Family History of Early Heart Disease
- The process of atherosclerosis or plaque buildup that results in cardiovascular disease (CVD) is very complex and involves multiple genetic, environmental and personal risk factors.1 A family history of CVD in a first degree relative represents the net effect of shared genetic, biochemical, behavioral and environmental components and represents an important independent risk factor for future CVD.2-4
- At a given level of modifiable risk factors, those with family history of premature heart disease has double the risk of heart disease compared to those without.5, 6 The risk may be as high as 12-fold when multiple family members in different generations died at a young age.7 The risk for CVD in offspring or sibling is strongly and inversely related to the age of the affected individual at the time of the first event.8 The risk of recurrent heart attack or stroke is even stronger for those with personal history of early heart disease.9, 10
- Cardiovascular diseases include not only heart attack, stroke or sudden cardiac death but also coronary angioplasty and/or stent, and coronary artery bypass surgery. However the vast majority of the people with coronary artery disease (CAD) have had no symptoms and therefore undiagnosed. Such silent heart disease can be readily and inexpensively diagnosed with a heart scan.
- Family history of premature heart disease is defined as the presence of premature CAD in first degree relatives before age 55 in a male and before age 65 in a female. By definition, the history of heart disease in a male relative after the age of 55 or female relative after the age of 65 is not considered a family history of premature heart disease. Since the parents and siblings of children and adolescents are usually young themselves, when evaluating family history in a child, history should also be ascertained for the occurrence of cardiovascular disease in grandparents, aunts and uncles.
- Identification of a positive family history for CV D should lead to evaluation of all family members.1, 11, 12The evaluation should include measurement of lipid profile and Lipoprotein (a)─ the foremost genetic factor for family history of early heart attack and death.13-18 (See family history and lipoprotein (a))
- Asian Indians have a national history of heart disease, which is also shared by other South Asian countries like Pakistan and Bangladesh and appears to be mediated by elevated levels of lipoprotein(a).19 Among all CVD deaths, 5% among whites 15% among blacks and 50% among Asian Indians occur in those younger than 50 years of age.20
1. Daniels SR. Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Report from National Heart, Lung and Blood Institute.Bethesda,http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm2011.
2. de Giorgis T, Giannini C, Scarinci A, et al. Family history of premature cardiovascular disease as a sole and independent risk factor for increased carotid intima-media thickness. J Hypertens. Apr 2009;27(4):822-828.
3. Hoseini K, Sadeghian S, Mahmoudian M, Hamidian R, Abbasi A. Family history of cardiovascular disease as a risk factor for coronary artery disease in adult offspring. Monaldi Arch Chest Dis. Jun 2008;70(2):84-87.
4. Leander K, Hallqvist J, Reuterwall C, Ahlbom A, de Faire U. Family history of coronary heart disease, a strong risk factor for myocardial infarction interacting with other cardiovascular risk factors: results from the Stockholm Heart Epidemiology Program (SHEEP). Epidemiology. Mar 2001;12(2):215-221.
5. Catapano AL, Reiner Z, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. Jul 2011;217 Suppl 1:1-44.
6. Chow CK, Islam S, Bautista L, et al. Parental history and myocardial infarction risk across the world: the INTERHEART Study. J Am Coll Cardiol. Feb 1 2011;57(5):619-627.
7. Mulders TA, Maurissen LF, Meyer Z, et al. A positive family history for premature cardiovascular disease identifies patients prone to recurrent arterial thrombotic events. Eur J Cardiovasc Prev Rehabil. Sep 13 2011.
8. Lloyd-Jones DM, Nam BH, D’Agostino RB, Sr., et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. Jama. May 12 2004;291(18):2204-2211.
9. Mulders TA, Meyer Z, van der Donk C, et al. Patients with premature cardiovascular disease and a positive family history for cardiovascular disease are prone to recurrent events. Int J Cardiol. Nov 17 2011;153(1):64-67.
10. Scheuner MT, Setodji CM, Pankow JS, Blumenthal RS, Keeler E. General Cardiovascular Risk Profile identifies advanced coronary artery calcium and is improved by family history: the multiethnic study of atherosclerosis. Circ Cardiovasc Genet. Feb 2010;3(1):97-105.
11. Glowinska B, Urban M, Koput A. Cardiovascular risk factors in children with obesity, hypertension and diabetes: lipoprotein(a) levels and body mass index correlate with family history of cardiovascular disease. Eur J Pediatr. Oct 2002;161(10):511-518.
12. Bailleul S, Couderc R, Rossignol C, et al. Lipoprotein(a) in childhood: relation with other atherosclerosis risk factors and family history of atherosclerosis. Clin Chem. Feb 1995;41(2):241-245.
13. Guardamagna O, Abello F, Anfossi G, Pirro M. Lipoprotein(a) and family history of cardiovascular disease in children with familial dyslipidemias. J Pediatr. Aug 2011;159(2):314-319.
14. De Simone M, Verrotti A, Cappa M, et al. Lipoprotein (a) in childhood: correlations with family history of cardiovascular disease. J Endocrinol Invest. May 2003;26(5):414-419.
15. Cabrinety N, Pisonero MJ, Ajram J, Armenteras A, Cuatrecasas JM. Lipoprotein (a) in obese children with a family history of cardiovascular disease. J Pediatr Endocrinol Metab. Jan 2002;15(1):77-80.
16. Gambhir JK, Kaur H, Prabhu KM, Morrisett JD, Gambhir DS. Association between lipoprotein(a) levels, apo(a) isoforms and family history of premature CAD in young Asian Indians. Clin Biochem. May 2008;41(7-8):453-458.
17. Casanueva V, Cid X, Calvo C, et al. [Lipoprotein in children and adolescents: relationship with family history of coronary artery disease]. Rev Med Chil. Jul 1996;124(7):799-804.
18. Gazzaruso C, Buscaglia P, Garzaniti A, et al. Lipoprotein(a) plasma concentrations, apolipoprotein (a) polymorphism and family history of coronary heart disease in patients with essential hypertension. J Cardiovasc Risk. Apr 1996;3(2):191-197.
19. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic USA; 2011.
20. Jolly S, Vittinghoff E, Chattopadhyay A, Bibbins-Domingo K. Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. Am J Med. Sep 2010;123(9):811-818.