Association between Family History and Coronary Heart Disease Death across Long-Term Follow-Up in Men: The Cooper Center Longitudinal Study.

Bachmann JM, Willis BL, Ayers CR, Khera A, Berry JD.

Source

1 University of Texas Southwestern Medical Center, Dallas, TX;

Abstract

BACKGROUND:

Family history of coronary heart disease (CHD) has been well studied as an independent risk factor for CHD events in the short-term (<10 years). However, data are sparse on the association between family history and risk for CHD across long-term follow-up.

METHODS AND RESULTS:

We included 49,255 men from the Cooper Center Longitudinal Study. Premature family history (pre-FHx) of CHD was defined as the presence of angina, myocardial infarction, angioplasty or bypass surgery in a relative age <50 years. Cause-specific mortality was obtained from National Death Index. The association between pre-FHx and cardiovascular disease (CVD) or CHD death was compared across three unique follow-up periods (0 to 10, 10 to 20, and >20 years). Lifetime risk was estimated using a modified survival analytic technique adjusted for competing risk with non-CVD death as the competing event. After 811,708 person-years of follow-up, there were 919 CHD deaths and 1,456 CVD deaths. After adjustment for traditional risk factors, pre-FHx was associated with CHD mortality across 10-20 years [1.59 (1.14-2.22)] and > 20 years [1.43 (1.05-1.95)] with wider confidence intervals at 0-10 years [1.32 (0.76-2.31)]. Similar findings were observed for CVD mortality. Pre-FHx was associated with more than an approximate 50% increase in the lifetime risk for both CHD and CVD mortality (13.7% vs. 8.9% and 21% vs. 14.1%, respectively).

CONCLUSIONS:

Pre-FHx was associated with a persistent increase in both CHD and CVD mortality across long-term follow-up, resulting in significantly higher lifetime risk estimates.