Risk Associated with Various Definitions of Family History of Coronary Heart Disease: The Newcastle Family History Study II

Abstract

The authors carried out a population-based case-control study to estimate the risk of an acute coronary disease event associated with various definitions of a family history of coronary heart disease (CHD). A detailed family history questionnaire was completed by 403 cases and 236 controls in Newcastle, New South Wales, Australia from 1992 to 1994. Odds ratios of an acute coronary disease event adjusted for proband age and sex ranged from 2.7 (95% confidence interval (CI) 1.8-4.1) for the simplest definition (one or more first-degree relatives with CHD at any age) to 5.4 (95% CI 1.7-16.8) for the most stringent definition (two or more first-degree relatives with CHD before age 55 years). In a series of nested models, the authors examined the improvement in model fit as each component of the detailed family history was added. Additional information was provided by accounting for "don't know" responses, the number of affected relatives, the age of the affected relative, and whether the first-degree relative was a sibling rather than a parent. The results were similar when the data were analyzed as a cohort design with proband disease status as the exposure variable. The authors suggest that, to facilitate preventive efforts in a population, more detailed family history definitions should be used to better target high risk subjects.

Familial Aggregation of Early-Onset Myocardial Infarction

“…Family history is a function of several factors, however, including the number of relatives, the biological relationship to the proband, and the disease frequency in the population [19]. Silberberg et al [18]addressed many of these factors in their examination of family history; however, as we noted above, the relationship between family history and coronary heart disease independent of other cardiovascular disease risk factors is unclear.…”

“…Using data on men and women aged ≤65 years and ≤70 years, respectively, from The Family History Study, Silberberg et al [18]identified a range of values for the strength of association between various definitions of family history and acute coronary disease. ORs for an acute coronary event ranged from 2.7, using a family history defined by at least one first-degree relative with coronary heart disease at any age, to 5.4, using a family history defined by at least two first-degree relatives with coronary heart disease before age 55 [18]. The investigators for both of the previous studies, however, did not adjust for other cardiovascular disease risk factors.…”

Can family history be used as a tool for public health and preventive medicine?

“…Henderson and Scheuner report on a study of managed care members where 53 charts from 15 primary care physicians selected randomly were reviewed for family history. 12 This included data Table 1 Prevalence and relative risk estimates due to family history for selected diseases Disease U.S. prevalence of the disease Risk due to family history Cardiovascular disease 58 million OR ϭ 2.0 (one 1st-degree relative) 38 OR ϭ 5.4 (two or more 1st-degree relatives with onset Ͻ55 yr) 39 Breast cancer 3 million women RR ϭ 2.1 (one 1st-degree relative) 40 RR ϭ 3.9 (three or more 1st-degree relatives) 41 Colorectal cancer Yearly incidence ϭ 130,000 OR ϭ 1.7 (one 1st-degree relative) 26 OR ϭ 4.9 (two 1st-degree relatives) 27 Prostate cancer Yearly incidence ϭ 200,000 RR ϭ 3.2 (one 1st-degree relative) 42 RR ϭ 11.0 (three 1st-degree relatives) 43 Melanoma 200,000 OR ϭ 2.7 (one or more 1st-degree relative) 44 OR ϭ 4.3 (one 1st-degree relative) 45 Type II diabetes 13 million RR ϭ 2.4 (mother) 46 RR ϭ 4.0 (maternal and paternal relatives) 47 Osteoporosis 8 million women OR ϭ 2.0 for osteoporotic fracture (female 1st-degree relative) 48 2 million men RR ϭ 2.4 for wrist fracture (father) 49 Asthma 17 million OR ϭ 3.0 (mother) 50 RR ϭ 7.0 (mother and father) 51 Family history tool for public health…”

Maternal and Paternal History of Myocardial Infarction and Risk of Cardiovascular Disease in Men and Women

“…4 -6 Limited epidemiological evidence exists in women regarding the association between parental history of MI and CVD risk. Moreover, various definitions of parental history of MI in the existing literature 7 neglect the separate effects of paternal and maternal history and whether there are comparable effects on the risk of CVD. Definitions of early parental history before the age of 60 years likely underestimate the impact of maternal history of MI because of the low incidence rates of MI in women before age 60.…”