Circulation, Vol 85, 2065-2072, Copyright © 1992 by American Heart Association
MC Roncaglioni, L Santoro, B D'Avanzo, E Negri, A Nobili, A Ledda, F Pietropaolo, MG Franzosi, C La Vecchia and GA Feruglio
BACKGROUND. A family history of heart disease has been reported to increase
the risk of coronary heart disease. We examined the relation between family
history of myocardial infarction (MI) and risk of acute MI to establish the
independency of this association, the degree of risk in relation to the
number and age of relatives affected, and the possible interaction between
family history and other major risk factors for MI. METHODS AND RESULTS. In
a case-control study conducted in Italy within the framework of the GISSI-2
Trial, 916 cases of newly diagnosed MI and 1,106 hospital controls were
identified. Using a structured questionnaire, data were collected on the
history of MI in first-degree relatives and the age at which the event
occurred. Compared with subjects without family history of MI in
first-degree relatives, the relative risk (RR) of MI was 2.0 (95%
confidence interval, CI, 1.6-2.5) in those with one and 3.0 (95% CI,
2.0-4.4) in those with two or more relatives affected (chi 2(1) test for
trend, 54.1; p less than 0.001). Such an increase was not substantially
affected by allowance for recognized risk factors. The risk related to
family history involving at least two relatives was higher for early MI
(less than 55 years) (RR, 20.0; 95% CI, 3.3-121.2) compared with later MI
(less than or equal to 65 years) (RR, 3.5; 95% CI, 1.8-6.6). When known
risk factors were considered for their interaction with family history, the
effect on RR was approximately multiplicative for several variables,
including smoking, serum cholesterol, hypertension, and hyperlipidemia but
not for diabetes and body mass index. Thus, the presence of both family
history and smoking and cholesterol levels greater than or equal to 226
mg/dl led to an RR of 14 (95% CI, 3.7- 50.0) and 8.3 (95% CI, 1.8-38.7),
respectively. CONCLUSIONS. This study indicates that a family history of MI
is an independent risk factor for MI, and that the number of relatives and
the age at which they were affected is related to the strength of the
association. There is a multiplicative effect on RR between family history
and several major risk factors for MI.
ARTICLES
Role of family history in patients with myocardial infarction. An Italian case-control study. GISSI-EFRIM Investigators
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italia.
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