A prospective study of parental history off myocardial infarction and coronary artery disease in men

doi:10.1016/0002-9149(91)90163-F

The American Journal of Cardiology

Volume 67, Issue 11, 1 May 1991, Pages 933-938

https://doi.org/10.1016/0002-9149(91)90163-F Get rights and content

Abstract

The relation between parental history of myocardial infarction (MI) and risk of coronary artery disease (CAD) was prospectively examined among 45,317 U.S. male health professionals who were free of diagnosed CAD, 40 to 75 years of age in 1986 and followed for 2 years. These men provided details of parental history of MI, including their parents' age at the first event, their personal history of hypertension, hypercholesterolemia and diabetes mellitus, and a detailed dietary assessment completed at baseline. During 72,454 person-years of follow-up, 181 nonfatal MIs were documented, 49 men died from MI or sudden death, and 140 underwent coronary artery surgery or angioplasty. Compared with men without any history of parental MI, those whose mothers or fathers had had an MI at <70 years of age had a substantially elevated risk of MI (relative risk = 2.2, 95% confidence interval, 1.2 to 3.8 for maternal history; relative risk = 1.7, 95% confidence interval 1.2 to 2.3 for paternal history). Risk of MI increased with decreasing age at parental MI. Paternal but not maternal history of MI was related to increased risk of coronary artery surgery. These associations were not appreciably altered by controlling for diet or established risk factors, either individually or in multivariate models. These prospective data indicate that a history of MI in either parent is associated with an increased risk of CAD among men.

References (31)

U Goldbourt et al.
Clinical myocardial infarction over a five-year period. III. A multivariate analysis of incidence: The Israeli ischemic Heart Disease Study
J Chronic Dis
(1975)
LP ten Kate et al.
Familial aggregation of coronary heart disease and its relation to known genetic risk factors
Am J Cardiol
(1982)
RI Hamby
Hereditary aspects of coronary artery disease
Am Heart J
(1981)
S Shea et al.
Family history as an independent risk factor for coronary artery disease
J Am Coll Cardiol
(1984)
B Paulweber et al.
Genetic variation in the apolipoprotein A1-C111-A1V gene cluster and coronary heart disease
Atherosclerosis
(1988)
T Gordon et al.
Predicting coronary heart disease in middle-aged and older persons: The Framingham Study
JAMA
(1977)
L Wilhelmsen et al.
Multivariate analysis of risk factors for coronary heart disease
Circulation
(1973)
C Muller
Angina pectoris in hereditary xanthomatosis
Arch Intern Med
(1939)
HN Neufeld et al.
Coronary heart disease: genetic aspects
Circulation
(1983)
K Berg
Genetics of coronary heart disease and its risk factors

G Rose

Familial patterns in ischemic heart disease

Br J Prev Soc Med

(1964)

RL Phillips et al.

Frequency of coronary heart disease and cerebrovascular accidents in parents and sons of coronary heart disease index cases and controls

Am J Epidemiol

(1974)

J Slack et al.

The increased risk of death from ischemic heart disease in first degree relatives of 121 men and 96 women with ischemic heart disease

J Med Genet

(1966)

J Nora et al.

Geneticepidemiologic study of early onset ischaemic heart disease

Circulation

(1980)

JH Chessbro et al.

Strong family history and cigarette smoking as risk factors of coronary heart disease in young adults

Br Heart J

(1982)

Cited by (158)

Association of diet with circulating trimethylamine-N-oxide concentration
2020, American Journal of Clinical Nutrition
Trimethylamine-N-oxide (TMAO) is a compound that is present in seafood and produced through human gut microbial metabolism of its precursors. Previous studies have suggested that elevated TMAO concentrations are associated with an increased risk of cardiovascular events. However, the association between diet and TMAO concentrations in free-living adult populations has not been adequately described.
The objective of this study was to identify dietary predictors of plasma TMAO concentrations.
TMAO concentrations were assessed in 2 fasting plasma samples collected 6 mo apart among 620 healthy men. Short-term and long-term dietary intakes were assessed during the same time-frame of blood collections via repeated 7-d dietary records (7DDRs) and a semiquantitative food-frequency questionnaire (SFFQ), respectively. We grouped individual food items into 21 groups and regressed against averaged TMAO concentrations. We also assessed the association between dietary scores and TMAO concentrations.
In models adjusted for demographic characteristics and mutually adjusted for food groups, SFFQ-assessments of fish and egg intakes were significantly associated with increased TMAO concentration (β = 0.082; 95% CI: 0.021, 0.14; P = 0.009 for fish; β = 0.065; 95% CI: 0.004, 0.13; P = 0.039 for egg). The positive association between fish consumption and TMAO concentration was replicated in the 7DDR-assessments (β = 0.12; 95% CI: 0.060, 0.18; P < 0.001). There was no association between red meat intake and TMAO concentrations. The unhealthful plant-based diet index (uPDI) was inversely associated (β = −0.013; 95% CI: −0.021, −0.005; P = 0.001) and healthy dietary scores were positively correlated with TMAO concentration.
TMAO concentration was significantly associated with fish intake, but not with red meat consumption. uPDI, an unhealthy dietary pattern, was inversely related to TMAO concentration. As such, this study suggests that in free-living populations, higher circulating concentrations of TMAO cannot simply be interpreted as a marker of unhealthy food intake or an unhealthy dietary pattern.
Smoking cessation and weight change in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes: a population-based cohort study
2020, The Lancet Diabetes and Endocrinology
Citation Excerpt :
However, since weight gain after cessation attenuated the beneficial effects of smoking cessation on the risk of incident cardiovascular disease, these findings also emphasise the importance of bodyweight control after smoking cessation in maximising the cardiovascular health benefits of quitting smoking among people with type 2 diabetes. To address the limitations of previous studies and to further clarify the role of weight gain in the association between smoking cessation and risk of cardiovascular disease and mortality in people with type 2 diabetes, we investigated smoking cessation and weight change in association with subsequent risk of total cardiovascular disease, coronary heart disease, stroke, and all-cause and cause-specific mortality among adults with type 2 diabetes who participated in the Nurses' Health Study or the Health Professionals Follow-Up Study.9,10 In this prospective, population-based cohort study, we used data from two cohorts of medical professionals in the USA.
To reduce their overall substantially increased risk of cardiovascular disease and premature mortality, smoking cessation is especially important for people with diabetes. However, the effect of weight change after quitting smoking on the long-term health consequences of smoking cessation is unclear. We aimed to examine smoking cessation and subsequent weight change in relation to incident cardiovascular disease events and mortality among adults with type 2 diabetes.
In this population-based cohort study, we analysed data from people with type 2 diabetes from two prospective cohorts in the USA: the Nurses' Health Study (1976–2014) and the Health Professionals Follow-Up Study (1986–2014). We included participants from both cohorts who either had prevalent type 2 diabetes or were diagnosed during the study, and who were either current smokers or never smokers without cardiovascular disease or cancer at diagnosis of diabetes. Information on demographics, newly diagnosed diseases, medical history, and lifestyle factors, including smoking status and weight change, was updated every 2 years through validated questionnaires. We assessed the incidence of cardiovascular disease and all-cause and cause-specific mortality among recent quitters (within 6 years of stopping) and long-term quitters (>6 years) associated with weight change within 6 years of smoking cessation among people with type 2 diabetes. We did a multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) for the associations of smoking cessation and weight change on the outcomes.
