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Rasooly D, Moonesinghe R, Littrell K, Hull L, Khoury MJ. Association Between a First-Degree Family History and Self-Reported Personal History of Obesity, Diabetes, and Heart and Blood Conditions: Results From the All of Us Research Program. J Am Heart Assoc 2023; 12:e030779. [PMID: 37947093 PMCID: PMC10727309 DOI: 10.1161/jaha.123.030779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Family history reflects the complex interplay of genetic susceptibility and shared environmental exposures and is an important risk factor for obesity, diabetes, and heart and blood conditions (ODHB). However, the overlap in family history associations between various ODHBs has not been quantified. METHODS AND RESULTS We assessed the association between a self-reported family history of ODHBs and their risk in the adult population (age ≥20 years) of the AoU (All of Us) Research Program, a longitudinal cohort study of diverse participants across the United States. We conducted a family history-wide association study to systematically assess the association of a first-degree family history of 15 ODHBs in AoU. We performed stratified analyses based on racial and ethnic categories, education, household income and gender minority status, and quantified associations by type of affected relatives. Of 125 430 participants, 76.8% reported a first-degree family history of any ODHB, most commonly hypertension (n=64 982, 51.8%), high cholesterol (49 753, 39.7%), and heart attack (29 618, 23.6%). We use the FamWAS method to estimate 225 familial associations among 15 ODHBs. The results include overlapping associations between family history of different types of cardiometabolic conditions (such as type 2 diabetes and coronary artery disease), and their risk factors (obesity, hypertension), where adults with a family history of 1 ODHB exhibited 1.1 to 5.6 times (1.5, on average) the odds of having a different ODHB. CONCLUSIONS Our findings inform the utility of family history data as a risk assessment and screening tool for the prevention of ODHBs and to provide additional insights into shared risk factors and pathogenic mechanisms.
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Affiliation(s)
- Danielle Rasooly
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Ramal Moonesinghe
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kevin Littrell
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Muin J. Khoury
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
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Mayerhofer E, Parodi L, Narasimhalu K, Harloff A, Georgakis MK, Rosand J, Anderson CD. Genetic and Nongenetic Components of Stroke Family History: A Population Study of Adopted and Nonadopted Individuals. J Am Heart Assoc 2023; 12:e031566. [PMID: 37830349 PMCID: PMC10757525 DOI: 10.1161/jaha.123.031566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Background Genetic and nongenetic factors account for the association of family history with disease risk. Comparing adopted and nonadopted individuals provides an opportunity to disentangle those factors. Methods and Results We examined associations between family history of stroke and heart disease with incident stroke and myocardial infarction (MI) in 495 640 UK Biobank participants (mean age, 56.5 years; 55% women) stratified by childhood adoption status (5747 adoptees). We estimated hazard ratios (HRs) per affected family member, and for polygenic risk scores in Cox models adjusted for baseline age and sex. A total of 12 518 strokes and 23 923 MIs occurred over a 13-year follow-up. In nonadoptees, family history of stroke and heart disease was associated with increased stroke and MI risk, with the strongest association of family history of stroke for incident stroke (HR, 1.16 [95% CI, 1.12-1.19]) and family history of heart disease for incident MI (HR, 1.48 [95% CI, 1.45-1.50]). In adoptees, family history of stroke associated with incident stroke (HR, 1.41 [95% CI, 1.06-1.86]), but family history of heart disease was not associated with incident MI (P>0.5). Polygenic risk scores showed strong disease-specific associations in both groups. In nonadoptees, the stroke polygenic risk score mediated 6% risk between family history of stroke and incident stroke, and the MI polygenic risk score mediated 13% risk between family history of heart disease and incident MI. Conclusions Family history of stroke and heart disease increases risk for their respective conditions. Family history of stroke contains substantial potentially modifiable nongenetic risk, indicating a need for novel prevention strategies, whereas family history of heart disease represents predominantly genetic risk.
