Abstract 19897: Better Detection of Adverse Risk Profiles in the General Population Through a Novel Family History Definition: First Results From the ASKLEPIOS Family History Database
Purpose: The importance of family history, the integration of risk within a family from shared genetic susceptibilities and familial clustering of environmental exposures, lifestyles and behaviors, is generally recognized. However, the potential of this useful, inexpensive tool remains underutilized in its current basic definition: premature cardiac disease in a first-degree relative. We describe the additional value of a new extended family history definition on the risk factor profile of a large representative population sample.
Methods: The Asklepios study is a random sample of 2524 M/F volunteers, representative of the Belgian population between 35-55 years, free from overt cardiovascular disease. The sample is extensively phenotyped, including biochemistry, cardiac and vascular echography and questionnaire data on 4 generations of family history. We propose a simple new, extended family history construct using key additional elements: age at onset of disease (not only premature, but also late occurrence of disease), degree of relationship (first, second degree), type of relative (sibling, parent), number of affected relatives and lineage.
Results: Compared to the classic, dichotomous (guidelines-based) definition, the new, extended definition was superior in predicting (all age & sex adjusted p<0.05): presence of obesity and the cluster of components comprising the metabolic syndrome, lipid abnormalities including lipid oxidation (oxidized low-density lipoprotein cholesterol), blood pressure, inflammation (interleukin-6), and compound risk scores. Interestingly, most relations with family risk were not graded but showed clear informational breakpoints, with absence of CVD (including late onset) in any first-degree relative being a particularly interesting phenotype for further study.
Interpretation: A new, extended definition of familial history for CVD, taking into account key additional elements also looking at later onset of disease, degree and type of relationship, number of affected relatives and lineage, is superior to the conventional, dichotomous definition. There remain clear opportunities to refine and increase performance and informational content of this readily available, simple, inexpensive tool.
- © 2010 by American Heart Association, Inc.