A Family Affair of the Heart
Abstract & Commentary
Synopsis: Maternal and paternal family history for myocardial infarction is a significant cardiovascular risk.
Source: Sesso HD, et al. Circulation. 2001;104:393-398.
A prospective analysis of the Physicians’ Health Study and the Women’s Health Study was performed to assess the relative strength of maternal and paternal history in predicting myocardial infarction (MI).1,2 The Physicians’ Health Study followed 22,071 male physicians for an average of 13 years. The Women’s Health Study is an ongoing trial that has followed 39,876 female health professionals for an average of 6.2 years. In both studies, participants were asked to identify if their mother or father had had an MI, and the age that it occurred. All subjects were followed for the primary outcome of MI. At the time of analysis, 2654 men and 563 women had had an MI.
When compared to subjects who had no family history of MI, a family history of both parents having had MI conferred a relative risk (RR) of 1.9 for men and 2.1 for women. The risk of one parent with an MI ranged from 1.2 (women with a father having an MI) to 1.7 (men with a mother having an MI). The earlier the parent had the MI, the greater the risk for the patient. Women with a maternal history of MI at younger than 50 had a RR of 2.6; men with a father who had an MI at younger than 50 had a RR of 2.2.
| Table: Relative Risk (RR) of Myocardial Infarction (MI) Based on Family History | ||||
| Male subjects | Female subjects | |||
| Age of parental MI |
Maternal history |
Paternal history |
Maternal history |
Paternal history |
| < 50 years | 1.0 | 2.2 | 2.6 | 1.6 |
| 50-59 years | 1.9 | 1.6 | 1.3 | 1.3 |
| 60-69 years | 1.9 | 1.4 | 1.5 | 1.1 |
| 70-79 years | 1.7 | 1.2 | Not assessed |
Not assessed |
| > 80 years | 1.2 | 0.9 | Not assessed |
Not assessed |
Comment by Jeff Wiese, MD
Family history of MI has long been considered a risk factor for MI.3 This study addresses 2 important questions regarding this risk factor: is there a difference between maternal and paternal history of MI, and does the age of parental infarction portend a greater risk?
This analysis is consistent with previous studies that have shown that a family history of MI is a moderate risk factor for MI (RR, 1.2-2.6). For both men and women, a maternal history of MI carried the greatest risk for MI. The exception to this was in men with a history of maternal MI that occurred prior to the age of 50 years. Sesso and colleagues note that this is likely due to the paucity of women who experience MI prior to this age.
The risk for MI was also greatest when the parent experienced the MI at a younger age. The greatest risk for men (RR, 2.2) and women (RR, 2.6) was seen when the parent of the corresponding gender experienced MI at an age younger than 50.
This study also refutes a common clinical dictum that a family history of MI after the age of 65 does not portend an increased risk for MI. For men, a father with a first MI after the age of 70 had a RR of 1.7.
So here’s the bottom line—a family history of MI increases a patient’s risk for MI by 2-to-3 fold. This risk is greatest when both parents have had an MI. The risk is even higher if the parent’s MI occurred at an early age. Maternal history of MI appears to portend the greatest risk. A family history of MI may still be significant even if the family member had an MI at an age older than 65.
References
1. Hennekens CH, et al. N Engl J Med. 1996;334:1145-1149.
2. Buring JE, et al. J Myocardial Ischemia. 1992;4:27-29.
3. Shea S, et al. J Am Coll Cardiol. 1984;4:793-801.
Dr. Wiese is Chief of Medicine, Charity, and University Hospitals, Associate Chairman of Medicine, Tulane Health Sciences Center, New Orleans, La.
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