Of 173 229 total cohort participants (121 700 from the Nurses' Health Study and 51 529 from the Health Professionals Follow-Up Study), 10 809 people with type 2 diabetes were included in the incident cardiovascular disease analysis and 9688 were included in the mortality analysis. 2580 incident cases of cardiovascular disease occurred during 153 166 person-years of follow-up, and 3827 deaths occurred during 152 811 person-years of follow-up. Recent quitters (2–6 consecutive years since smoking cessation) without weight gain within the first 6 years of quitting had a significantly lower risk of cardiovascular disease than people who continued to smoke (multivariable-adjusted HR 0·83 [95% CI 0·70–0·99] among all recent quitters, 0·77 [0·62–0·95] among recent quitters without weight gain, 0·99 [0·70–1·41] among recent quitters with weight gain of 0·1–5·0 kg, 0·89 [0·65–1·23] among recent quitters with weight gain of >5·0 kg, and 0·72 [0·61–0·84] among longer-term quitters [>6 consecutive years since smoking cessation]). Weight gain within 6 years after smoking cessation did not attenuate the inverse relation between long-term cessation and all-cause mortality (multivariable-adjusted HR 0·69 [95% CI 0·58–0·82] among long-term quitters without weight gain, 0·57 [0·45–0·71] among long-term quitters with weight gain of 0·1–5·0 kg, and 0·51 [0·42–0·62] among long-term quitters with weight gain of >5·0 kg), with similar results observed for cardiovascular disease and cancer mortality.
Smoking cessation without subsequent weight gain is associated with a reduced risk of cardiovascular disease and mortality among smokers with type 2 diabetes. Weight gain after smoking cessation attenuates the reduction in risk of developing cardiovascular disease, but does not attenuate the beneficial effect of smoking cessation with respect to mortality. These findings confirm the overall health benefits of quitting smoking among people with type 2 diabetes, but also emphasise the importance of weight management after smoking cessation to maximise its health benefits.
US National Institutes of Health.
Age threshold for proper definition of premature coronary artery disease in males
2018, Journal of Forensic and Legal Medicine
There is no universally accepted definition for the cut point age before which atherosclerosis is considered “premature.” This is a retrospective study aimed to utilize the medico legal autopsy information for finding a proper definition of the age threshold of premature atherosclerosis in males.
This work aimed to utilize autopsy reports data that were issued at Jordan University Hospital to evaluate age-related differences in the distribution of coronary atherosclerotic and myocardial lesions and the determination of the age threshold at which such differences became apparent in male deaths. Such a threshold might provide a proper definition for premature atherosclerosis and premature sudden atherosclerotic cardiac death. At the same time, the meaning of a reference age for mature atherosclerotic death incidents could be elucidated.
A total of 1139 male autopsy reports with sudden coronary atherosclerotic death were reviewed.
There is an overall decreasing trend in the prevalence of coronary thrombosis with age, where the prevalence of coronary thrombosis was more common in younger age groups and constitutes 59.9% of cases in the age groups less than 45 years in comparison to 42.7% of cases in the ages more than 65 years. The same trend was noticed for the prevalence of cases without evident myocardial fibrosis. On the other hand, the trend was increasing for stenosis without apparent thrombosis and for myocardial fibrosis. In spite of that, the detailed pattern of the prevalence of these pathologies with age did not show a steady, and a continuous change through the whole spanned age groups. Instead, two distinct phases were observed, the first phase represents the cases less than 49 years of age and the second phase represents the cases more than the age of 54 and the age group between 50/54 is what we called the “turn-interval.”