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Affiliation(s)
- Ernst Mayerhofer
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Livia Parodi
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
- Department of NeurologyBrigham and Women’s HospitalBostonMA
| | - Kaavya Narasimhalu
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center–University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Marios K. Georgakis
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
- Institute for Stroke and Dementia ResearchUniversity Hospital, Ludwig‐Maximilians‐University MunichMunichGermany
| | - Jonathan Rosand
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
| | - Christopher D. Anderson
- Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Medical and Population GeneticsBroad Institute of Harvard and the Massachusetts Institute of TechnologyCambridgeMA
- McCance Center for Brain HealthMassachusetts General HospitalBostonMA
- Department of NeurologyBrigham and Women’s HospitalBostonMA
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Mayerhofer E, Parodi L, Narasimhalu K, Harloff A, Georgakis MK, Rosand J, Anderson CD. Genetic and non-genetic components of family history of stroke and heart disease: a population-based study among adopted and non-adopted individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.28.23290649. [PMID: 37398414 PMCID: PMC10312864 DOI: 10.1101/2023.05.28.23290649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background It is increasingly clear that genetic and non-genetic factors account for the association of family history with disease risk in offspring. We sought to distinguish the genetic and non-genetic contributions of family history of stroke and heart disease on incident events by examining adopted and non-adopted individuals. Methods We examined associations between family history of stroke and heart disease with incident stroke and myocardial infarction (MI) in 495,640 participants of the UK Biobank (mean age 56.5 years, 55% female) stratified by early childhood adoption status into adoptees (n=5,747) and non-adoptees (n=489,893). We estimated hazard ratios (HRs) per affected nuclear family member, and for polygenic risk scores (PRS) for stroke and MI in Cox models adjusted for baseline age and sex. Results 12,518 strokes and 23,923 MIs occurred over a 13-year follow-up. In non-adoptees, family history of stroke and heart disease were associated with increased stroke and MI risk, with the strongest association of family history of stroke for incident stroke (HR 1.16 [1.12, 1.19]) and family history of heart disease for incident MI (HR 1.48 [1.45, 1.50]). In adoptees, family history of stroke associated with incident stroke (HR 1.41 [1.06, 1.86]), but family history of heart disease did not associate with incident MI (p>0.5). PRS showed strong disease-specific associations in adoptees and non-adoptees. In non-adoptees, the stroke PRS mediated 6% risk between family history of stroke and incident stroke, and the MI PRS mediated 13% risk between family history of heart disease and MI. Conclusions Family history of stroke and heart disease increase risk for their respective conditions. Family history of stroke contains a substantial proportion of potentially modifiable non-genetic risk, indicating a need for further research to elucidate these elements for novel prevention strategies, whereas family history of heart disease represents predominantly genetic risk.
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Miroševič Š, Klemenc-Ketiš Z, Peterlin B. Family history tools for primary care: A systematic review. Eur J Gen Pract 2022; 28:75-86. [PMID: 35510897 PMCID: PMC9090347 DOI: 10.1080/13814788.2022.2061457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Many medical family history (FH) tools are available for various settings. Although FH tools can be a powerful health screening tool in primary care (PC), they are currently underused. Objectives This review explores the FH tools currently available for PC and evaluates their clinical performance. Methods Five databases were systematically searched until May 2021. Identified tools were evaluated on the following criteria: time-to-complete, integration with electronic health record (EMR) systems, patient administration, risk-assessment ability, evidence-based management recommendations, analytical and clinical validity and clinical utility. Results We identified 26 PC FH tools. Analytical and clinical validity was poorly reported and agreement between FH and gold standard was commonly inadequately reported and assessed. Sensitivity was acceptable; specificity was found in half of the reviewed tools to be poor. Most reviewed tools showed a capacity to successfully identify individuals with increased risk of disease (6.2–84.6% of high and/or moderate or increased risk individuals). Conclusion Despite the potential of FH tools to improve risk stratification of patients in PC, clinical performance of current tools remains limited as well as their integration in EMR systems. Twenty-one FH tools are designed to be self-administered by patients.
