Parental history of premature coronary heart disease: An independent risk factor of myocardial infarction

doi:10.1016/0895-4356(95)00581-1

Journal of Clinical Epidemiology

Volume 49, Issue 5, May 1996, Pages 497-503

https://doi.org/10.1016/0895-4356(95)00581-1 Get rights and content

Abstract

We assessed the role of parental history of premature coronary heart disease (CHD) in the risk of acute myocardial infarction (AMI) and the extent to which the risk associated with positive parental history was independent of other risk factors: smoking, high serum cholesterol, elevated blood pressure, diabetes and obesity, and of socioeconomic status. The study is a prospective 12-year follow-up of 15,620 men and women aged from 30 to 59 years in eastern Finland. Parental history of premature CHD was defined as either fatal or nonfatal myocardial infarction or angina pectoris before the age of 60 years. The end point of the follow-up was either nonfatal AMI or coronary death. The risk ratio (RR) of AMI associated with positive family history of either parent was 1.61 in men and 1.85 in women. The risk decreased only slightly when an adjustment was made for other risk factors, and did not change at all when an adjustment was made for the indicators of socioeconomic status. The risk was slightly higher for early AMI (<55 years) compared with later AMI (≥55 years), RR 1.71 versus 1.50, among men and markedly higher, RR 2.87 versus 1.49, among women. These results from this population with an exceptionally high risk of CHD support the hypothesis that positive family history is an independent risk factor of AMI.

References (44)

AM Rissanen
Familial occurrence of coronary heart disease: Effect of the age and at the diagnosis
Am J Cardiol
(1979)
LP Ten Kate et al.
Familial aggregation of coronary heart disease and its relation to known genetic risk factors
Am J Cardiol
(1982)
JM Schildkraut et al.
Coronary risk associated with age and sex of parental heart disease in Framingham Study
Am J Cardiol
(1989)
RH Myers et al.
Parental history is an independent risk factor for coronary artery disease: The Framingham Study
Am Heart J
(1990)
GA Colditz et al.
A prospective study of parental history of myocardial infarction and coronary artery disease in men
Am J Cardiol
(1991)
E Lahelma et al.
Health and social inequities in Finland and elsewhere
Soc Sci Med
(1990)
JS Silberberg
Estimating the benefits of cholesterol lowering: Are risk factors for coronary heart disease multiplicative?
J Clin Epidemiol
(1990)
GD Friedman et al.
Precursors of essential hypertension: Body weight, alcohol and salt use, and parental history of hypertension
Prev Med
(1988)
A Hamsten
The hemostatic system and coronary heart disease
Thromb Res
(1993)
DJP Barker et al.
Fetal nutrition and cardiovascular disease in adult life
Br Med J
(1993)

G Rose

Familial patterns in ischaemic heart disease

Br J Prev Soc Med

(1964)

GD Friedman et al.

Kaiser-Permanente epidemiologic study of myocardial infarction. Study design and results for standard risk factors

Am J Epidemiol

(1974)

RI Sholtz et al.

The relationship of reported parental history to the incidence of coronary heart disease in Western Collaborative Group Study

Am J Epidemiol

(1975)

DS Thelle et al.

The cardiovascular study in Finnmark County: Coronary risk factors and the occurrence of myocardial infarction in first degree relatives and in subjects of different ethnic origin

Am J Epidemiol

(1979)

JJ Nora et al.

Genetic epidemiologic study of early onset ischemic heart disease

Circulation

(1980)

CB Snowden et al.

Predicting coronary heart disease in siblings—a multivariate assessment. The Framingham Heart Study

Am J Epidemiol

(1982)

E Barret-Connor et al.

Family history of heart attack as an independent predictor of death due to cardiovascular disease

Circulation

(1984)

KE Perkins

Family history of coronary heart disease: Is it an independent risk factor

Am J Epidemiol

(1986)

J Nyboe et al.

Risk factors for acute myocardial infarction in Copenhagen. I. Hereditary, educational and socioeconomic factors

Eur Heart J

(1989)

RM Lauer

A family history of risk factors and cardiovascular diseases

Circulation

(1991)

MC Roncaglioni et al.

Role of family history in patients with myocardial infarction. An Italian case-control study

Circulation

(1992)

ME Marenberg et al.

Genetic susceptibility to death from coronary heart disease in a study of twins

N Engl J Med

(1994)

Cited by (120)

Basic vs More Complex Definitions of Family History in the Prediction of Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis
2018, Mayo Clinic Proceedings
To determine whether family history of coronary heart disease (FH) definitions differ in their association with atherosclerotic cardiovascular disease (ASCVD) events.
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.
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.
A single question regarding the presence of FH in any first-degree relative performs just as well as more complicated assessments in predicting CHD.
clinicaltrials.gov Identifier: NCT00005487.
Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health
2017, Journal of Pediatrics
Family history and perceived risk of diabetes, cardiovascular disease, cancer, and depression
2016, Preventive Medicine
Family history is a useful and inexpensive tool to assess risks of multifactorial diseases. Family history enables individualized disease prevention, but its effects on perceived risks of various diseases need to be understood in more detail. We examined how family history relates to perceived risk of diabetes mellitus, cardiovascular disease (CVD), cancer, and depression, and whether these associations are independent of or moderated by sociodemographic factors, health behavior/weight status (smoking, alcohol consumption, physical activity, BMI [kg/m²]), or depressive symptoms.
Participants were Finnish 25–74-year-olds (N = 6258) from a population-based FINRISK 2007 study. Perceived absolute lifetime risks (Brewer et al., 2004; Becker, 1974; Weinstein and Nicolich, 1993; Guttmacher et al., 2004; Yoon et al., 2002) and first-degree family history of CVD, diabetes, cancer and depression, and health behaviors were self-reported. Weight and height were measured in a health examination.
Family history was most prevalent for cancer (36.7%), least for depression (19.6%). Perceived risk mean was highest for CVD (2.8), lowest for depression (2.0). Association between family history and perceived risk was strongest for diabetes (β = 0.34, P < 0.001), weakest for depression (β = 0.19, P < 0.001). Adjusting for sociodemographics, health behavior, and depressive symptoms did not change these associations. The association between family history and perceived risk tended to be stronger among younger than among older adults, but similar regardless of health behaviors or depressive symptoms.
Association between family history and perceived risk varies across diseases. People's current understandings on heritability need to be acknowledged in risk communication practices. Future research should seek to identify effective strategies to combine familial and genetic risk communication in disease prevention.
40-Year CHD Mortality Trends and the Role of Risk Factors in Mortality Decline: The North Karelia Project Experience
2016, Global Heart
In the 1960s and early 1970s, coronary heart disease (CHD) mortality in Finland was the highest in the world, and within Finland, mortality was particularly high in the eastern part of the country. The North Karelia Project, the first large community-based cardiovascular diseases prevention program was established in 1972 to reduce the extremely high CHD mortality through behavioral change and reduction of the main cardiovascular disease risk factors among the whole population of North Karelia, the easternmost province of Finland. During the 40-year period from 1972 to 2012, smoking prevalence, serum total cholesterol, and systolic blood pressure declined markedly, except a small increase in serum cholesterol levels between 2007 and 2012. From the early 1970s to 2012, CHD mortality decreased by 82% (from 643 to 118 per 100,000) among working-age (35 to 64 years) men. Among working-age women, the decline was 84% (from 114 to 17 per 100,000). During the first 10 years, changes in these 3 target risk factors explained nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than the predicted reduction. In the early 1970s, premature CHD mortality (35 to 74 years) was about 37% higher among Eastern Finnish men and 23% higher among Eastern Finnish women, compared with men and women in Southwestern Finland. During the last 40 years, premature CHD mortality declined markedly in both areas, but the decline was larger in Eastern Finland and the mortality gap between the two areas nearly disappeared.
Genetic and Environmental Contributions to Cardiovascular Risk: Lessons From North Karelia and FINRISK
2016, Global Heart
Systematic collection of DNA samples started in FINRISK during the 1992 survey and has continued in all surveys since then. At the moment, FINRISK has DNA, careful phenotyping at baseline, and prospective follow-up for incident disease for about 34,000 participants. These data have been used for genome-wide association studies by contributing to numerous large international consortia, mainly focused on cardiovascular diseases and their risk factors. In parallel, genomic data from FINRISK have been used for cardiovascular risk estimation, and our constantly improving knowledge of cardiovascular disease risk variants generates promising prospects in this field. The isolated nature of the Finnish population and recent bottlenecks in our population history, particularly in eastern Finland, provide certain advantages for sequencing studies. The power to detect low-frequency variants is stronger in isolated populations, like those in eastern Finland, than in more admixed populations. Together with country-wide and reliable electronic health records, this provides a resource that is currently widely utilized in whole exome and whole genome sequencing studies.
Genomic Medicine and Ethnic Differences in Cardiovascular Disease Risk
2016, Translational Cardiometabolic Genomic Medicine
The origins of health disparities are a poorly understood public health problem. The effects of culture, environmental hazards, and social marginalization differ between ethnicities and have strong effects on health differences. The role of the genome in health is well established and we present a summary of its roles in risk of cardiovascular disease (CVD), its risk factors, and selected biomarkers of risk. We discuss why the genome may, alongside environmental hazards, contribute to ethnic differences in CVD. We also present the growing and diverse role of genetic factors on the risk of CVD and the impact of recent expansion of the human population on increased genomic diversity. Genetic backgrounds also differ between ethnicities, albeit in a manner more representative of the continuum of difference between individuals, rather than reflecting discrete categories, highlighting the need to move beyond our artificial socioeconomic constructs. In particular, the allele frequencies of putative “causal variants” can be significantly different according to ancestry, which may account for much of the genomic contribution to health disparities and the manner in which we view personalized genomic medicine. Methodological issues including power and ancestry definition need to be resolved in order to more finely map the contribution of the genome to health and to population health differences. This area of research will remain vital if we are to minimize health disparities between non-Hispanic Whites and minority groups and so reduce the incidence of CVD in the Unites States.