sThe “turn-interval” was considered as the scientific basis to define the age threshold that differentiates the premature atherosclerotic coronary diseases. Accordingly, it was proposed that male premature coronary artery diseases constituted the cases suffering from the heart attack, or died as a result of cardiac attacks below the age of 49, and the mature disease that affects people who is older than 54 years old.
Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus
2018, Journal of the American College of Cardiology
Citation Excerpt :
The NHS (Nurses’ Health Study) was established in 1976 with the enrollment of 121,700 U.S. female nurses age 30 to 55 years from 11 U.S. states (16). The HPFS (Health Professionals Follow-Up Study) was initiated in 1986, enrolling 51,529 U.S. male health professionals age 40 to 75 years from 50 U.S. states (17). The detailed information on dietary and lifestyle factors, medical history, and disease status was updated every 2 to 4 years through validated questionnaires (18).
Evidence is limited regarding the impact of healthy lifestyle practices on the risk of subsequent cardiovascular events among patients with diabetes.
The purpose of this study was to examine the associations of an overall healthy lifestyle, defined by eating a high-quality diet (top two-fifths of Alternative Healthy Eating Index), nonsmoking, engaging in moderate- to vigorous-intensity physical activity (≥150 min/week), and drinking alcohol in moderation (5 to 15 g/day for women and 5 to 30 g/day for men), with the risk of developing cardiovascular disease (CVD) and CVD mortality among adults with type 2 diabetes (T2D).
This prospective analysis included 11,527 participants with T2D diagnosed during follow-up (8,970 women from the Nurses’ Health Study and 2,557 men from the Health Professionals Follow-Up Study), who were free of CVD and cancer at the time of diabetes diagnosis. Diet and lifestyle factors before and after T2D diagnosis were repeatedly assessed every 2 to 4 years.
There were 2,311 incident CVD cases and 858 CVD deaths during an average of 13.3 years of follow-up. After multivariate adjustment of covariates, the low-risk lifestyle factors after diabetes diagnosis were each associated with a lower risk of CVD incidence and CVD mortality. The multivariate-adjusted hazard ratios for participants with 3 or more low-risk lifestyle factors compared with 0 were 0.48 (95% confidence interval [CI]: 0.40 to 0.59) for total CVD incidence, 0.53 (95% CI: 0.42 to 0.66) for incidence of coronary heart disease, 0.33 (95% CI: 0.21 to 0.51) for stroke incidence, and 0.32 (95% CI: 0.22 to 0.47) for CVD mortality (all p trend <0.001). The population-attributable risk for poor adherence to the overall healthy lifestyle (<3 low-risk factors) was 40.9% (95% CI: 28.5% to 52.0%) for CVD mortality. In addition, greater improvements in healthy lifestyle factors from pre-diabetes to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and CVD mortality. For each number increment in low-risk lifestyle factors there was a 14% lower risk of incident total CVD, a 12% lower risk of coronary heart disease, a 21% lower risk of stroke, and a 27% lower risk of CVD mortality (all p < 0.001). Similar results were observed when analyses were stratified by diabetes duration, sex/cohort, body mass index at diabetes diagnosis, smoking status, and lifestyle factors before diabetes diagnosis.
Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and CVD mortality among adults with T2D. These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in patients with T2D.
Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009–2012 National Health and Nutrition Examination Survey
2017, Preventive Medicine
Citation Excerpt :
Both diabetes and cardiovascular disease have known genetic susceptibility among progeny. However, evidence suggests that lifestyle behaviors play a major role in influencing the risk of disease, particularly among susceptible individuals (Lauer, 1999; Williams et al., 2001; Harrison et al., 2003; Colditz et al., 1991; Kardia et al., 2003; Hunt et al., 2003). Therefore, the significance of family history as a way of identifying individuals who should receive more intensive lifestyle modification counseling by health care providers should be a priority.
Family history is a well-known risk factor for diabetes and cardiovascular disease (CVD) and modification of lifestyle risk factors can significantly lessen such risk.
Our aim was to assess the association between family history of diabetes and/or CVD and lifestyle behaviors and risk factors (smoking, low physical activity, excessive dietary sodium and cholesterol intake and obesity) in a nationally representative sample of U.S. adults.
