Institute (NHLBI) and by grants UL1-TR-000040/001079/001420 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the views of the NHLBI or the National Institutes of Health.

    Potential Competing Interests: Drs Patel, Al Rifai, Shea, Blumenthal, Blaha, and McEvoy report no competing interests. Dr Scheuner holds 2 patents for familial risk assessment algorithms: US 7,951,078 B2 (Method and apparatus for determining familial risk of disease) and US 8,719,045 (Personal assessment including familial risk analysis for personalized disease prevention plan). Dr Nasir has reported consulting for Regeneron and is on the advisory board of Quest Diagnostics.

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