Although family history (FH) of coronary artery disease (CAD) is considered a risk factor for future cardiovascular events, the prevalence, extent, severity, and prognosis of young patients with FH of CAD have been inadequately studied. From 27,125 consecutive patients who underwent coronary computed tomographic angiography, 6,308 young patients (men aged <55 years and women aged <65 years) without known CAD were identified. Obstructive CAD was defined as >50% stenosis in a coronary artery >2 mm diameter. Risk-adjusted logistic regression, Kaplan-Meier, and Cox proportional-hazards models were used to compare patients with and without FH of CAD. Compared with subjects without FH of CAD, those with FH of CAD (FH+) had higher prevalences of any CAD (40% vs 30%, p <0.001) and obstructive CAD (11% vs 7%, p <0.001), with multivariate odds of FH+ increasing the likelihood of obstructive CAD by 71% (p <0.001). After a mean follow-up period of 2 ± 1 years (42 myocardial infarctions and 39 all-cause deaths), FH+ patients experienced higher annual rates of myocardial infarction (0.5% vs 0.2%, log-rank p = 0.001), with a positive FH the strongest predictor of myocardial infarction (hazard ratio 2.6, 95% confidence interval 1.4 to 4.8, p = 0.002). In conclusion, young FH+ patients have higher presence, extent, and severity of CAD, which are associated with increased risk for myocardial infarction. Compared with other clinical CAD risk factors, positive FH in young patients is the strongest clinical predictor of future unheralded myocardial infarction.
Bibliographical noteFunding Information:
Dr. Achenbach received grant support from Siemens Healthcare, Erlangen, Germany, and Bayer Schering Pharma AG, Berlin, Germany, and has served as a consultant for Servier, Neuilly-sur-Seine, France. Dr. Al-Mallah received support from the American Heart Association, Dallas, Texas; the Blue Cross Blue Shield of Michigan Foundation, Detroit, Michigan; and Astellas Pharma Inc., Tokyo, Japan. Dr. Cademartiri received grant support from GE Healthcare and has served on the speakers' bureau of Bracco, Milan, Italy, and as a consultant for Servier. Dr. Chinnaiyan received grant support from Bayer Schering Pharma AG and Blue Cross Blue Shield Blue Care Michigan, Detroit, Michigan. Dr. Chow received research and fellowship support from GE Healthcare; research support from Pfizer, Inc., New York, New York, and AstraZeneca, Wilmington, Delaware; and educational support from TeraRecon, Foster City, California. Dr. Hausleiter received a research grant from Siemens Medical Systems, Forchheim, Germany. Dr. Maffei received grant support from GE Healthcare. Dr. Kaufmann received institutional research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr. Raff received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Schering Pharma AG. Dr. Min received modest speakers' bureau and medical advisory board compensation and significant research support from GE Healthcare, Milwaukee, Wisconsin.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine