Family history and coronary heart disease--common, actionable, under-appreciated
A
family history of coronary heart disease is an independent, common,
actionable and perhaps under-appreciated risk factor for developing
coronary heart disease in otherwise healthy people (1). In addition to
shared genes, other factors such as blood lipid levels, blood pressure
levels, body weight, type 2 diabetes, smoking habits, eating patterns,
alcohol consumption, physical activity and socioeconomic status, also
tend to cluster in families (2). Due to the fact that family health
history captures the consequences of genetic, environmental and
behavioral risk factors on cardiac health, it may be a better indicator
of a person’s chances of developing CHD than many of the other risk
factors that are more commonly relied upon for this purpose (1).
Familial
coronary heart disease accounts for a significant fraction of the
burden of CHD in the population. In a large study of over 122,000
families who were not selected for CHD and were ascertained through
high school health classes, 72% of early-onset CHD and 48% of all CHD
were clustered in 14% of the families studied (3). Community-based
preventive interventions that included visits by public health nurses,
were shown to be effective in educating families about their risks,
assisting in making appropriate referrals and supportive for long term
behavior changes (4). Preventive interventions that focus on families
therefore may have a significant impact on reducing cardiovascular
disease risk factors in the population as a whole. In addition, the
populations with the greatest familial risk for CHD also show the
greatest risk reduction in response to preventive interventions (5).
Family
history of CHD is also very commonly encountered in the population. In
a recent national mail survey (Healthstyles) that collected information
on the health attitudes, behaviors, conditions and knowledge of a
population that is representative of the U.S. population, almost 50% of
the respondents reported a family history of CHD in a close relative
(parent or sibling), suggesting at least a moderate familial risk (6).
Considering
the prevalence, predictive power and actionable nature of family
history of CHD, it is important for health practitioners to be able to
confidently interpret the significance of a family history of CHD, to
understand the potential consequences for their patient’s health, and
to determine appropriate follow-up and screening (7). In general, the
risk of CHD increases as the age of onset of heart disease in the
family gets younger and the number of relatives who are affected
increases, especially if the relatives are female. In addition, the
risk increases as the relationship of affected relatives gets closer.
Other characteristics of familial susceptibility include the presence
of multiple CHD risk factors in affected relatives or the presence of
related disorders (e.g. type 2 diabetes, hypertension or stroke) in
family members (7). In families with moderate histories of CHD, the
cardiac health history of siblings seems to be even more predictive of
CHD than that of parents (8).
Although there are no universal
screening or follow up guidelines that are recommended for all
individuals with a family history of CHD, one or more of a range of
options may be appropriate and effective in addressing a familial risk
of CHD. Interventions may range from counseling on relatively minor
changes in behavior or diet to referral for further evaluation to a
cardiologist or medical geneticist. In general, the aggressiveness of
intervention is determined by the degree of the family history of CHD
encountered and the underlying etiologies that are responsible. More
detailed information on risk stratification and appropriate
interventions for patients at risk for familial CHD are collected in a
recent review (7). For more information on familial CHD or assistance
for appropriate referrals for familial CHD contact the Chronic Disease
Genomics Project at the Minnesota Department of Health at 651-201-3609.
1.
Kardia
SLR, et al. Family-centered approaches to understanding and preventing
coronary heart disease. Am J Prev Med 2003; 24(2):143-1512.
Higgins M. Epidemiology and prevention of coronary heart disease in families. Am J Med 2000; 108(5):387-395
3.
Williams
RR, et al. Usefulness of cardiovascular family history data for
population-based preventive medicine and medical research (The Health
Family Tree Study and the NHLBI Family Heart Study). Am J Cardiol 2001;
87:129-135
4.
Johnson
J, et al. Utah’s Family High Risk Program: Bridging the gap between
genomics and public health. Prev Chronic Dis [serial online] 2005 Apr.
5.
Hunt
SC, et al. Family history assessment: Strategies for prevention of
cardiovascular disease. Am J Prev Med 2003; 24(2):136-1426.
McCusker
ME, et al. Family history of heart disease and cardiovascular disease
risk-reducing behaviors. Genet Med 2004; 6(3):153-1587.
Scheuner,
MT. Clinical application of genetic risk assessment strategies for
coronary artery disease: genotypes, phenotypes, and family history.
Primary Care Clinics in Office Practice 2004; 31(3): 711-7378.
Nasir
K, et al. Coronary artery calcification and family history of premature
coronary heart disease: Sibling history is more strongly associated
than parental history. Circulation 2004; 110:2150-2156
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Comments
Yes to detailed medical family history data have been proposed to be effective in identifying high-risk families for targeted intervention. With use of a validated and standardized quantitative family risk score (FRS), the degree of familial aggregation of coronary heart disease (CHD), stroke, hypertension, and diabetes.
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Posted by: Breast Cancer Symptoms | December 21, 2008 3:33 AM
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meaningful to whom needed. Interesting!!
Posted by: Breast Cancer Symptoms | December 21, 2008 3:37 AM