Family history in patients with transient ischemic attacks.

Abstract

To determine the influence of family history on vascular disease, we surveyed hospital patients discharged with a diagnosis of transient ischemic attack. Of 117 respondents, 81 knew their family history for myocardial infarction and 81 knew their family history for stroke. Of 83 responding 43 reported a personal history of myocardial infarction, and of 85 responding 66 reported a personal history of stroke. As expected, there was an association between positive family and personal histories of myocardial infarction in younger (aged <70 years) patients (Fisher's two-tailed exact test, p=0.014). This association was reversed for stroke (Fisher's two-tailed exact test, p=0.017). Older (aged >70 years) patients had a stronger association between positive family and personal histories of stroke; 14 (74%) of 19 older patients with a positive personal history of stroke had a positive family history of stroke. The reason for this reversal in the relation between family and personal histories of stroke compared with myocardial infarction may relate to the older age at onset of most strokes, differing stroke subtypes in older age groups, or lower rates of fatal myocardial infarction. This study suggests that familial factors may be important in some subtypes of cerebrovascular disease. Familial effects may be different in vascular diseases of the heart and brain. (Stroke 1991;22:837-841)A ssessment of risk factors in different races, / \ sexes, and age groups can provide important J. \ . clues to the pathogenesis of cerebrovascular disease and provide direction for the development of preventive strategies. Strong familial risk factors, both genetic and environmental, have been implicated in coronary artery disease (CAD), especially in younger patients.12 Although strokes, both ischemic and hemorrhagic, have been observed to cluster in families, few studies have examined familial risks. Given the possible implications for preventive therapies, we began preliminary investigations into the familial risk of stroke in a high-risk population. Subjects and MethodsTo select a group at high risk for stroke, we surveyed all patients with a discharge diagnosis of transient ischemic attack (TLA) from Yale-New Haven Hospital, New Haven, Conn., for a 4-year period (January 1985-January 1989. Using the hospital's Received September 14, 1990; accepted March 18, 1991. Clinical Information System, patients were identified using the International Classification of Diseases coding for TIA as either a primary or secondary discharge diagnosis. A questionnaire was developed as part of a Department of Epidemiology project on risk factor modification after TIA. The questionnaire included information on personal and family histories of both myocardial infarction (MI) and stroke, as well as on common vascular risk factors. A positive family history was defined as a "yes" response to the question, "Has anyone in your immediate family (blood relative) had an Ml/stroke/hypertension/diabetes?" Specific information on which family members were affect...

Systematic Review of Methods and Results of Studies of the Genetic Epidemiology of Ischemic Stroke

“…They consisted of 3 twin studies that investigated the concordance of stroke in monozygotic versus dizygotic twins (1 group published a follow-up report on their original article as an abstract), 9 -12 19 articles that published data on 17 independent cohort studies, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][65][66][67] and 37 articles that published data on 33 independent case-control studies. 29 -64,68 Of these, 9 cohort studies 15,18,20,[22][23][24][25]28,66 and 6 case-control studies 33,34,36,40,43,54 only reported relative risks or ORs and gave no absolute numbers and therefore could not be included in any meta-analysis.…”

“…One study 21 only reported ischemic stroke outcomes, and 1 study examined a cohort of TIA patients. 14 None of the remainder distinguished between hemorrhagic and ischemic strokes. All but 3 studies 13,14,67 defined which relatives were considered in the family history (FDR, mainly parents).…”

“…Two prospective cohort studies 14,17 reported the influence of family history of stroke on the subgroup of individuals who had their strokes when aged Ͻ65 or 70 years, respectively, during follow-up. They found a reduced effect in younger probands (OR, 0.41; 95% CI, 0.2 to 0.8; Pϭ0.29; heterogeneity Pϭ0.85; 38 stroke outcomes); however, the number of strokes was very small.…”

Genetic Predisposition to Stroke in Relatives of Hypertensives

“…5,6 Family history of stroke is perceived to be an important risk factor for stroke, but the importance of this risk factor has not been confirmed conclusively by epidemiological studies. [7][8][9][10][11][12][13][14][15][16][17] To further understand the genetic relationship between stroke and hypertension, we evaluated the aggregation of stroke in families prone to hypertension.…”

Family History of Stroke Does Not Predict Risk of Stroke After Transient Ischemic Attack

“…Yet, there has been only 1 study of the predictive value of family history of stroke (FHx stroke ) in TIA patients. 7 We therefore studied detailed FHx stroke in 2 population-based TIA cohorts 8,9 and a consecutive hospital-referred series. 10 …”