Skip to main content

Advertisement

SpringerLink
Log in

Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease

  • CARDIOVASCULAR DISEASE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

A parental history of premature coronary heart disease (CHD) is an established risk factor for CHD events in descendants. The study aim was to investigate whether subclinical coronary artery calcification (CAC) differs between asymptomatic individuals (a) without a parental CHD history, (b) with a parental history and (c) without knowledge of parental CHD history. The inclusion of individuals without knowledge of parental CHD history is a new approach. We also differentiated between CHD of mother and father to gain insight into their individual contributions. Data was obtained for 4,301 subjects aged 45–75 years free of overt CHD from the baseline screening of the population-based Heinz Nixdorf Recall study. CAC, measured by electron-beam computed tomography, was modeled conducting logistic regressions. Model 1 included family history, Model 2 was adjusted for age (and gender) and Model 3 added common CHD risk factors. The CAC score was dichotomized using the age and sex-specific 75th percentile. The odds ratio (OR) for CAC ≥ age and sex-specific 75th percentile was 1.33 among individuals with parental premature CHD history (95 % confidence interval [95 %CI]: 1.08, 1.63), which did not change after full adjustment (OR 1.40, 95 %CI: 1.13, 1.74). Individuals with an unknown biological father or mother had a high chance of elevated CAC scores (fully adjusted; father: OR 1.38, 95 %CI: 1.01, 1.90, mother: OR 1.86, 95 %CI: 0.90, 3.84) compared to the reference group. The current study showed an association between parental CHD history and CAC independent of common CHD risk factors. This association affirms the use of parental CHD history in cardiovascular risk assessment among asymptomatic adults in routine practice. The observation that individuals who did not know their mother or father are prone to increased CAC scores needs further confirmation in large scale studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CAC:

Coronary artery calcification

CHD:

Coronary heart disease

CI:

Confidence interval

CVD:

Cardiovascular disease

Gen3:

Third generation cohorts

HDL:

High-density lipoprotein

HNR:

Heinz Nixdorf Recall study

LDL:

Low-density lipoprotein

PROCAM:

Prospective cardiovascular Münster

OR(s):

Odds ratio(s)

sig.:

Significance

SES:

Socioeconomic status

References

  1. Friedlander Y, Siscovick DS, Weinmann S, et al. Family history as a risk factor for primary cardiac arrest. Circulation. 1998;97(2):155–60.

    Article  PubMed  CAS  Google Scholar 

  2. Barrett-Connor E, Khaw K. Family history of heart attack as an independent predictor of death due to cardiovascular disease. Circulation. 1984;69(6):1065–9.

    Article  PubMed  CAS  Google Scholar 

  3. Eaton C, Bostom A, Yanek L, et al. Family history and premature coronary heart disease. J Am Board Fam Pract Am Board Fam Pract. 1996;9(5):312.

    CAS  Google Scholar 

  4. Kardia SLR, Modell SM, Peyser PA. Family-centered approaches to understanding and preventing coronary heart disease. Am J Prev Med. 2003;24(2):143–51.

    Article  PubMed  Google Scholar 

  5. Leander K, Hallqvist J, Reuterwall C, Ahlbom A. Family history of coronary heart disease, a strong risk factor for myocardial infarction interacting with other cardiovascular risk factors: results from the Stockholm heart epidemiology program (SHEEP). Epidemiology. 2001;12(2):215.

    Article  PubMed  CAS  Google Scholar 

  6. Lloyd-Jones DM, Nam BH, D’Agostino RB, et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults. JAMA J Am Med Assoc. 2004;291(18):2204.

    Article  CAS  Google Scholar 

  7. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women. JAMA J Am Med Assoc. 2007;297(6):611.

    Article  CAS  Google Scholar 

  8. Roncaglioni MC, Santoro L, D’Avanzo B, et al. Role of family history in patients with myocardial infarction. An Italian case-control study. GISSI-EFRIM investigators. Circulation. 1992;85(6):2065–72.

    Article  PubMed  CAS  Google Scholar 

  9. Sesso HD, Lee I. Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women. Circulation. 2001;104(4):393.

    Article  PubMed  CAS  Google Scholar 

  10. Assmann G, Schulte H, Seedorf U. Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) study. Int J Obes. 2008;32:S11–6.

    Article  CAS  Google Scholar 

  11. Anderson K, Wilson P, Odell P, Kannel W. An update coronary risk profile. A statement for health professionals. Office of scientific affairs, American heart association, Dallas, TX 75. Circulation. 1991;83:356–62.

    Article  PubMed  CAS  Google Scholar 

  12. Conroy R, Pyörälä K, Fitzgerald A, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987.

    Article  PubMed  CAS  Google Scholar 

  13. Nashef S, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16(1):9–13.

    Article  PubMed  CAS  Google Scholar 

  14. Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American heart association and the American college of cardiology. Circulation. 1999;100(13):1481.

    Article  PubMed  CAS  Google Scholar 

  15. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American college of cardiology foundation/American heart association task force on practice guidelines developed in collaboration with the American society of echocardiography, American society of nuclear cardiology, society of atherosclerosis imaging and prevention, society for cardiovascular angiography and interventions, society of cardiovascular computed tomography, and society for cardiovascular magnetic resonance. J Am Coll Cardiol. 2010;56(25):e50.

    Article  PubMed  Google Scholar 

  16. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36(4):1253–60.

    Article  PubMed  CAS  Google Scholar 

  17. Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J. 2001;141(3):375–82.

    Article  PubMed  CAS  Google Scholar 

  18. Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol. 2000;86(5):495–8.

    Article  PubMed  CAS  Google Scholar 

  19. Wang TJ, Nam BH, D’Agostino RB, et al. Carotid intima-media thickness is associated with premature parental coronary heart disease. Circulation. 2003;108(5):572–6.

    Article  PubMed  Google Scholar 

  20. Erbel R, Möhlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56(17):1397–406.

    Article  PubMed  Google Scholar 

  21. Schmermund A, Möhlenkamp S, Stang A, et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: Rationale and design of the Heinz Nixdorf Recall study. Am Heart J. 2002;144(2):212–8.

    Article  PubMed  Google Scholar 

  22. Nasir K, Budoff MJ, Wong ND, et al. Family history of premature coronary heart disease and coronary artery calcification: multi-ethnic study of atherosclerosis (MESA). Circulation. 2007;116(6):619.

    Article  PubMed  Google Scholar 

  23. Parikh NI, Hwang SJ, Larson MG, et al. Parental occurrence of premature cardiovascular disease predicts increased coronary artery and abdominal aortic calcification in the Framingham Offspring and Third Generation cohorts. Circulation. 2007;116(13):1473–81.

    Article  PubMed  Google Scholar 

  24. Nasir K, Michos ED, Rumberger JA, et al. Coronary artery calcification and family history of premature coronary heart disease: sibling history is more strongly associated than parental history. Circulation. 2004;110(15):2150.

    Article  PubMed  Google Scholar 

  25. Stang A, Moebus S, Dragano N, et al. Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall study: identifiability of phone numbers as the major determinant of response. Eur J Epidemiol. 2005;20(6):489–96.

    Article  PubMed  CAS  Google Scholar 

  26. Schmermund A, Möhlenkamp S, Berenbein S, et al. Population-based assessment of subclinical coronary atherosclerosis using electron beam CT. Atherosclerosis. 2006;185:177–82.

    Article  PubMed  CAS  Google Scholar 

  27. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.

    Article  PubMed  CAS  Google Scholar 

  28. Erbel R, Möhlenkamp S, Lehmann N, et al. Sex related cardiovascular risk stratification based on quantification of atherosclerosis and inflammation. Atherosclerosis. 2008;197(2):662–72.

    Article  PubMed  CAS  Google Scholar 

  29. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA J Am Med Assoc. 2001;285(19):2486–97.

    Google Scholar 

  30. Taylor A, Merz C, Udelson J. 34th Bethesda Conference: Executive summary–can atherosclerosis imaging techniques improve the detection of patients at risk for ischemic heart disease? J Am Coll Cardiol. 2003;41(11):1860.

    Article  PubMed  Google Scholar 

  31. Wilson PWF, Smith SC Jr, Blumenthal RS, Burke GL, Wong ND. Task force #4–how do we select patients for atherosclerosis imaging? J Am Coll Cardiol. 2003;41(11):1898.

    Article  PubMed  Google Scholar 

  32. Budoff MJ, Nasir K, McClelland RL, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2009;53(4):345.

    Article  PubMed  CAS  Google Scholar 

  33. Stang A, Moebus S, Möhlenkamp S, et al. Algorithms for converting random-zero to automated oscillometric blood pressure values, and vice versa. Am J Epidemiol. 2006;164(1):85.

    Article  PubMed  Google Scholar 

  34. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28:37–42.

    Article  Google Scholar 

  35. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.

    Article  PubMed  CAS  Google Scholar 

  36. Scheuner M, Wang S, Raffel L, Larabell S, Rotter J. Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood. American Journal of Medical Genetics Part A. 1997;71(3):315–24.

    Article  CAS  Google Scholar 

  37. Bromen K, Stang A, Baumgardt-Elms C, et al. Testicular, other genital, and breast cancers in first-degree relatives of testicular cancer patients and controls. Cancer Epidemiol Biomark Prev. 2004;13(8):1316–24.

    Google Scholar 

  38. Chow C, Pell A, Walker A, O’Dowd C, Dominiczak A, Pell J. Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention. BMJ Br Med J. 2007;335(7618):481.

