Impact of Family History of Coronary Artery Disease in Young Individuals (From the CONFIRM Registry)
What is the association of family history of premature coronary artery disease (CAD) and risk for cardiovascular events among young adults?
Data from CONFIRM (the Coronary Computed Tomography Angiography [CCTA] Evaluation for Clinical Outcomes: An International Multicenter Registry) were used for the current analysis. From 27,125 consecutive patients who underwent CCTA, 6,308 young patients (men ages <55 years and women ages <65 years) without known CAD were identified between 2003 and 2009 (12 separate centers). Prior to the CT scan, information on cardiovascular risk factors including family history was collected. Positive family history was defined as myocardial infarction, cardiac death, or need for coronary artery revascularization in a first-degree relative with early onset. CT scans were performed using a single-source 64-slice scanner or a dual-source scanner. Obstructive CAD was defined as >50% stenosis in a coronary artery >2 mm diameter.
Of the 6,308 adults included, 31% had a family history of premature heart disease (n = 1,981). Over the mean 2-year follow-up period, 42 myocardial infarctions and 39 all-cause deaths occurred. Compared with subjects without a family history of premature CAD, those with family history of premature CAD had a higher prevalence of any CAD (40% vs. 30%, p < 0.001) and obstructive CAD (11% vs. 7%, p < 0.001). After adjustment for potential confounders, a family history of premature heart disease was associated with an increasing likelihood of obstructive CAD by 71% (p < 0.001). The family history of premature heart disease patients experienced higher annual rates of myocardial infarction (0.5% vs. 0.2%, log-rank p = 0.001), with a positive family history being the strongest predictor of myocardial infarction (hazard ratio, 2.6; 95% confidence interval, 1.4-4.8; p = 0.002).
The investigators concluded that young patients with a family history of premature heart disease have higher presence, extent, and severity of CAD, which is associated with increased risk for myocardial infarction. Among younger adults, a family history of premature heart disease was a strong independent predictor of future CAD.
These data suggest the importance of asking about a family history of premature heart disease in younger adults. Such information can provide them with prognostic information to be used in management decisions related to treatable risk factors such as lipids or blood pressure.
Keywords: Coronary Artery Disease, Hypertension
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