Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Dec;96(24):1985-9.
doi: 10.1136/hrt.2010.210740. Epub 2010 Oct 20.

Family history of premature coronary heart disease and risk prediction in the EPIC-Norfolk prospective population study

Suthesh Sivapalaratnam  1 , S Matthijs Boekholdt, Mieke D Trip, Manjinder S Sandhu, Robert Luben, John J P Kastelein, Nicholas J Wareham, Kay-Tee Khaw
Affiliations

Family history of premature coronary heart disease and risk prediction in the EPIC-Norfolk prospective population study

Suthesh Sivapalaratnam et al. Heart. 2010 Dec.

Abstract

Objective: The value of a family history for coronary heart disease (CHD) in addition to established cardiovascular risk factors in predicting an individual's risk of CHD is unclear. In the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort, the authors tested whether adding family history of premature CHD in first-degree relatives improves risk prediction compared with the Framingham risk score (FRS) alone.

Methods and results: This study comprised 10,288 men and 12,553 women aged 40-79 years participating in the EPIC-Norfolk cohort who were followed for a mean of 10.9±2.1 years (mean±SD). The authors computed the FRS as well as a modified score taking into account family history of premature CHD. A family history of CHD was indeed associated with an increased risk of future CHD, independent of established risk factors (FRS-adjusted HR of 1.74 (95% CI 1.56 to 1.95) for family history of premature CHD). However, adding family history of CHD to the FRS resulted in a negative net reclassification of 2%. In the subgroup of individuals estimated to be at intermediate risk, family history of premature CHD resulted in an increase in net reclassification of 2%. The sensitivity increased with 0.4%, and the specificity decreased 0.8%.

Conclusion: Although family history of CHD was an independent risk factor of future CHD, its use did not improve classification of individuals into clinically relevant risk categories based on the FRS. Among study participants at intermediate risk of CHD, adding family history of premature CHD resulted in, at best, a modest improvement in reclassification of individuals into a more accurate risk category.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Age of coronary heart disease in first degree family member
I-IV represent different categories based on the age of onset of coronary heart disease in a first degree relative, using the following age cut-offs in years: I; < 55 in men and < 65 in women; II; ≥ 55 en <65 in men and ≥ 65 and < 75 in women; III; ≥65 and <75 in men and ≥75 and <85 in women; IV: ≥ 75 in men and ≥ 85 in women. The reference group for the calculated odds ratios consisted of participants with a negative family history of CHD.
Figure 2
Figure 2. Reclassification based on family history of premature coronary heart disease
See this image and copyright information in PMC

Comment in

References

    1. 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. 2004 May 12;291(18):2204–11. - PubMed
    1. Murabito JM, Pencina MJ, Nam BH, et al. Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults. JAMA. 2005 Dec 28;294(24):3117–23. - PubMed
    1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143–421. - PubMed
    1. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002 Jan 22;105(3):310–5. - PubMed
    1. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007 Jul 21;335(7611):136. - PMC - PubMed

Publication types