A new study just published in the Journal of the American College of Cardiology Cardiovascular Imaging confirms the importance of family history in assessing the risk of heart attack. The study also shows the added value of coronary artery calcium scoring, an imaging technique using computed tomography (CT) scanning. This scanning quantifies the burden of atherosclerotic plaque in the heart’s arteries, predicting coronary heart disease risk.
In this study, Dr. Andre Paixao and colleagues from Dallas, Texas assessed 2,390 participants without cardiovascular disease at the time of enrollment in the Dallas Heart Study. They evaluated the impact of family history of heart attack in a first-degree relative, and a coronary artery calcium score greater than zero on the risk of three things:
- Coronary heart disease related death
- Heart attack
- The need for a stent or bypass (coronary revascularization)
At the start of the study, the average age of the population was young, about 44 years. Slightly more than half of the participants (56 percent) were women and about half (48 percent) were African American. The average period of follow-up was 8 years.
Most participants (80 percent) were considered to be at low risk for coronary events at the start, on the basis of the Framingham risk score and 47 percent had a coronary artery calcium score of zero. Family history of heart attack at any age was reported by about a third (32 percent) of patients. Family history of premature heart attack was reported by only 10 percent, and was defined as heart attack occurring before the age of 50 years in a first-degree male relative, or before the age of 55 years in a first-degree female relative.
Higher Risks With Family History of Heart Attack
Despite the young age and low risk of this population, 76 had at least one of the three coronary heart disease events during the 8 years of follow-up. Family history of heart attack was a strong and independent predictor of these events.
People with a family history of heart attack had a 2.6-fold (260 percent) increase in the risk of dying from coronary heart disease, having a heart attack, or the need for coronary revascularization. A family history of premature heart attack did not increase this risk by much. The impact of family history of heart attack was seen in people with and without a positive coronary artery calcium score.
A positive coronary artery calcium score was also associated with an increase in risk. Its greatest impact was in those who also had a family history of heart attack. The cumulative incidence of coronary events in those with both a family history of heart attack and a positive coronary artery calcium score was 8.8 percent versus 3.3 percent in those with a positive coronary artery calcium score alone. These numbers compare to a cumulative incidence of coronary events in those with a family history of heart attack alone of 1.9 percent versus 0.4 percent in those with neither of these risk factors.
Get to Know Your Family Heart History
This study confirms the importance of family history of heart attack and coronary artery calcium scoring in the assessment of coronary heart disease risk. Despite the known predictive value of coronary artery calcium scoring, family history still counts.
So what’s one to do if either or both of these risk factors are present? Managing known modifiable risk factors becomes of paramount importance, including (when present):
- Smoking cessation
- Treatment of high blood pressure
- Treatment of diabetes
- Treatment of high cholesterol
Lifestyle changes, including exercise and weight loss in overweight people, are also important preventive measure to take.
Finally, while coronary artery calcium scoring is not routinely recommended for otherwise healthy young people, those with a family history of heart attack might consider discussing this option with their physician.
Articles from & picture ：everydayhealth.com