Family History: An Index of Genetic and Environmental Predisposition to Coronary Artery Disease

Abstract

It is well known that family history of coronary heart disease reflects genetic predisposition to develop atherosclerosis. Individuals with a family history of premature CHD are at a significantly increased risk for CHD events. They form a potential target population for early, aggressive primary prevention strategies. However, the conventional cardiovascular risk factors (age, total cholesterol, smoking, HDL cholesterol, and systolic blood pressure) are precisely characterized and incorporated in the Framingham Risk evaluation algorithm. They do not include family history information as a criterion to guide primary prevention endeavors. Emerging evidence indicates that subjects with positive family history are unequivocally a high-risk group and candidates for prompt primary prevention efforts. In this chapter, we have highlighted overwhelming evidence indicating positive family history of CHD to be associated with an independent predictor of subclinical CHD markers, such as assessed CAC, Carotid-IMT, flow-mediated dilatation, among various others. On the basis of these facts, we propose following modifications in the risk prediction algorithm currently being used. Individuals in the Framingham low risk category, (estimated 10-year coronary mortality <10%) with family history, can be considered as intermediate risk and be targets for further risk stratification using CAC testing. On the other hand, those within the “intermediate-risk” range should be considered as high risk and treated aggressively as CHD equivalent with LDL goals of less than 70 mg/dl, and lipid lowering therapy be initiated, if LDL≥100 mg/dl. We believe that this will be a cost effective approach in utilizing appropriate therapies and advance risk stratifying tools, such as CAC testing, in this vulnerable population.