Family history of vascular disease and the risk of cardiovascular events

Abstract

A positive family history of cardiovascular disease is an established risk factor for the development of cardiovascular disease. In clinical practice, this evident relation between the presence of cardiovascular disease in families and first cardiovascular events has resulted in family history being an integral part of a patient’s medical history. However, in cardiovascular risk prediction models, family history of cardiovascular disease is undervalued. In the present thesis it was demonstrated that offspring of patients at increased vascular risk (presence of cardiovascular risk factors or established vascular disease) have a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus at young age compared with the general population. This demonstrates the importance of family history from a young age already. In European and American cardiovascular guidelines, no strict definition of a positive family history is used. In this thesis it was demonstrated that there is no difference in vascular risk in offspring having a father with vascular disease or a mother with vascular disease and therefore in family history inquiry no distinction has to be made whether the affected parent is the mother or the father. The location of vascular disease of the affected family member should be taken into account as it was demonstrated that offspring of patients with established peripheral artery disease have a higher risk of developing cardiovascular disease than offspring of patients with cerebrovascular disease and coronary artery disease. In patients with established vascular disease, the clinical value of family history in risk assessment is not as clear as for patients without vascular disease, since the risk for subsequent vascular events did not increase for the majority of patients with vascular disease having a positive parental or sibling history. This is different for having a child with vascular disease or risk factors. Currently, it is not standard in clinical practice to also assess the presence of vascular disease in offspring, probably because offspring are considered too young to have developed cardiovascular disease yet. However, the risk of developing new or subsequent vascular events more than tripled in patients at increased vascular risk having offspring with vascular disease or risk factors (especially diabetes mellitus) compared with patients at increased vascular risk without affected offspring. This positive offspring history may be interpreted as a proxy of the genetic base of the parent and of the degree of exposure to (unknown) risk factors. Although family history assessment towards children of patients is a new approach, substantial increased risks are observed and increasing awareness of this approach by physicians may influence further differentiation in therapy. Since gathering information regarding the offspring’s health is easy to add as part of a patient’s (family history), it can easily be implemented in clinical practice.