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.
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 16, 2018
Footnotes
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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