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