Importance of sex and age factor in assessing family history of stroke

Incidence of stroke differs between men and women and it increases nearly exponentially with age. Therefore, assessment of family history of stroke disregarding sex and age of family members results in bias or misclassification. In this study the effects of sex and age on the positivity of the past history were analyzed numerically. Sex- and age-specific proportion of a positive history of stroke among 24,007 family members was obtained from a questionnaire survey of 2,316 high school students. By analyzing the sex- and age-specific proportion with the logistic regression model odds ratios resulting from sex and age difference were estimated. The odds ratio for sex difference was 2.458 (95% confidence interval: 2.067-2.924) and odds ratio for age difference was 1.064 (95% confidence interval: 1.058-1.070). This indicated that a positive history of stroke was 2.458 times higher in male members than in female members of the same age and that a positive history increased by (1.064)y, where y was age difference in years. Potential bias or misclassification resulting from disregarding sex and age can be substantial. Some measures to control for sex and age of family members are required in assessing the family history.     

Productivity loss resulting from coronary heart disease in Australia

Background

Coronary heart disease (CHD) is the largest single cause of death in Australia. It places a heavy financial burden on the country’s health system. To date, no study has systematically assessed CHD-related productivity loss in Australia.

Objective

To quantify CHD-related productivity loss in Australia using both the human capital method and the friction method.

Methods

Mathematical models adjusting for economic activity, unemployment and the elasticity of productivity loss of labour reduction were proposed for the quantification. Where Australian data were unavailable, parameters were estimated using data from studies in European countries. Sensitivity analysis was conducted around uncertain parameters.

Results

The annual potential CHD-related productivity loss was estimated to be Australian dollars ($A)1.79 billion in 2004 using the human capital method. The potential loss was considerably higher than the actual loss, estimated to be $A25.02 million using the friction method.

Conclusions

CHD results in significant productivity loss in Australia. A valid economic evaluation of the full scale of the impact of CHD should consider the potential and actual productivity loss as well as the direct healthcare costs incurred by the disease.     

Interactions between diabetes and family history of coronary heart disease and other risk factors for coronary heart disease among adults with diabetes in Utah

We used a unique data base containing medical family history information from representative Utah families to investigate interactions between diabetes and family history of coronary heart disease and other risk factors for coronary heart disease. We compared nonrelated individuals reported to have had diabetes mellitus diagnosed over the age of 19 (948) with 2150 nondiabetic individuals. Among both men and women, diabetes and family history of early coronary heart disease magnified the risk for coronary heart disease, so that in diabetic individuals with a positive family history of coronary heart disease, about 74% of the coronary heart disease could be attributed to interaction. Relative to nondiabetics without a family history of early coronary heart disease, nondiabetics with family history had a relative risk of 4.5 (2.3-8.7), diabetics without a family history had a relative risk of 2.8 (1.6-4.9), and diabetics with a family history had a relative risk of 21.3 (9.1-50.0). Smoking also interacted with diabetes; among smoking diabetics, 47% of early heart disease may be attributable to interaction between smoking and diabetes. Smoking entailed the highest risk for diabetic women. Hypertension and diabetes appeared to act additively, with little interaction. Among women, family history of diabetes was a risk factor for coronary heart disease with a relative risk of 2.5 (1.0-6.4), whereas for men the relative risk was estimated to be 0.4 (0.2-1.1).     

疾病家族史与冠心病发生风险的关联研究

目的 分析疾病家族史对急性冠心病事件（MCE）及缺血性心脏病（IHD）发病风险的影响。方法 研究对象来自中国慢性病前瞻性研究,剔除基线时患有恶性肿瘤、心脏病及脑卒中的个体,纳入485 784人进行分析。统计分析采用Cox比例风险模型。结果 研究人群随访M=7.2年,随访期间新发MCE 3 934例,IHD 24 537例。与无家族史者相比,有家族史者发生MCE及IHD的风险均较高,HR值（95% CI）分别为1.41（1.19~1.65）和1.25（1.18~1.33）。与双亲型家族史相比,同胞型家族史与早发MCE的关联更强（HR=2.97,95% CI：1.80~4.88）;超重/肥胖者中家族史与MCE、IHD的关联更强;吸烟者中家族史与MCE的关联更强。结论 有家族史者发生MCE及IHD的风险较高。结果提示应鼓励个体根据疾病家族史信息,及早开展生活方式干预和相关基础疾病的治疗管理。     

Comparison of family history measures used to identify high risk of coronary heart disease

We examined 15 published continuous family history measures (scores) as well as two new formulations in terms of several desirable properties. We applied the scores to sample pedigrees and found that some systematically increase with family size. In contrast to aggregate scores, non-aggregate scores are sensitive to the age, sex, and covariate status of individual relatives but are unstable when the families are small. We also applied these scores to our own population case-control data, characterised by a high proportion of missing and false-negative responses. In these small families, all scores provided significant discrimination between CHD cases and controls beyond the usual categorical definition of positive family history, but appeared no better than detailed categorical definitions or even simple counts. Our new formulations offer no solution to the problems of few data; most scores apply asymptotic approximations to differences between observed and expected number of affected relatives and are not suited to small families. All scores would be improved by ruling out families with only one affected relative, as is being done in the NHLBI Family Heart Study. We recommend that researchers, when using a family history measure, consider the number of informative families and other characteristics of their data prior to choosing any particular formulation.     

Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease

OBJECTIVES: This study evaluated the association of physical activity with serum lipoprotein(a) [La(a)] levels in individuals according to whether they had a family history of coronary heart disease (CHD). METHODS: Lp(a) levels in 332 healthy Spanish men aged 20 to 60 years were measured. Physical activity and family history of CHD were assessed. RESULTS: For men with a family history of CHD, the odds ratio for Lp(a) levels above the median value was 0.13 (95% confidence interval = 0.03, 0.50) in very active men (energy expended in physical activity > 300 kcal/day) compared with active men (energy expended in physical activity < 300 kcal/day). CONCLUSIONS: Regular daily physical activity in individuals with a family history of CHD could be useful for controlling Lp(a) levels.     

超敏C-反应蛋白在冠心病评估中的作用

目的探讨在不同类型冠心病中超敏C反应蛋白(hs-CRP)浓度变化的临床意义。方法将145例胸痛患者分为稳定型心绞痛组(Stable angina pectoris SAP)和急性冠脉综合征(Acute coronary syndromes ACS)组和健康对照组,均行冠状动脉造影并测定血清hs-CRP水平,进行统计学处理。结果冠心病组hs-CRP浓度显著高于对照组(P﹤0.001),ACS组显著高于稳定型心绞组(P﹤0.001)。结论 hs-CRP可以作为评价冠心病患者斑块稳定性的指标之一。     

冠心病基因检测与冠心病的关联性

目的观察冠心病基因检测与冠心病是否有关联性,以及关联程度如何。方法选取120例住院患者,其中60例为冠心病人,60例为非冠心病人。年龄40—65岁。冠心病为观察A组,非冠心病为对照B组,记录性别、年龄、冠心病家族史、高血压史、糖尿病史,并均抽血行冠心病基因检测。A组选1人和B组选1人按年龄相近、性别相同配对,共形成60对。开始进行1：1条件Logistic回归分析。结果冠心病家族史、高血压史、糖尿病史、以及冠心病基因检测与冠心病均有关联性。其中冠心病基因检测与冠心病的关联程度低于其他3个因素。结论冠心病基因检测与冠心病有关联性。     

不同性别冠心病患者危险因素及冠状动脉病变特点分析

目的 分析不同性别冠心病(CHD)患者危险因素及其冠状动脉(冠脉)病变的特点.方法 纳入2009年1月至2011年1月在解放军总医院经冠脉造影确诊为CHD患者共3765例(男性2661例,女性1104例),收集患者各类临床资料及冠脉病变数据.根据患者年龄和性别进行分层,应用logistic回归模型分析CHD传统危险因素及冠脉病变的特点.结果 (1)女性发病年龄迟于男性,且合并CHD传统危险因素多;女性随年龄增长,吸烟的比例下降,血脂异常和糖尿病的比例显著升高.男性患者中,吸烟是最常见的危险因素.(2)性别间比较的logistic回归模型提示,糖尿病可显著增加女性罹患CHD的风险(OR=2.05,95％CI:1.49～ 2.81,P＜0.001),而吸烟则可明显增加男性罹患CHD的风险(OR=9.27,95％CI:7.68～11.19,P＜0.001).(3)随着年龄增长,女性患者冠脉病变支数增加,血管狭窄程度加重;而男性冠脉病变程度无随年龄增长而变化的趋势.结论 不同性别的CHD患者在不同年龄段具有不同的危险因素和冠脉病变特点.糖尿病和血脂异常似对女性冠脉病变的影响较大,而吸烟则对男性影响较大.     

The joint impact of family history of myocardial infarction and other risk factors on 12-year coronary heart disease mortality.

We investigated the impact of family history of myocardial infarction on 12-year coronary heart disease mortality. Men and women with a family history had an increased risk for coronary heart disease death, irrespective of other risk factors (RR = 1.58; 95% CI = 1.17-2.13 and RR = 2.12; 95% CI = 1.11-4.05, respectively). Women with a family history seemed to be more susceptible to the detrimental effects of smoking; not to the effects of other risk factors. We found no effect modification by family history in men.     

Family history and the risk of coronary heart disease: comparing predictive models

Family history is commonly used when evaluating coronary heart disease (CHD) risk yet it is usually treated as a simple binary variable according to the occurrence or non-occurrence of disease. This definition however fails to consider the potential components of a family history which may in fact exert different degrees of influence on the overall risk profile. The purpose of this paper is to compare different predictive models for CHD which incorporate family history as either a binary variable or different types of family risk indices in terms of their predictive ability. Models for estimating CHD risk were constructed based on usual risk factors and different family history variables. This construction was accomplished using logistic regression and RECursive Partition and AMalgamation (RECPAM) trees. Our analyses demonstrate the importance of using more sophisticated definitions of family history variables compared to a simple binary approach since this leads to a significant improvement in the predictive ability of CHD risk models.     

