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• W2088522056 abstract "The occurrence of coronary heart disease (CHD) in successive generations of families was first observed by Sir William Osler almost 100 years ago.1 Since then, numerous cross-sectional and some longitudinal studies of diverse populations have reported clustering of CHD in families.2–7 While the specific mechanisms remain to be fully clarified, the interplay of genetic and shared common environmental factors including lifestyle behaviors has been implicated in familial aggregation of CHD. Several very recent reports add uniquely to the existing database and underscore the importance of family history of CHD in risk prediction and disease prevention.8–12 Specifically, results from the Framingham Offspring Study indicate that early-onset parental CHD is an independent predictor of offspring cardiovascular events in middle-aged men and women (mean age, 44 years).8 After adjustment for other risk factors, premature CHD in at least 1 parent was associated with a significant doubling in risk for men and a 70% increase in risk for women over a period of 8 years. Parental CHD was found to discriminate risk best among offspring with intermediate levels of cardiovascular risk as predicted by individual traditional risk factors and multivariable risk equations.8 Other recent studies of population-based cohorts demonstrate associations of familial CHD with subclinical atherosclerosis including increased carotid intima-media thickness and coronary artery calcium (CAC), a surrogate measure of the presence and burden of coronary atherosclerosis.9–12 Results from a recent study conducted by Nasir and colleagues9 are particularly noteworthy and suggest that sibling history of CHD may be more strongly associated with subclinical atherosclerosis than parental history of premature CHD. In this cross-sectional study of 8549 asymptomatic individuals (69% men; mean age 52 ± 9 years), the association of a reported family history of early-onset (before age 55 years) CHD with the presence and extent of CAC measured by electron beam tomography was examined. After adjustment for other risk factors, the odds ratio for the presence of CAC was 2.5 in men and 1.9 in women with a positive family history in both a sibling and a parent. Those who reported a premature CHD event in a sibling had a 2.5 odds risk (150% more likely) of having CAC; individuals with a history of premature CHD in parents had a 1.3 odds risk (30% more likely) of having CAC.9 Taken together, the results of these studies provide additional support for the inclusion of family history of premature CHD in risk assessment and stratification and for family-based approaches to CHD prevention.13 Current guidelines for primary and secondary prevention of CHD in children and adults advocate for family-based approaches to cardiovascular health promotion and risk reduction.14–18 The National Cholesterol Education Program (NCEP), for example, suggests a high-risk approach to identifying children at risk of CHD on the basis of family history of premature disease and/or parental dyslipidemia.14 Recent American Heart Association guidelines support and extend this approach to include early identification and vigilant follow-up of children with family history of CHD and other established risk factors including hypertension and obesity.15 Although family history is not incorporated into some widely used multivariable risk algorithms including the NCEP's Adult Treat Panel (ATP III) guidelines,18 family-based approaches to risk reduction including therapeutic lifestyle modification are emphasized by the NCEP and in the American Heart Association's prevention guidelines for adults.16,17 Across healthcare and community settings, cardiovascular nurse-clinicians are well-positioned and prepared to identify persons at risk of CHD on the basis of family history. For example, in the acute care and cardiac cath lab settings, first- and second-degree relatives of persons with early-onset disease (≤55 in men; ≤65 in women) could be identified, counseled, and/or referred to their primary healthcare provider for assessment and management of risk factors. In view of the evidence indicating intrafamilial associations of CHD-related lifestyle behaviors as well as traditional independent risk factors, family-based approaches to cardiovascular health promotion and risk reduction are clearly warranted. Given the state of the science in this area of CHD prevention, cardiovascular nurse scientists are presented with numerous research opportunities such as determining how family history of CHD can be used to educate and motivate those at risk to modify health behaviors, developing and testing family-based therapeutic lifestyle interventions, and developing and implementing innovative models of healthcare delivery that enable more effective and more efficient family-focused cardiovascular care." @default.
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• W2088522056 date "2005-01-01" @default.
• W2088522056 modified "2023-09-25" @default.
• W2088522056 title "Preventing Cardiovascular Disease" @default.
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• W2088522056 doi "https://doi.org/10.1097/00005082-200501000-00013" @default.
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