"Treatment decisions are often difficult in patients with intermediate CHD risk, such as those patients with borderline hypertension or borderline elevated lipid levels," said Kristina Sundquist, MD, PhD, assistant professor at the Karolinska Institute's Center for Family Medicine in Stockholm, Sweden. "Current risk assessments mention family history of CHD, but do not necessarily take into account the sex of the parent or if both parents have the disease. We wanted to discover another piece of evidence that can help determine which of these intermediate patients are at high risk."
Dr. Sundquist presented these findings today at an American Medical Association media briefing, Cardiovascular Disease, in New York City.
Dr. Sundquist and her colleagues created a database using Swedish government-based statistics from the Multigeneration Register, National Census Data, Cause of Death Register and Swedish Hospital Discharge Register. This vast amount of information allowed them to track all Swedish men and women born since 1932, their registered parents, CHD-related hospital admissions and CHD deaths. The final result was a database consisting of 10,946 male cases and 3,281 female cases with a mother and/or father with CHD.
Researchers compared the number of CHD patients with parental history of disease to the number of CHD patients with no parental history of the disease. Because the dataset was so large, they were also able to stratify analysis by age, gender, occupational status and region.
Men had a 55 percent greater risk of developing disease if they had a maternal history of CHD and a 41 percent greater risk if they had a paternal history of CHD, than those male patients with no familial history. The risk more than doubled if both parents had the disease.
The percentages were similar in women, said Dr. Sundquist. "Maternal transmission of CHD was stronger than paternal transmission in women, as well--43 percent vs. 17 percent, respectively. The risk if both parents had CHD was 82 percent. We were also able to determine that affected male and female patients who had parents with premature CHD--before age 55 in men and before age 65 in women--were more likely to get CHD."
The differences in percentages between men and women were not fully explained in the study; it is likely a result of the basic differences between men and women, she said. However, Dr. Sundquist hypothesizes that the increased transmission from mothers may be due to risky habits and behaviors. "Children tend to spend more time with their mothers than their fathers. Therefore, they may be more likely to pick up their mother's bad habits, including physical inactivity, smoking and a poor diet. It has been well established that each of these behaviors puts one at greater risk for disease."
"These findings indicate that patients with intermediate CHD risk and maternal presence of CHD or CHD in both parents should be treated more aggressively, because they are at a greater risk," explained Dr. Sundquist. "The patient and physician can work together to determine whether either medication, intervention or lifestyle change is the correct approach to combating each individual's risk."
Editor's Note: Dr. Sundquist has no financial interests, arrangements, nor affiliations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation to disclose. Dr. Sundquist has received an honorarium from the American Medical Association to speak at today's conference.
Journal
American Journal of Preventive Medicine