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Am Fam Physician. 2005;72(5):910-914

The presence of one or more first-degree relatives with a history of premature coronary heart disease (CHD) is an independent risk factor for CHD. Nasir and colleagues investigated the strength of association between coronary artery calcification, as measured by electron beam tomography, and a sibling or parental history of premature CHD.

A consecutive sample of physician-referred patients presenting to one electron beam tomography facility between July 1999 and June 2003 were evaluated for inclusion in the study. Patients were excluded if they reported a history of previous myocardial infarction, coronary or peripheral arterial revascularization, or current symptoms of chest discomfort. The study group consisted of 8,549 patients; 69 percent were men and the average age was 52 years.

In addition to self-reporting sibling and parental histories of premature coronary heart disease (defined in this study as a fatal or non-fatal myocardial infarction and/or coronary revascularization before 55 years of age), the study population provided information on demographics, medications, physical activity, and other coronary risk factors such as tobacco use, hyperlipidemia, and diabetes. The amount of coronary artery plaque noted on electron beam tomography screening was measured according to a standardized coronary artery calcification score, which was subsequently classified into one of five categories.

Multivariable logistic regression was used to analyze the strength of association between self-reported family history and categories of calcification scores. There was no significant association between the calcification score and a positive family history in a first-degree relative 55 years or older. However, increasing calcification scores were strongly associated with parental and sibling histories of premature CHD, with the sibling history being more significant. The authors conclude that these data support recommendations to include a family history of premature CHD in the coronary risk assessment for subclinical atherosclerosis. In addition, they suggest paying particular attention to the sibling family history because it seems to confer a higher level of risk than the parental history. Key limitations of this study include its reliance on self-reporting of family histories (as opposed to chart reviews) and its physician-referred rather than randomly selected population.

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