Addition of a Novel, Protective Family History Category Allows Better Profiling of Cardiovascular Risk and Atherosclerotic Burden in the General Population. The Asklepios Study

Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium.
PLoS ONE (Impact Factor: 3.23). 05/2013; 8(5):e63185. DOI: 10.1371/journal.pone.0063185
Source: PubMed


Whereas the importance of family history (FH) is widely recognized in cardiovascular risk assessment, its full potential could be underutilized, when applied with its current simple guidelines-based definition (cFH): presence of premature cardiovascular disease (CVD) in a first-degree relative. We tested the added value of a new, extended family history definition (eFH), also taking into account later onset of disease, second-degree relatives and number of affected relatives, on profiling cardiovascular risk and atherosclerotic burden in the general population.
longitudinal population study.
random, representative population sample from Erpe-Mere and Nieuwerkerken (Belgium, primary care).
2524 male/female volunteers, aged 35-55 years, free from overt CVD.
Subjects were extensively phenotyped including presence of atherosclerosis (ultrasound) and a newly developed FH questionnaire (4 generations).
Compared to cFH, eFH was superior in predicting an adverse risk profile (glycemic state, elevated blood pressure, lipid abnormalities, presence of metabolic syndrome components) and presence of atherosclerosis (all age & sex-adjusted p<0.05). Unlike cFH, eFH remained a significant predictor of subclinical atherosclerosis after adjusting for confounders. Most relations with eFH were not graded but showed clear informational breakpoints, with absence of CVD (including late onset) in any first-degree relative being a negative predictor of atherosclerosis, and a particularly interesting phenotype for further study.
A novel, extended FH definition is superior to the conventional definition in profiling cardiovascular risk and atherosclerotic burden in the general population. There remain clear opportunities to refine and increase the performance and informational content of this simple, readily-available inexpensive tool.

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    ABSTRACT: Background Moderate to small heritability has been observed for left ventricular (LV) structure and function in genetic epidemiology and genomewide association studies. The aim of this study was to explore whether this would be mirrored in an independent association between LV structure and function and a family history (FH) of cardiovascular disease (CVD) in a large population of middle-aged adults. Methods Subjects enrolled in the Asklepios Study, a population-based sample of 2,524 male and female volunteers, aged 35 to 55 years, free of overt CVD at baseline, were studied. LV structure and function were assessed using transthoracic echocardiography (by a single sonographer). FH data spanning 4 generations were acquired using a questionnaire. Results In unadjusted analyses, only small effects of FH of CVD on LV structure (relative wall thickness, P = .042; interventricular septal thickness, P = .002; LV mass, P = .038; allometrically adjusted LV mass, P = .014) and diastolic function (mitral annular e′, P = .02) were observed. After adjusting for the more adverse risk factor profile associated with FH, no significant associations persisted. These results did not appreciably change using a more extended definition of FH of CVD or FH of hypertension. Conclusions A positive FH for CVD was associated with differences in offspring cardiac structure and function, largely mediated by (but not independent from) a more adverse risk profile in those subjects with positive FH.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 11/2013; 26(11):1290–1297.e2. DOI:10.1016/j.echo.2013.07.024 · 4.06 Impact Factor

Tim De Meyer