View all citing articles on Scopus

View full text

Original articleParental history of premature coronary heart disease: An independent risk factor of myocardial infarction

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

Soc Sci Med

J Clin Epidemiol

Prev Med

Thromb Res

Br Med J

Familial patterns in ischaemic heart disease

Br J Prev Soc Med

Kaiser-Permanente epidemiologic study of myocardial infarction. Study design and results for standard risk factors

Am J Epidemiol

The relationship of reported parental history to the incidence of coronary heart disease in Western Collaborative Group Study

Am J Epidemiol

The cardiovascular study in Finnmark County: Coronary risk factors and the occurrence of myocardial infarction in first degree relatives and in subjects of different ethnic origin

Am J Epidemiol

Genetic epidemiologic study of early onset ischemic heart disease

Circulation

Predicting coronary heart disease in siblings—a multivariate assessment. The Framingham Heart Study

Am J Epidemiol

Family history of heart attack as an independent predictor of death due to cardiovascular disease

Circulation

Family history of coronary heart disease: Is it an independent risk factor

Am J Epidemiol

Risk factors for acute myocardial infarction in Copenhagen. I. Hereditary, educational and socioeconomic factors

Eur Heart J

A family history of risk factors and cardiovascular diseases

Circulation

Role of family history in patients with myocardial infarction. An Italian case-control study

Circulation

Genetic susceptibility to death from coronary heart disease in a study of twins

N Engl J Med

Original article
Parental history of premature coronary heart disease: An independent risk factor of myocardial infarction