HISTÓRIA FAMILIAR E RISCO CARDIOVASCULAR

Family history

Family history is an independent risk factor for CHD, particularly among younger individuals with a family history of premature disease. The definition of what constitutes a family history of premature atherosclerosis has been somewhat variable in different studies. However, there is general agreement that a myocardial infarction (MI) or death from CHD in a first degree relative (ie, parent or sibling) prior to age 50 (males) or 60 (females) denotes a significant family history. A wider definition of a significant family history of CVD might also include other manifestations of atherosclerosis beyond MI or CHD death, including stroke or transient ischemic attack, CHD requiring revascularization in the absence of MI, peripheral artery disease, and abdominal aortic aneurysm.

The importance of a family history of premature CVD death appears to be magnified in families with multiple premature deaths. Using data from the Danish Family Relations Database (3,985,301 persons born between 1950 and 2008 followed for nearly 90 million person-years), persons from families with two or more premature cardiovascular deaths among first-degree relatives had a threefold greater risk of developing CVD before age 50 (incidence risk ratio 3.30, 95% CI 2.77-3.94). Similar findings have been noted among 185,810 cases of hospitalization or death due to CHD in the Swedish Multi-Generation Registry, in which the risk of hospitalization or death due to CHD was increased six- to sevenfold in persons with two or three siblings with CHD.

Despite multiple studies showing that family history of CHD in a first degree relative increases one's risk of developing CHD, the incremental predictive value of adding family history to an established risk score appears to be small, ranging from 2 to 5 percent upward reclassification of risk. In the EPIC-Norfolk prospective cohort of 22,841 patients (45 percent male) aged 40 to 79 years who were followed for a mean of 10.9 years, a family history of CHD in a first degree relative was significantly associated with increased risk of future CHD independent of the Framingham Risk Score (FRS) estimate (adjusted HR 1.74, 95% CI 1.56-1.95). Despite this significant increased risk, the addition of family history to the FRS estimate resulted in minimal reclassification of patients into different risk groups (only 2 percent of patients deemed intermediate risk by FRS were reclassified to high risk because of family history).

Referência: UpToDate - Overview of the risk equivalents and established risk factors for cardiovascular disease