绝经前后不同年龄冠心病患者危险因素及冠状动脉病变特征的差异

目的探讨绝经前后不同年龄冠心病患者危险因素及冠状动脉病变特征的差异。方法选取2009年1月-2015年8月经冠状动脉造影确诊冠心病患者(至少有1支主要冠状动脉狭窄程度≥50%)87例,分为未绝经冠心病组(19例),绝经时间≤10年冠心病组35例,绝经时间10年冠心病组33例,进行对比分析。结果 1各组比较除体重指数和吸烟外,其余各指标均有统计学意义,其中未绝经组患者冠心病家族史、糖尿病及结缔组织病发生率最高;随着年龄的增加,各组高血压及高血脂的发生率逐渐升高;5例甲状腺功能低下患者均发生在绝经时间10年的冠心病组。2各组患者临床心绞痛多不典型,以稳定型心绞痛及急性冠脉综合征为临床表现的患者比例无统计学意义(P0.05),但在冠状动脉病变特征上各组存在统计学意义,其中未绝经冠心病组及绝经时间≤10年组冠状动脉病变以单支病变为主,绝经10年组冠状动脉病变组以多支病变为主,组间比较均有统计学意义(P0.05)。结论绝经前后冠心病患者的危险因素及冠状动脉病变特征存在差异,在临床可采取有效针对性的干预措施,及早诊治。     

Assessing family history of heart disease in primary care consultations: a qualitative study

BACKGROUND: Current primary prevention guidelines recommend the assessment of family history of coronary heart disease (CHD) to identify at-risk individuals. OBJECTIVE: To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care. METHODS: A qualitative study. Patients completed a validated family history questionnaire. Consultations with clinicians were video recorded, and semi-structured interviews conducted with patients after consultation. The participants were 21 primary care patients and seven primary care clinicians (two practice nurses, five GPs). Four practices in South West England. RESULTS: Patients and clinicians usually agreed about the patient's level of risk and how to reduce it. Patients were mostly satisfied with their consultations and having their family history assessed. However, three issues were identified from the consultations which contributed to concerns and unanswered questions for patients. Problems arose when there were few modifiable risk factors to address. Firstly, patients' explanations of their family history were not explored in the consultation. Secondly, the relationship between the patient's family history and their other risk factors, such as smoking or cholesterol, was rarely discussed. Thirdly, clinicians did not explain the integration of family history into the patient's overall cardiovascular disease risk. CONCLUSIONS: Clinicians appeared to lack a rhetoric to discuss family history, in terms of capturing both genetic and environmental factors and its relation to other risk factors. This created uncertainties for patients and carries potential clinical and social implications. There is a need for better guidance for primary care clinicians about family history assessment.     

Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care: ADDFAM study protocol

Background  

Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) records. Primary prevention of CHD through lifestyle advice has sometimes yielded modest results although, for example, behavioural interventions targeted at "at risk" patients have produced encouraging findings. A family history approach, targeted at those requesting CHD assessment, could motivate lifestyle change. The project will assess the clinical value of incorporating systematic family history information into CHD risk assessment in primary care, from the perspective of the users of this service, the health care practitioners providing this service, and the National Health Service.     

A prospective study of parental history of myocardial infarction and coronary heart disease in women

Among 121,964 women aged 30-55 years in 1976, 117,156 who were initially free from coronary heart disease provided information on a number of coronary risk factors including parental history of myocardial infarction and were followed prospectively. In 1976, 31,101 (26.5%) reported that at least one parent had suffered a myocardial infarction. Questionnaires in 1978 and 1980 identified women who had developed nonfatal myocardial infarction (n = 132) and angina pectoris (n = 101). Fatal coronary heart disease cases (n = 42) were ascertained by searches of state vital records. The age-adjusted relative risk of nonfatal myocardial infarction for women with a parental history of myocardial infarction less than or equal to 60 years of age compared with women with no family history was 2.8 (95% confidence limits (CL) 1.8, 4.3). For those with a parental history of myocardial infarction greater than 60 years of age, the age-adjusted relative risk of nonfatal myocardial infarction was 1.0 (CL 0.5, 1.8). The age-adjusted relative risks of fatal coronary heart disease were 5.0 (CL 2.7, 9.2) for parental history before age 61 and 2.6 (CL 1.1, 5.8) for parental history after age 60. The corresponding relative risks of angina pectoris were 3.4 (CL 2.2, 5.2) and 1.9 (CL 1.2, 3.2), respectively. These associations were only slightly altered by adjustment for history of hypertension, diabetes, high cholesterol, use of oral contraceptives, menopause, postmenopausal hormone use, obesity, or smoking, in individual stratified analysis or in multivariate analyses. These data support the hypothesis that parental history of myocardial infarction has an independent effect on risk that is not explained solely by individual risk factors.