Family history (FHx) of premature coronary artery disease (CAD) is a risk factor for
development of incident cardiovascular disease. However the association between FHx
and outcomes in patients with established CAD is unclear. We followed 84,373 patients
with angiographic CAD enrolled in the inclusive Alberta Provincial Project for Outcomes
Assessment in Coronary Heart Disease registry between April 2002 and March 2013. Overall,
25,566 (30%) self-reported an FHx of CAD, defined as a first-degree relative with
premature CAD (men, age <55 years; women, age <65 years). We tested the association
between FHx and all-cause mortality using multivariable Cox proportional hazards regression.
After adjusting for baseline differences in clinical characteristics, indication,
and extent of CAD, FHx was associated with reduced all-cause mortality over a median
5.6 years in follow-up (hazard ratio [HR] 0.77 [95% CI 0.73 to 0.80]). The magnitude
of this protective association was weaker in those with versus without a previous
myocardial infarction (HR 0.87 [95% CI 0.81 to 0.93] versus 0.72 [0.69 to 0.76], interaction
p <0.0001) and slightly stronger in those presenting with versus without an acute
coronary syndrome (HR 0.74 [0.70 to 0.79] versus 0.80 [0.75 to 0.85], interaction
p = 0.08). There was attenuation of association with increasing age, but FHx remained
protective even in those aged older than 80 years (HR 0.86 [0.77 to 0.95]). In conclusion,
in patients with angiographic CAD, self-reported FHx of premature CAD is associated
with improved long-term survival rate, independent of clinical characteristics, mode
of presentation, and extent of disease. Further investigation of potential patient-
and system-level mediators of this seemingly paradoxical relation is required.
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Article info
Publication history
Published online: November 17, 2015
Accepted:
November 3,
2015
Received in revised form:
November 3,
2015
Received:
September 2,
2015
Footnotes
See page 357 for disclosure information.
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Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
