title: Significance of a positive family history for coronary heart disease in patients with a zero coronary artery calcium score (from the Multi-Ethnic Study of Atherosclerosis).
abstract: Although a coronary artery calcium (CAC) score of 0 is associated with a very low 10-year risk for cardiac events, this risk is nonzero. Subjects with a family history of coronary heart disease (CHD) has been associated with more subclinical atherosclerosis than subjects without a family history of CHD. The purpose of this study was to assess the significance of a family history for CHD in subjects with a CAC score of 0. The Multi-Ethnic Study of Atherosclerosis cohort includes 6,814 participants free of clinical cardiovascular disease (CVD) at baseline. Positive family history was defined as reporting a parent, sibling, or child who had a heart attack. Time to incident CHD or CVD event was modeled using the multivariable Cox regression; 3,185 subjects were identified from the original Multi-Ethnic Study of Atherosclerosis cohort as having a baseline CAC score of 0 (mean age 58 years, 37% men). Over a median follow-up of 10 years, 101 participants (3.2%) had CVD events and 56 (1.8%) had CHD events. In age- and gender-adjusted analyses, a family history of CHD was associated with an ∼70% increase in CVD (hazard ratio 1.73, 95% confidence interval 1.17 to 2.56) and CHD (hazard ratio 1.72, 95% confidence interval 1.01 to 2.91) events. CVD events remained significant after further adjustment for ethnicity, risk factors, and baseline medication use. In conclusion, asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family history of CHD, although absolute event rates remain low.
authors.affiliation: Division of Cardiology, Mt. Sinai St. Luke's-Roosevelt Hospital, New York, New York. Electronic address: racohen@chpnet.org.
authors.forename: Randy
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Center, Torrence, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sillau
authors.affiliation: Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Gregory
authors.initials: G
authors.lastname: Burke
authors.affiliation: Ciccarone Preventive Cardiology Center, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Blaha
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Department of Cardiology, Morristown Medical Center, Morristown, New Jersey.
authors.forename: Seth
authors.initials: S
authors.lastname: Uretsky
authors.affiliation: Division of Cardiology, Mt. Sinai St. Luke's-Roosevelt Hospital, New York, New York.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.affiliation: Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Columbia University, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000208:ethnology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000208:ethnology*; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000208:ethnology*; D003331:Coronary Vessels / Q000378:metabolism*; D005006:Ethnicity; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D002118:Calcium