Positive family history of cardiovascular disease and long-term outcomes after coronary artery bypass grafting: a genetic paradox?

Abstract

OBJECTIVES Parental cardiovascular disease (CVD) is a known risk factor for premature CVD. It is unknown whether a positive family history (PFH) affects outcomes after coronary artery bypass grafting (CABG). METHODS Data come from a retrospective longitudinal study of CABG patients consecutively recruited from 2001 to 2018 (n = 5389). From this study, 2535 patients with premature CVD undergoing CABG under the age of 60 years and information on parental CVD were identified. The Framingham offspring study criteria were used to identify PFH of CVD. Multivariable Cox proportional hazards regression models were used to assess the effect of PFH on overall and major adverse cardiovascular and cerebrovascular event-free survival. RESULTS A total of 273 deaths and 428 major adverse cardiovascular and cerebrovascular events occurred during follow-up. PFH of CVD was found in 54.2% of patients (n = 1375). Within these patients, 66.1% had a father who experienced a premature cardiovascular event (n = 909), 27.8% a mother (n = 382) and 6.1% both a mother and a father (n = 84). In the majority of cases, the patient’s parent had experienced a cardiac event (85.9%, n = 1181) and 14.1% of patients with PFH reported parental stroke (n = 194). Following CABG, PFH was associated with improved overall [adjusted hazards ratio (HR) 0.67, 95% confidence interval (CI) 0.50–0.90; P = 0.008] and major adverse cardiovascular and cerebrovascular event-free survival (adjusted HR 0.73, 95% CI 0.68–0.89; P = 0.01). Among the covariates adjusted for age, diabetes, renal insufficiency, peripheral arterial disease, ejection fraction, previous cerebrovascular events and previous mediastinal radiation were all associated with poorer outcomes. CONCLUSIONS Although it is well established that a PFH increases the risk of requiring CABG at younger ages, this study shows that, paradoxically, PFH is also protective regarding long-term outcomes. Registration number local IRB UN4232 297/4.3 (retrospective study).

Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery

“…As an important finding positive family history was associated with lower mortality and MACE post-CABG which was in line with Preisler et al study [27]. As Ruttmann et al study suggests this may be because a positive family history as a reason for premature CVD is likely a more benign alternative regarding survival outcomes than some of the other causes that lead to this disease [28].…”

Evaluation of cardiovascular diseases risk factors in a group of men hospitalized after myocardial infarction

“…A positive (parental) family history of cardiovascular disease, especially at baseline, is a widely accepted risk factor for cardiovascular events in offspring [11,34]. Obesity is associated with the development of various lifestyle-related diseases and is also known to be a strong risk factor for CVD [14].…”

Development and Validation of a Predictive Model for Chronic Kidney Disease After Percutaneous Coronary Intervention in Chinese

“…8 Numerous studies found that for patients with CVD in addition to risk factors, full consideration of positive family history of CVD is helpful for primary prevention and treatment decision-making in CVD. 9 Here, positive family history was also an important predictor.…”