Basic vs More Complex Definitions of Family History in the Prediction of Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis

Abstract

Objective: To determine whether family history of coronary heart disease (FH) definitions differ in their association with atherosclerotic cardiovascular disease (ASCVD) events.

Patients and methods: Participants who provided FH data from July 17, 2000, through February 24, 2004, were identified. Definitions of FH were any, premature, and Familial Risk Assessment (FRA). Outcomes included coronary heart disease (CHD), stroke, peripheral artery disease, angina, and congestive heart failure. Multivariable-adjusted Cox models examined the association of FH definitions with events. C statistics and the net reclassification index examined the incremental prognostic contribution of each definition.

Results: In 6200 participants, the proportions of any FH and premature FH were 36% and 16%, respectively, and of weak, moderate, and strong familial risk were 20%, 16%, and 20%, respectively. Over median follow-up of 10.1 years (range, 0.02-11.5 years), 741 participants experienced a composite event. Compared with no FH, any FH was associated with incident CHD, angina, and composite ASCVD (hazard ratios [95% CIs]: 1.4 [1.1-1.8], 1.6 [1.2-2.1], and 1.3 [1.1-1.5], respectively). Similar results were obtained for premature FH compared with no FH and for strong compared with weak FRA for these 3 outcomes. There was no association between the FH definitions and noncoronary cardiovascular events. Compared with traditional risk factors (C statistic = 0.740), any FH, premature FH, and FRA all improved discrimination of composite ASCVD (all P < .01); however, the differences in C statistics among any FH (0.743), premature FH (0.742), and FRA (0.744) were numerically small, as were differences in the net reclassification index.

Conclusion: A single question regarding the presence of FH in any first-degree relative performs just as well as more complicated assessments in predicting CHD.

Trial registration: clinicaltrials.gov Identifier: NCT00005487.

Figure 1

Crude incidence rates of cardiovascular outcomes by familial risk stratification^*† * ASCVD = atherosclerotic cardiovascular disease, CHD = Coronary Heart Disease, CHF = Congestive Heart Failure, PAD – Peripheral Artery Disease † P-value refers to the comparison of incidence rates using non-parametric testing

Figure 2

a: Receiver operator curves showing area under the curve for incident CHD among those with any-FH, premature-FH, and FRA^* *ASCVD – atherosclerotic cardiovascular disease, FH = family history of coronary heart disease, FRA – familial risk assessment, PCE – pooled cohorts equation b: Receiver operator curves showing area under the curve for incident ASCVD among those with any-FH, premature-FH, and FRA^* *ASCVD – atherosclerotic cardiovascular disease, FH = family history of coronary heart disease, FRA – familial risk assessment, PCE – pooled cohorts equation.

Figure 2

a: Receiver operator curves showing area under the curve for incident CHD among those with any-FH, premature-FH, and FRA^* *ASCVD – atherosclerotic cardiovascular disease, FH = family history of coronary heart disease, FRA – familial risk assessment, PCE – pooled cohorts equation b: Receiver operator curves showing area under the curve for incident ASCVD among those with any-FH, premature-FH, and FRA^* *ASCVD – atherosclerotic cardiovascular disease, FH = family history of coronary heart disease, FRA – familial risk assessment, PCE – pooled cohorts equation.