Heart Attacks Have Beginnings



Heart Attacks Are 'All in the Family'

When a parent has a heart attack, it doubles the risk that their children will also have a heart attack.

By Crystal Phend, MedPage Today

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A parental history of heart attack predicts heart disease risk beyond what other traditional risk factors such as high cholesterol or high blood pressure or even genetic markers, according to an international study of almost 30,000 adults.

The study compared risk factors — including family history — in about 12,000 people who had a first heart with same information from healthy individuals.

About 18 percent of the persons who had a first heart attack reported a history of heart attack in either parent versus 12 percent of the controls, and the earlier.

Having a parent who had a heart attack in their 40s — or younger — made it about two and half times more likely that the son or daughter would have a heart attack and if both parents had heart attacks before age 50 the heart attack risk was more than six-fold higher for the children.

The near doubling in heart attack risk with a positive parental history was consistent across income, sex, and age groups and all regions of the world studied, according to Dr. Clara K. Chow, of McMaster University in Hamilton, Ontario, and the University of Sydney, Australia.

Chow and her colleagues reached that conclusion after studying data from the 30,000-patient study.

“Further, clinical grading of risk determined by self-reported information from a patient on the age at onset of disease in parents and whether one or both parents are affected provides a simple but robust assessment,” they wrote in the Feb. 1 issue of theJournal of the American College of Cardiology.

While the Framingham risk score snubbed family history of heart disease, several others developed over the past decade for clinical risk assessment have incorporated it, noted Dr. Themistocles L. Assimes, of Stanford University in Stanford, Calif., in an accompanying editorial.

The international results are an important addition to the evidence supporting use of family history as a factor in risk calculation, he wrote, noting that the value of family history is likely only to grow.

“In developed countries, the predictive ability of a family history probably improved over the past few decades in parallel with an enhanced ability to diagnose heart disease and the public’s increasing awareness of its causes and consequences,” he wrote in the paper.

“In the future, the predictive ability of a family history may further improve as linked electronic medical records facilitate the reliable identification of family members with cardiovascular disease as well as traditional risk factors,” he added.

The subanalysis of the multinational INTERHEART study included 12,149 individuals presenting with a first heart attack and 14,467 healthy controls matched for age and sex.

Eighteen percent of the persons who had a first heart attack reported a history of heart attack in either parent versus 12 percent of the controls.

Earlier and more parental history appeared to have a dose-dependent effect with adjusted odds ratios of:

  • 1.67 for MI in one parent at age 50 or older
  • 2.36 for MI in one parent before age 50
  • 2.90 for MI in both parents at 50 or older
  • 3.26 for MI in both parents, one at 50 or older and the other before 50
  • 6.56 for MI in both parents before age 50

While these results support the predictive value of parental history of MI, they raise the question of what parental history is a measure of, Chow’s group noted.

Perhaps unmeasured factors like early life stress and nutrition or home environment or unexamined genetic factors are the explanation, they suggested.

The investigators cautioned that the study didn’t collect history of heart attacks in siblings or other relatives, examined only a limited number of genetic polymorphisms in a limited sample, and could have been subject to recall bias.






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Date: 06.12.2018, 22:41 / Views: 82383