title: A positive family history for premature cardiovascular disease identifies patients prone to recurrent arterial thrombotic events.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is characterized by slow progressive atherosclerosis and arterial thrombotic events, leading to occlusions. Whether either of these presentations is more likely in patients with a genetic predisposition for CVD is still unknown. We suggest that a genetic predisposition for CVD is related to recurrent events of the same nature.
  
  
  METHODS
  We retrospectively investigated 275 patients with premature CVD and divided them in two groups according to their first event: an arterial thrombotic event or stable atherosclerosis. We used a Cox proportional-hazards model to estimate the effect of a positive family history for CVD on recurrent events of the same nature. This was tested in the entire cohort and in patients with coronary artery disease only.
  
  
  RESULTS
  Patients with a first arterial thrombotic event and a positive family history had a threefold increased risk for a recurrent event of the same nature, compared to patients with a negative family history (hazard ratio 3.00, 95% confidence interval 1.32-6.81); p < 0.05). In contrast, a positive family history was not associated with an increased risk for a recurrent stable atherosclerosis (hazard ratio 0.98 (95% confidence interval 0.59-1.63). These findings were similar analysing the patients with coronary artery disease only. Additional adjustments for other risk factors did not change these associations.
  
  
  CONCLUSIONS
  Patients with a first premature arterial thrombotic event and a positive family history for CVD have an increased risk for a second event of the same nature. This might be due to unknown hereditary mechanisms leading to recurrent acute events.
authors.affiliation: University Medical Centre, Maastricht, The Netherlands.
authors.forename: Ties A
authors.initials: TA
authors.lastname: Mulders
authors.forename: Lisbeth F A
authors.initials: LF
authors.lastname: Maurissen
authors.forename: Zainna
authors.initials: Z
authors.lastname: Meyer
authors.forename: Marijn
authors.initials: M
authors.lastname: Hameeteman
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: Tilman M
authors.initials: TM
authors.lastname: Hackeng
authors.forename: Sara-Joan
authors.initials: SJ
authors.lastname: Pinto-Sietsma
mesh_terms: D000328:Adult; D017668:Age of Onset; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D050197:Atherosclerosis / Q000453:epidemiology / Q000235:genetics; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000235:genetics; D018572:Disease-Free Survival; D005260:Female; D020022:Genetic Predisposition to Disease; D040941:Heredity; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010375:Pedigree; D010641:Phenotype; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*