    Article  CAS  Google Scholar 

  39. Burke V, Gracey MP, Milligan R, Thompson C, Taggart AC, Beilin LJ. Parental smoking and risk factors for cardiovascular disease in 10-to 12-year-old children. J Pediatr. 1998;133(2):206–13.

    Article  PubMed  CAS  Google Scholar 

  40. Mosca L, Mochari H, Christian A, et al. National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation. 2006;113(4):525–34.

    Article  PubMed  Google Scholar 

  41. Hunt K, Davison C, Emslie C, Ford G. Are perceptions of a family history of heart disease related to health-related attitudes and behaviour? Health Educ Res. 2000;15(2):131.

    Article  PubMed  CAS  Google Scholar 

  42. McCusker ME, Yoon PW, Gwinn M, Malarcher AM, Neff L, Khoury MJ. Family history of heart disease and cardiovascular disease risk-reducing behaviors. Genet Med. 2004;6(3):153.

    Article  PubMed  Google Scholar 

  43. Loucks EB, Almeida ND, Taylor SE, Matthews KA. Childhood family psychosocial environment and coronary heart disease risk. Psychosom Med. 2011;73(7):563–71.

    Article  PubMed  Google Scholar 

  44. Higgins M. Epidemiology and prevention of coronary heart disease in families. Am J Med. 2000;108(5):387–95.

    Article  PubMed  CAS  Google Scholar 

  45. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.

    Article  PubMed  Google Scholar 

  46. Bensen J, Liese A, Rushing J, et al. Accuracy of proband reported family history: the NHLBI family heart study (FHS). Genet Epidemiol. 1999;17(2):141–50.

    Article  PubMed  CAS  Google Scholar 

  47. Watt G, McConnachie A, Upton M, Emslie C, Hunt K. How accurately do adult sons and daughters report and perceive parental deaths from coronary disease? J Epidemiol Community Health. 2000;54(11):859.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We would like to thank the Heinz Nixdorf Foundation (Chairman Martin Nixdorf, former Chairman: †Dr. jur. Schmidt), Germany, for their generous support of this study. The study is also supported by the German Ministry of Education and Science (BMBF), and the German Aerospace Center (Deutsches Zentrum für Luft- und Raumfahrt, DLR), Bonn, Germany. Assessment of psychosocial factors is funded by the German Research Foundation (DFG; Project SI 236/8-1 and SI 236/9-1). We kindly acknowledge the support of Sarstedt AG & Co. (Nümbrecht, Germany) with regard to the laboratory equipment. We are indebted to all study participants and to the dedicated personnel of both the study centre of the Heinz Nixdorf Recall Study and the EBT-scanner facilities as well as to the investigative group, in particular D. Grönemeyer, R Seidel, U Roggenbuck and S Slomiany.

Conflict of interest

None of the authors has declared any conflict of interests or has any financial disclosure to report.

Author information

Authors and Affiliations

  1. Centre for Health and Society, Institute for Medical Sociology, University Clinic Düsseldorf, University of Düsseldorf, Düsseldorf, Germany

    Stefanie Wahl & Nico Dragano

  2. Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    Susanne Moebus, Silke Andrich & Karl-Heinz Jöckel

  3. Clinic of Cardiology, Bethanien Hospital Moers, Moers, Germany

    Stefan Möhlenkamp

  4. Clinic of Cardiology, West-German Heart Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    Raimund Erbel

  5. Institute of Clinical Epidemiology, Medical Faculty, University Halle-Wittenberg, Halle, Germany

    Andreas Stang

Authors
  1. Stefanie Wahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Möhlenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raimund Erbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne Moebus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silke Andrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Stang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl-Heinz Jöckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nico Dragano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nico Dragano.

Additional information

This study was conducted on behalf of the Heinz Nixdorf Recall Investigative Group.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 145 kb)

Appendix: Advisory Board

Appendix: Advisory Board

Meinertz T, Hamburg, Germany (Chair); Bode C, Freiburg, Germany; de Feyter PJ, Rotterdam, Netherlands; Güntert B, Hall i. T., (Austria); Gutzwiller F, Bern, Switzerland; Heinen H, Bonn, Germany; Hess O, Bern, Switzerland; Klein B, Essen, Germany; Löwel H, Neuherberg, Germany; Reiser M, Munich, Germany; Schmidt G, Essen, Germany; Schwaiger M, Munich, Germany; Steinmüller C, Bonn, Germany; Theorell T, Stockholm, Sweden; Willich SN, Berlin, Germany.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wahl, S., Möhlenkamp, S., Erbel, R. et al. Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease. Eur J Epidemiol 28, 301–310 (2013). https://doi.org/10.1007/s10654-012-9743-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-012-9743-1

Keywords

Search

Navigation