Family history of heart attack as an independent predictor of death due to cardiovascular disease.

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Abstract
Although a family history of ischemic heart disease is a well-accepted risk factor for cardiovascular disease, only 3 prospective studies, all in men, have examined the predictive strength of a positive family history after adjusting for other heart disease risk factors. The present analysis is based on a 9 yr follow-up of 4014 men and women from 40 to 79 yr old who reported no known cardiovascular disease in response to a standardized interview. At baseline 38% of this group reported a family history of a heart attack in a parent, sibling, or child; 15% of those with a positive family history in a 1st-degree relative indicated that the heart attack had occurred before the relative was 50 yr old. Younger men (< 60 yr) with a positive family history at any age had significantly higher mean blood pressures and total plasma cholesterol levels; older men were more likely to have diabetes mellitus. Younger women with a positive family history were more likely to smoke cigarettes and older women had higher cholesterol levels and were more likely to use exogenous estrogens. The independent contribution of a positive family history of heart attack to subsequent cardiovascular death was determined by the Cox model after adjusting for age, systolic blood pressure, total plasma cholesterol level, obesity, cigarette smoking, personal history of diabetes, and estrogen use (in women). In men, but not in women, a positive family history of heart attack was independently predictive of death from all causes and from cardiovascular and ischemic heart disease. Significant differences were restricted to younger men; those with a positive family history had a 5-fold excess risk of cardiovascular death independent of other risk factors. A family history of premature heart attack (< 50 yr) was not predictive of mortality in men or women. The differences between younger and older men probably reflect survivorship, but the differences between men and women are unexplained.