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

      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

      Abbreviations and Acronyms:

      ASCVD (atherosclerotic cardiovascular disease), BMI (body mass index), BP (blood pressure), CHD (coronary heart disease), CHF (congestive heart failure), DM (diabetes mellitus), FH (family history of coronary heart disease), FRA (Familial Risk Assessment), FRS (Framingham risk score), HDL-C (high-density lipoprotein cholesterol), IR (incident event rate), LDL-C (low-density lipoprotein cholesterol), MESA (Multi-Ethnic Study of Atherosclerosis), NRI (net reclassification index), PAD (peripheral artery disease), PCE (pooled cohort equations)
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