title: Patients with premature cardiovascular disease and a positive family history for cardiovascular disease are prone to recurrent events.
abstract: BACKGROUND
  Premature cardiovascular disease (CVD) is treated in the same way as CVD of advanced age. However, in patients with premature CVD and a family history of CVD, different -possibly genetic- mechanisms may underlie this disease, which current medical treatment is not targeted to. This suggests that subjects with a genetic predisposition to CVD are more likely to have recurrent cardiovascular events.
  
  
  METHODS
  We retrospectively investigated 291 patients with premature CVD and assessed the amount of recurrent events according to family history in a follow-up period of 31 years. Premature CVD was defined as an event <51 years for men or <56 for women. We used a Cox proportional hazards model to estimate the relationship between a positive family history and recurrence of cardiovascular events.
  
  
  RESULTS
  Patients with recurrent events had more often a positive family history (60.0% vs. 47.1%; p<0.05), were more often smokers (85.2% vs. 70.7%; p<0.05), had more often hypertension (36.3% vs. 23.6%; p<0.05) and had a longer follow-up period (10.0 years vs. 5.4 years; p<0.001) than patients without recurrent events. After adjusting for these differences and modelling time to events, a positive family history was independently associated with recurrent events (Hazard ratio 1.31 (95% confidence intervals (CI) 1.01-1.72; p<0.05)).
  
  
  CONCLUSIONS
  Patients with a genetic predisposition for CVD are at risk for recurrent events, after adjusting for risk factors and other confounders. This might imply that in subjects with a genetic predisposition for CVD different pathophysiological mechanisms are active, leading to recurrent events.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, Subdivision of Vascular Medicine, University Medical Centre Maastricht, The Netherlands.
authors.forename: Ties A
authors.initials: TA
authors.lastname: Mulders
authors.forename: Zainna
authors.initials: Z
authors.lastname: Meyer
authors.forename: Christel
authors.initials: C
authors.lastname: van der Donk
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferreira
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: Sara-Joan
authors.initials: SJ
authors.lastname: Pinto-Sietsma
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies