Abstract 17927: A Cumulative Family History Score is Associated with Greater Severity and Progression of Angiographic Coronary Artery Disease

Abstract

Introduction: A family history (FH) of coronary heart disease (CHD) is a significant risk factor for development of atherosclerosis. We sought to determine whether a greater number of affected first degree relatives, is associated with greater severity and progression of angiographically defined CAD.

Methods: 3358 subjects undergoing cardiac catheterization were recruited into the Emory Cardiovascular Biobank. A FH score ranging from 0 to ≥ 3 was created based on number of first degree relatives (parents, siblings and children) with prior MI or coronary revascularization. Significant angiographic CAD was defined as presence of ≥70% stenosis in the left main, anterior descending, circumflex or right coronary artery (n=1983, 59.1%). CAD severity was determined using Gensini score (GS). CAD progression was defined as a binary variable based on a net change of ≥3 points of GS/year, in 811 subjects with at least two coronary angiograms performed at least one year apart. We tested for association between FH score with a) severity of CAD and b) progression of angiographic CAD, after adjustment for traditional risk factors.

Results: Patients with higher FH score were more likely to have significant CAD (figure A). They also have higher CAD severity with median GS of 10, 14, 19 and 39 in those with FH risk scores of 0, 1, 2, and ≥ 3, respectively, (p <0.001). Furthermore, among 811 patients with follow-up angiograms, patients with a stronger FH of CHD were more likely to progress (figure B). The prediction for CAD progression improves with the addition of FH risk score to traditional risk factors (AUC increased by 1.2% p value<0.001).

Conclusion: A FH score based on number of first degree relatives with history of CHD is associated with both increased severity of CAD and more rapid progression of CAD. Scores based on detailed evaluation of FH of CHD can be very useful in predicting CAD outcomes in high risk subjects.