We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2012. Family history, lifestyle behaviors and risk factors were defined using self-reported and physical examination data.
The study sample included 10,988 participants with a mean age of 47 years. Among the U.S. adult population, 29.5%, 5.7% and 6.5% had a family history of diabetes, CVD and both diseases respectively. Compared to participants with no family history, participants with a family history of diabetes, CVD and both diabetes and CVD were more likely to be current smokers (OR = 1.18[95% CI, 1.03–1.35], OR = 1.68[95% CI, 1.31–2.17] and OR = 1.71[95% CI, 1.30–2.26] respectively). Participants with a family history of diabetes (OR = 1.42[95% CI, 1.26–1.61]) and both diabetes and CVD were more likely to be overweight/obese (OR = 2.06[95% CI, 1.57–2.69]). There was no association between family history and dietary factors or physical activity.
In the U.S., there is a high prevalence of modifiable risk factors among persons with a family history of diabetes and/or CVD. Healthcare providers have a significant role to play in targeting these individuals for lifestyle changes.
Paternal or maternal history of cardiovascular disease and the risk of cardiovascular disease in offspring. A systematic review and meta-analysis
2015, International Journal of Cardiology
Parental history of cardiovascular disease (CVD) is an established risk factor for the development of CVD in offspring. Several studies have suggested that a maternal transmission of CVD is more important for the development of CVD than paternal transmission.
A systematic search and meta-analysis were conducted, using the Medline and Embase databases. Included were cohort, case–control and cross-sectional studies (n = 26) focusing on the relation between paternal and maternal histories of cardiovascular disease and offspring CVD (myocardial infarction, stroke or cardiovascular mortality). The pooled estimates were calculated using a random-effects model.
The pooled OR of CVD in offspring having a positive paternal history of CVD compared to not having a positive parental history was 1.91 (95% CI 1.56–2.34; I²53%), the RR1.54 (95% CI 1.33–1.77; I²96%). The OR of a maternal history was 2.16 (95% CI 1.71–2.74; I²50%), RR1.59 (95% CI 1.38–1.84; I²90%). Regarding different age limits, a maternal history < 50 years (3.15, 95% CI 2.18–4.55) and paternal history < 55 years (2.82, 95% CI 2.25–3.54) were associated with the highest cardiovascular risk. Additional analyses for sons demonstrated an estimate for a positive paternal history of 1.55 (95% CI 1.39–1.71; I²74%) and 1.56 (95% CI 1.46–1.67; I²16%) for maternal history. For daughters, the estimate for paternal history was 1.48 (95% CI 1.26–1.74; I²73%) and 1.79 (95% CI 1.50–2.13; I²68%) for maternal history .
The conferred risk of CVD in offspring was not substantially different between positive paternal and maternal histories of CVD, the highest risk was observed for maternal history < 50 years. Since a positive parental history of CVD involves an increased cardiovascular risk, parental history inquiry is useful in clinical practice. No distinction has to be made whether the affected parent is the mother or the father.

View all citing articles on Scopus

^☆: This study was supported by Research Grant HL 35464 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. During this investigation.

¹: Eric Rimm was supported by National Research Service Award 5T32 ES07069 from the National Institute of Environmental Health Sciences, Bethesda, Maryland.

View full text

A prospective study of parental history off myocardial infarction and coronary artery disease in men☆

Abstract

J Chronic Dis

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Atherosclerosis

Predicting coronary heart disease in middle-aged and older persons: The Framingham Study

JAMA

Multivariate analysis of risk factors for coronary heart disease

Circulation

Angina pectoris in hereditary xanthomatosis

Arch Intern Med

Coronary heart disease: genetic aspects

Circulation

Genetics of coronary heart disease and its risk factors

Familial patterns in ischemic heart disease

Br J Prev Soc Med

Frequency of coronary heart disease and cerebrovascular accidents in parents and sons of coronary heart disease index cases and controls

Am J Epidemiol

The increased risk of death from ischemic heart disease in first degree relatives of 121 men and 96 women with ischemic heart disease

J Med Genet

Geneticepidemiologic study of early onset ischaemic heart disease

Circulation

Strong family history and cigarette smoking as risk factors of coronary heart disease in young adults

Br Heart J