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Cardiovascular disease: a serious family affair

A recent study,1 published in the Journal of the American College of Cardiology, confirms that parental history of cardiovascular disease nearly doubles a person’s risk in all regions of the world, even after considering all other known risk factors.

The INTERHEART Study, a multinational, case-control study, examined whether the relationship between parental history of myocardial infarction (MI) and MI risk is independent of known cardiovascular risks and a small number of genetic variants mostly related to risk factors.

generations2Compiling data gathered from 12,149 patients presenting with a first MI and 14,467 controls matched for age and sex, the researchers found that both maternal and paternal histories are associated with an increased risk – the younger the incidence in the parent, the higher the risk. After making adjustments for a set of nine risk factors – both biological and behavioral (i.e., abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, physical activity, fruit and vegetable consumption, and alcohol consumption) – it was determined that the overall association of parental history is an important, consistent and global indicator.

Lead author Dr Clara Chow (Head Cardiac Program, The George Institute; Senior Lecturer, University of Sydney) said: “This study finds that parental history of myocardial infarction, a very easy-to-measure risk factor, approximately doubles your risk of future heart attack regardless of all other risk factors, including ethnicity, gender, and socioeconomic position”.

“While other studies have shown the relationship between parental history and risk, they have not established its independence from the extensive list of other potential explanatory factors as measured by the INTERHEART Study and not established it in other world regions or ethnic groups,” she added. The team asserts that their study will put to rest the criticism that parental history is insignificant relative to other risks, speculating that as-yet unknown environmental or genetic factors may account for the association.

In his accompanying editorial[2] Dr Themistocles Assimes, Assistant Professor at Stanford University School of Medicine, asserts that measures of familial risk such as that in the study by Chow et al “have the potential to play an important role in…substantially reducing the global burden of cardiovascular disease”. He elsewhere elaborated: “This study confirms that unknown genetic and environmental factors play an important role in determining one’s risk of heart disease in all major regions and ethnicities throughout the world. We have much important and challenging research left to do to identify these unknown risk factors, but they seem to be present to a similar degree everywhere in the world”.[3]

“In the meantime, there is no reason we should not use this information worldwide to better predict who is at a higher risk of a heart attack. We can then spend a little extra time counseling these individuals on the importance of lifestyle changes such as weight loss, exercise, and smoking cessation and/or medicines that reduce blood pressure or cholesterol. These interventions can serve to neutralize the excess risk related to a family history.”


  1. Parental History and Myocardial Infarction Risk Across the World, INTERHEART study, Chow, C. et al, J Am Coll Cardiol 57;5:2011:619 – 627
  2. Family History of Heart Disease: The Re-Emergence of a Traditional Risk Factor, Assimes, T., J Am Coll Cardiol 57;5:2011:628 – 629
  3. Press release for February 1st 2011 issue of the Journal of the American College of Cardiology

Published on: February 2, 2011

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