title: Family history: impact on coronary heart disease risk assessment beyond guideline-defined factors.
abstract: OBJECTIVE
  Family history (FH) provides insights into the effects of shared genomic susceptibilities, environments and behaviors, making it a potentially valuable risk assessment tool for chronic diseases. We assessed whether coronary heart disease (CHD) risk assessment is improved when FH information is added to other clinical information recommended in guidelines.
  
  
  METHODS
  We applied logistic regression analyses to cross-sectional data originally obtained from a UK study of women who delivered a live-born infant between 1951 and 1970. We developed 3 models: Model 1 included only the covariates in a guideline applicable to the population, Model 2 added FH to Model 1, and Model 3 included a fuller range of risk factors. For each model, its ability to discriminate between study subjects with and those without CHD was evaluated and its impact on risk classification examined using the net reclassification index.
  
  
  RESULTS
  FH was an independent risk factor for CHD (odds ratio = 1.7, 95% confidence interval = 1.26-2.47) and improved discrimination beyond guideline-defined clinical factors (p < 0.0006). However, the difference in the area under the curve of 2.8% and the extent of patient reclassification resulting from the inclusion of FH were small (p = 0.11).
  
  
  CONCLUSIONS
  While FH were a significant independent risk factor for CHD, it added little to risk factors typically included in guidelines.
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont., Canada.
authors.forename: Q
authors.initials: Q
authors.lastname: Hasanaj
authors.forename: B J
authors.initials: BJ
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Little
authors.forename: Z
authors.initials: Z
authors.lastname: Montazeri
authors.forename: J C
authors.initials: JC
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000175:diagnosis / Q000235:genetics*; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom; D055815:Young Adult