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Affiliation(s)
- Špela Miroševič
- Department of Family Medicine, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical Faculty Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Association between a polygenic and family risk score on the prevalence and incidence of myocardial infarction in the KORA-F3 study. Atherosclerosis 2022; 352:10-17. [DOI: 10.1016/j.atherosclerosis.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
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Andreotti F, Crea F, Patti G, Shoulders CC, Navarese EP, Robishaw J, Maseri A, Hennekens CH. Family history in first degree relatives of patients with premature cardiovascular disease. Int J Cardiol 2021; 333:215-218. [PMID: 33737169 DOI: 10.1016/j.ijcard.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Family history (FH) of cardiovascular disease (CVD) in first degree relatives (FDR) is a major risk factor, especially for premature events. Data are sparse on FH of different manifestations of CVD among FDRs of patients with premature myocardial infarction (MI), chronic stable angina (CSA) or peripheral vascular disease (PVD). METHODS We obtained FHs from first degree relatives (parents or siblings) of 230 consecutive patients with premature (men < 60 and women < 65 years) CVD, including 79 wth MI, 39 CSA, 51 PVD and 61 blood donors. Among 1225 parents or siblings, 421 had MI, 222 CSA, 261PVD and 321 were among blood donors. RESULTS FH of MI were 5.6% (18/321) among blood donors, 14.0% (59/421) among patients with premature MI, 14.4% (32/222) CSA, and 8.0% (21/261) PVD. (all p < 0.05). For FH of CSA the corresponding frequencies were 3.7% 5.2%, 11.3%, and 6.9%. (all p < 0.05). For PVD, the corresponding frequencies were 2.1%, 3.4%, 0.9% and 0.7%, respectively. (p = ns). CONCLUSIONS These data are compatible with the hypothesis that FH of MI, CSA and PVD are significantly different for patients with premature MI or CSA but not PVD.
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Affiliation(s)
- Felicita Andreotti
- Dept of Cardiovascular Sciences, Catholic University Hospital, Scientific Directorate, FPUG IRCCS, Rome, Italy.
| | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, FPUG IRCCS, Rome, Italy.
| | - Giuseppe Patti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
| | | | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Janet Robishaw
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
| | - Attilio Maseri
- Fondazione per il Tuo Cuore, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy.
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
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Bylstra Y, Lim WK, Kam S, Tham KW, Wu RR, Teo JX, Davila S, Kuan JL, Chan SH, Bertin N, Yang CX, Rozen S, Teh BT, Yeo KK, Cook SA, Jamuar SS, Ginsburg GS, Orlando LA, Tan P. Family history assessment significantly enhances delivery of precision medicine in the genomics era. Genome Med 2021; 13:3. [PMID: 33413596 PMCID: PMC7791763 DOI: 10.1186/s13073-020-00819-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Family history has traditionally been an essential part of clinical care to assess health risks. However, declining sequencing costs have precipitated a shift towards genomics-first approaches in population screening programs rendering the value of family history unknown. We evaluated the utility of incorporating family history information for genomic sequencing selection. METHODS To ascertain the relationship between family histories on such population-level initiatives, we analysed whole genome sequences of 1750 research participants with no known pre-existing conditions, of which half received comprehensive family history assessment of up to four generations, focusing on 95 cancer genes. RESULTS Amongst the 1750 participants, 866 (49.5%) had high-quality standardised family history available. Within this group, 73 (8.4%) participants had an increased family history risk of cancer (increased FH risk cohort) and 1 in 7 participants (n = 10/73) carried a clinically actionable variant inferring a sixfold increase compared with 1 in 47 participants (n = 17/793) assessed at average family history cancer risk (average FH risk cohort) (p = 0.00001) and a sevenfold increase compared to 1 in 52 participants (n = 17/884) where family history was not available (FH not available cohort) (p = 0.00001). The enrichment was further pronounced (up to 18-fold) when assessing only the 25 cancer genes in the American College of Medical Genetics (ACMG) Secondary Findings (SF) genes. Furthermore, 63 (7.3%) participants had an increased family history cancer risk in the absence of an apparent clinically actionable variant. CONCLUSIONS These findings demonstrate that the collection and analysis of comprehensive family history and genomic data are complementary and in combination can prioritise individuals for genomic analysis. Thus, family history remains a critical component of health risk assessment, providing important actionable data when implementing genomics screening programs. TRIAL REGISTRATION ClinicalTrials.gov NCT02791152 . Retrospectively registered on May 31, 2016.
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Affiliation(s)
- Yasmin Bylstra
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore.,SingHealth Duke-NUS Genomic Medicine Center, Singapore Health Services, Singapore, Singapore
| | - Sylvia Kam
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Koei Wan Tham
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,Department of Physiology, National University of Singapore, Singapore, Singapore
| | - R Ryanne Wu
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore
| | - Sonia Davila
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,SingHealth Duke-NUS Genomic Medicine Center, Singapore Health Services, Singapore, Singapore.,Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Jyn Ling Kuan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore
| | - Sock Hoai Chan
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Nicolas Bertin
- Centre for Big Data and Integrative Genomics, Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Cheng Xi Yang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Steve Rozen
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Bin Tean Teh
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart Alexander Cook
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Saumya Shekhar Jamuar
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore.,SingHealth Duke-NUS Genomic Medicine Center, Singapore Health Services, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lori A Orlando
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore Health Services, Singapore, Singapore. .,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore. .,Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore.
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Family history of premature myocardial infarction modifies the associations between bilateral oophorectomy and cardiovascular disease mortality in a US national cohort of postmenopausal women. Menopause 2020; 27:658-667. [PMID: 32132444 DOI: 10.1097/gme.0000000000001522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test the hypothesis that a family history of premature myocardial infarction (FHPMI) will modify the associations between bilateral salpingo-oophorectomy (BSO) and mortality due to heart disease (HD), cardiovascular disease (CVD), or all-cause mortality with stronger associations observed for BSO occurring before 45 years. METHODS We analyzed data from 2,763 postmenopausal women aged 40 years or older who participated in the National Health and Nutrition Examination Survey (1988-1994) and were followed through December 31, 2015. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes (HD, CVD, and all-cause). RESULTS At baseline, the average age was 62 years. There were 610 women with BSO, 338 women with FHPMI, and 95 women with both BSO and FHPMI. During a median follow-up of 22 years, 1,713 deaths occurred of which 395 and 542 were attributed to HD and CVD, respectively. In models adjusting for CVD risk factors and hormone therapy use, HD mortality was greater among women with both BSO and FHPMI compared to those without either of these conditions (HR: 2.88, 95% CI: 1.72-4.82, PInteraction = 0.016). HD mortality was higher among women with FHPMI and BSO at an earlier age (<45 y: HR: 4.32, 95% CI: 1.95-9.50 vs ≥45 y: HR: 1.60, 95% CI: 0.63-4.09). Similar observations were seen for CVD and all-cause mortality. CONCLUSIONS In this study, the risk of HD, CVD, and all-cause mortality in women with BSO was modified by an FHPMI with the risk limited to women undergoing BSO at younger ages.
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Ginsburg GS, Wu RR, Orlando LA. Family health history: underused for actionable risk assessment. Lancet 2019; 394:596-603. [PMID: 31395442 PMCID: PMC6822265 DOI: 10.1016/s0140-6736(19)31275-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/04/2019] [Accepted: 05/16/2019] [Indexed: 01/04/2023]
Abstract
Family health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to screening guidelines, genetic counselling, genetic risk testing, and other screening methods. Challenges to the routine acquisition of FHH include constraints on provider time to collect data and the difficulty in accessing risk calculators. Disease-specific and broader risk assessment software platforms have been developed, many with clinical decision support and informatics interoperability, but few access patient information directly. Software that allows integration of FHH with the electronic medical record and clinical decision support capabilities has provided solutions to many of these challenges. Patient facing, electronic medical record, and web-enabled FHH platforms have been developed, and can provide greater identification of risk compared with conventional FHH ascertainment in primary care. FHH, along with cascade screening, can be an important component of population health management approaches to overall reduction of risk.
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Affiliation(s)
- Geoffrey S Ginsburg
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - R Ryanne Wu
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Durham Veteran Affairs Cooperative Studies Program Epidemiology Center, Durham, NC, USA
| | - Lori A Orlando
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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10
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Rasooly D, Ioannidis JPA, Khoury MJ, Patel CJ. Family History-Wide Association Study to Identify Clinical and Environmental Risk Factors for Common Chronic Diseases. Am J Epidemiol 2019; 188:1563-1568. [PMID: 31172187 PMCID: PMC6670049 DOI: 10.1093/aje/kwz125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/15/2023] Open
Abstract
Family history is a strong risk factor for many common chronic diseases and summarizes shared environmental and genetic risk, but how this increased risk is mediated is unknown. We developed a "family history-wide association study" (FamWAS) to systematically and comprehensively test clinical and environmental quantitative traits (CEQTs) for their association with family history of disease. We implemented our method on 457 CEQTs for association with family history of diabetes, asthma, and coronary heart disease (CHD) in 42,940 adults spanning 8 waves of the 1999-2014 US National Health and Nutrition Examination Survey. We conducted pooled analyses of the 8 survey waves and analyzed trait associations using survey-weighted logistic regression. We identified 172 (37.6% of total), 32 (7.0%), and 78 (17.1%) CEQTs associated with family history of diabetes, asthma, and CHD, respectively, in subcohorts of individuals without the respective disease. Twenty associated CEQTs were shared across family history of diabetes, asthma, and CHD, far more than expected by chance. FamWAS can examine traits not previously studied in association with family history and uncover trait overlap, highlighting a putative shared mechanism by which family history influences disease risk.
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Affiliation(s)
- Danielle Rasooly
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | | | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
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11
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McAlister FA, Yan L, Roos LL, Lix LM. Parental Atrial Fibrillation and Stroke or Atrial Fibrillation in Young Adults. Stroke 2019; 50:2322-2328. [PMID: 31337299 DOI: 10.1161/strokeaha.119.025124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background and Purpose- Cryptogenic strokes are often the first clinical manifestation of undiagnosed atrial fibrillation (AF). We designed this study to test whether parental AF is a risk factor for stroke in young adults. Methods- Population-based cohort study using linked administrative databases from April 1, 1972 to March 31, 2016 in Manitoba, Canada for 325 333 offspring (age ≥18 years) with at least 1 linked parent (total 582 195 parents). We examined the association between parental history of AF and stroke or transient ischemic attack (TIA) in the offspring using multivariable Cox proportional hazards models. Results- Offspring median age at study entry was 18 years. During 5.533 million person-years of follow-up (mean 17 years), 8678 offspring had an incident stroke or TIA (5.2% of the 24 583 offspring with a parental history of AF compared with 2.5% of the 300 750 offspring with no parental history of AF), and 1430 were diagnosed with AF (1.9% versus 0.3%). Incidence rates for stroke/TIA were higher in offspring with a parental history of AF (195.0 versus 156.6 per 100 000 person-years). Parental AF was associated with elevated risk in offspring of stroke/TIA (hazard ratio 1.11; 95% CI, 1.04-1.18) or AF (hazard ratio 1.75; 95% CI, 1.55-1.97) and a higher frequency of other cardiovascular risk factors. After adjusting for demographics, region of residence, socioeconomic status, and other stroke risk factors in offspring, parental AF was associated with AF in their offspring in young adulthood (adjusted hazard ratio 1.61; 95% CI, 1.43-1.82); the association of parental AF with offspring stroke/TIA was attenuated (adjusted hazard ratio 1.05; 95% CI, 0.99-1.12) after adjusting for the other cardiovascular risk factors. Conclusions- Parental AF is associated with increased risk of AF and other cardiovascular risk factors in their offspring during early adulthood, resulting in increased stroke risk.
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Affiliation(s)
- Finlay A McAlister
- From the Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
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Moonesinghe R, Yang Q, Zhang Z, Khoury MJ. Prevalence and Cardiovascular Health Impact of Family History of Premature Heart Disease in the United States: Analysis of the National Health and Nutrition Examination Survey, 2007-2014. J Am Heart Assoc 2019; 8:e012364. [PMID: 31303097 PMCID: PMC6662130 DOI: 10.1161/jaha.119.012364] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Because family history is a known risk factor for heart disease, it is important to characterize its public health impact in terms of population prevalence of family history of heart disease, the burden of heart disease attributable to family history, and whether family history interacts with modifiable risk factors for heart disease. Methods and Results We used population data from NHANES (the National Health and Nutrition Examination Survey [2007–2014]) to measure the association of self‐reported family history of premature heart disease (FHPHD) with cardiovascular disease (n=19 253) and to examine the association between cardiovascular health metrics and FHPHD (n=16 248). Using logistic regression and multivariable adjustment, family history odds ratios were 5.91 (95% CI, 3.34–10.44) for ages 20 to 39, 3.02 (95% CI, 2.41–3.79) for ages 40 to 59, and 1.87 (95% CI, 1.54–2.28) for age ≥60 for cardiovascular disease. The prevalence of cardiovascular disease for the population with a FHPHD (15.72%; 95% CI, 13.81–17.64) was more than double the prevalence of cardiovascular disease for those without a family history (6.25%; 95% CI, 5.82–6.69). Compared with participants with optimum cardiovascular health, the prevalence ratio for FHPHD was 1.98 (95% CI, 1.40–2.79) for those with inadequate cardiovascular health. Conclusions Millions of people who are at high risk of having cardiovascular disease could be identified using FHPHD. FHPHD can become an important component of public health campaigns that address modifiable risk factors that plan to reduce the overall risk of heart disease.
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Affiliation(s)
- Ramal Moonesinghe
- 1 Office of Minority Health and Health Equity Centers for Disease Control and Prevention Atlanta GA
| | - Quanhe Yang
- 2 Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Atlanta GA
| | - Zefeng Zhang
- 2 Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Atlanta GA
| | - Muin J Khoury
- 3 Office of Public Health Genomics Centers for Disease Control and Prevention Atlanta GA
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13
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Yeung EH, Park H, Nobles C, Mumford SL, Silver R, Schisterman EF. Cardiovascular disease family history and risk of pregnancy loss. Ann Epidemiol 2019; 34:40-44. [PMID: 31076211 DOI: 10.1016/j.annepidem.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine whether family history of cardiovascular disease (CVD) is a risk factor for pregnancy loss, given potential shared etiology, including vascular mechanisms involved in reproduction and placentation. METHODS In a prospective study, first-degree family histories were self-reported before pregnancy among women with 1-2 previous losses. Women were followed for up to 6 menstrual cycles while attempting pregnancy and through pregnancy. Pregnancies were ascertained by urinary human chorionic gonadotropin and confirmed by ultrasound. Risk ratios and 95% confidence intervals for pregnancy loss were estimated using weighted Poisson regression models with robust standard errors adjusted for covariates including prepregnancy body mass index and sociodemographics. RESULTS Of 1228 women enrolled, 742 had a clinically confirmed pregnancy, and of these, 18% experienced a clinical pregnancy loss. Forty six percent of women reported family history of CVD, diabetes, hypertension, or hypercholesterolemia/dyslipidemia. Family history of CVD was not associated with the risk of pregnancy loss overall (1.01; 95% confidence interval: 0.64, 1.59) or among women with 2 previous losses (1.05; 0.51, 2.17). Family history of hypertension was also not associated with pregnancy loss (0.98; 0.65, 1.46). CONCLUSIONS Family history of CVD is not providing additional information helpful in determining the risk of subsequent pregnancy loss in an at-risk group.
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Affiliation(s)
- Edwina H Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
| | - Hyojun Park
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Robert Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City; Intermountain Healthcare, Maternal Fetal Medicine, Salt Lake City, UT
| | - Enrique F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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14
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Lin J, Myers MF, Koehly LM, Marcum CS. A Bayesian hierarchical logistic regression model of multiple informant family health histories. BMC Med Res Methodol 2019; 19:56. [PMID: 30871571 PMCID: PMC6419428 DOI: 10.1186/s12874-019-0700-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Family health history (FHH) inherently involves collecting proxy reports of health statuses of related family members. Traditionally, such information has been collected from a single informant. More recently, research has suggested that a multiple informant approach to collecting FHH results in improved individual risk assessments. Likewise, recent work has emphasized the importance of incorporating health-related behaviors into FHH-based risk calculations. Integrating both multiple accounts of FHH with behavioral information on family members represents a significant methodological challenge as such FHH data is hierarchical in nature and arises from potentially error-prone processes. Methods In this paper, we introduce a statistical model that addresses these challenges using informative priors for background variation in disease prevalence and the effect of other, potentially correlated, variables while accounting for the nested structure of these data. Our empirical example is drawn from previously published data on families with a history of diabetes. Results The results of the comparative model assessment suggest that simply accounting for the structured nature of multiple informant FHH data improves classification accuracy over the baseline and that incorporating family member health-related behavioral information into the model is preferred over alternative specifications. Conclusions The proposed modelling framework is a flexible solution to integrate multiple informant FHH for risk prediction purposes. Electronic supplementary material The online version of this article (10.1186/s12874-019-0700-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jielu Lin
- Northern Arizona University, Flagstaff, AZ, USA
| | - Melanie F Myers
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
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15
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Pape K, Svanes C, Malinovschi A, Benediktsdottir B, Lodge C, Janson C, Moratalla J, Sánchez-Ramos JL, Bråbäck L, Holm M, Jögi R, Bertelsen RJ, Sigsgaard T, Johannessen A, Schlünssen V. Agreement of offspring-reported parental smoking status: the RHINESSA generation study. BMC Public Health 2019; 19:94. [PMID: 30665381 PMCID: PMC6341700 DOI: 10.1186/s12889-019-6414-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With increasing interest in exposure effects across generations, it is crucial to assess the validity of information given on behalf of others. AIMS To compare adult's report of their parent's smoking status against parent's own report and examine predictors for discrepant answers. METHODS We studied 7185 offspring (18-51 years) and one of their parents, n = 5307 (27-67 years) participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Information about parent's smoking status during offspring's childhood and mother's smoking status during pregnancy was obtained by questionnaires from parents and their offspring. We calculated sensitivity, specificity and Cohen's Kappa [κ] for agreement using parent's own report as the gold standard. We performed logistic regression to examine if offspring's sex, age, educational level, asthma status, own smoking status or parental status, as well as the parent's sex and amount of smoking during childhood predicted disagreement. RESULTS The sensitivity for offspring's correct report of parent's smoking status during childhood (0-10 years) was 0.82 (95% CI 0.81-0.84), specificity was 0.95 (95% CI 0.95-0.96) and a good agreement was observed, κ = 0.79 (95% CI 0.78-0.80). Offspring's report of mothers' smoking status during pregnancy showed a lower sensitivity, 0.66 (95% CI 0.60-0.71), a slightly lower specificity, 0.92 (95% CI 0.90-0.95) and a good agreement, κ = 0.61 (95% CI 0.55-0.67). In multivariate logistic regression analysis, offspring not having children was a predictor for discrepant answers (odds ratio [OR] 2.11 [95% CI 1.21-3.69]). Low amount of parents' tobacco consumption, < 10 cigarettes/day (OR 2.72 [95% CI 1.71-4.31]) also predicted disagreement compared to ≥10 cigarettes per day, and so did offspring's reports of fathers' smoking status (OR 1.73 [95% CI 1.09-2.74]) compared to mothers' smoking status. Offspring's sex, asthma status, educational level, smoking status or age was not related to discrepant answers. CONCLUSIONS Adults report their parent's smoking status during their childhood, as well as their mother' smoking status when pregnant with them, quite accurately. In the absence of parents' direct report, offspring's reports could be valuable.
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Affiliation(s)
- Kathrine Pape
- Section for Environment, Occupation and Health, Department of Public Health, Aarhus University, Aarhus, Denmark. .,National Research Center for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen O, Denmark.
| | - Cecilie Svanes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Bryndis Benediktsdottir
- University of Iceland, Medical Faculty, Iceland. Primary Health Care Center, Gardabaer, Iceland
| | - Caroline Lodge
- Centre for Molecular, Environmental, Genetic & Analytic (MEGA) Epidemiology, University of Melbourne, Melbourne, Australia
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Jesus Moratalla
- Department of Internal Medicine, Albacete University Hospital, Albacete, Spain
| | | | - Lennart Bråbäck
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mathias Holm
- Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rain Jögi
- Department of Pulmonary Medicine, Tartu University, Tartu, Estonia.,Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Division of Experimental Asthma Research, University of Kiel, Kiel, Germany
| | - Randi Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torben Sigsgaard
- Section for Environment, Occupation and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ane Johannessen
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Section for Environment, Occupation and Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen O, Denmark
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16
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Hermansson J, Hallqvist J, Karlsson B, Knutsson A, Gillander Gådin K. Shift work, parental cardiovascular disease and myocardial infarction in males. Occup Med (Lond) 2019; 68:120-125. [PMID: 29444274 DOI: 10.1093/occmed/kqy008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers. Aims To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men. Methods A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI). Results There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02‒5.6 and AP = 0.4; 95% CI 0.08‒0.73]. Conclusions Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.
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Affiliation(s)
- J Hermansson
- Angereds Närsjukhus. Angered, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Hallqvist
- Department of Public Health and Caring Sciences, Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - B Karlsson
- Department of Public Health and Clinical Medicine, Occupational Medicine, University of Umeå, Umeå, Sweden
| | - A Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - K Gillander Gådin
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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17
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KOTZE LMDS, KOTZE LR, MORENO I, NISIHARA R. IMMUNE MEDIATED DISEASES IN PATIENTS WITH CELIAC DISEASE AND THEIR RELATIVES: A COMPARATIVE STUDY OF AGE AND SEX. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:346-351. [DOI: 10.1590/s0004-2803.201800000-77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/08/2018] [Indexed: 01/03/2023]
Abstract
ABSTRACT BACKGROUND: Up to 15% of other immune-mediated diseases (IMDs) can occur in patients with CD throughout their lives and are associated with multiple factors, including sex and sex hormone levels. Moreover, sex is associated with differences in clinical presentation, onset, progression, and outcomes of disorders. OBJECTIVE: To investigate the prevalence of IMDs at diagnosis in patients with celiac disease (CD) and their first-degree relatives and to compare the findings between female and male patients of different age. METHODS: A retrospective study including Brazilian patients with CD who visited the same doctor during January 2012 to January 2017 was performed. Demographic and medical history data were collected through self-administered questionnaires and medical charts of the patients. In total, 213 patients were examined at diagnosis: 52 males (mean age, 40.0 years) and 161 females (mean age, 41.4 years). The patients were divided into two groups according to sex and age. RESULTS: IMDs were observed in 60.2% of the female (97/161) and 42.3% of the male patients (22/52; P=0.22). However, the frequency of IMDs was significantly higher in females aged 51-60 years than in males with same age (P=0.0002). Dermatitis herpetiformis (DH) was significantly more prevalent in males (P=0.02), whereas atopy was more prevalent in females (P=0.02). IMDs observed in first-degree relatives were similar to those observed in patients (70.9%; P<0.001), with a higher number observed in female relatives. CONCLUSION: The frequency of IMDs in CD patients was similar in all age groups and both sexes, except women diagnosed with CD after 51 years of age presented with an increased frequency of IMDs compared with males. Dermatitis herpetiformis was more prevalent in males, whereas atopy was more prevalent in females. No difference was observed in the type of IMDs between the first-degree relatives of both sexes.
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Affiliation(s)
| | | | | | - Renato NISIHARA
- Universidade Federal do Paraná, Brazil; Universidade Positivo, Brazil
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18
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Hsu L, Gorfine M, Zucker DM. On Estimation of the Hazard Function from Population-based Case-Control Studies. J Am Stat Assoc 2018; 113:560-570. [PMID: 30906082 DOI: 10.1080/01621459.2017.1356315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The population-based case-control study design has been widely used for studying the etiology of chronic diseases. It is well established that the Cox proportional hazards model can be adapted to the case-control study and hazard ratios can be estimated by (conditional) logistic regression model with time as either a matched set or a covariate (Prentice and Breslow, 1978). However, the baseline hazard function, a critical component in absolute risk assessment, is unidentifiable, because the ratio of cases and controls is controlled by the investigators and does not reflect the true disease incidence rate in the population. In this paper we propose a simple and innovative approach, which makes use of routinely collected family history information, to estimate the baseline hazard function for any logistic regression model that is fit to the risk factor data collected on cases and controls. We establish that the proposed baseline hazard function estimator is consistent and asymptotically normal and show via simulation that it performs well in finite samples. We illustrate the proposed method by a population-based case-control study of prostate cancer where the association of various risk factors is assessed and the family history information is used to estimate the baseline hazard function.
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Affiliation(s)
- Li Hsu
- Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center
| | - Malka Gorfine
- Department of Statistics and Operations Research, Tel Aviv University
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19
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Niiranen TJ, McCabe EL, Larson MG, Henglin M, Lakdawala NK, Vasan RS, Cheng S. Risk for hypertension crosses generations in the community: a multi-generational cohort study. Eur Heart J 2018; 38:2300-2308. [PMID: 28430902 DOI: 10.1093/eurheartj/ehx134] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/28/2017] [Indexed: 01/02/2023] Open
Abstract
Aims Parental hypertension is known to predict high blood pressure (BP) in children. However, the extent to which risk for hypertension is conferred across multiple generations, notwithstanding the impact of environmental factors, is unclear. Our objective was therefore to evaluate the degree to which risk for hypertension extends across multiple generations of individuals in the community. Methods and results We studied three generations of Framingham Heart Study participants with standardized blood pressure measurements performed at serial examinations spanning 5 decades (1948 through 2005): First Generation (n = 1809), Second Generation (n = 2631), and Third Generation (n = 3608, mean age 39 years, 53% women). To capture a more precise estimate of conferrable risk, we defined early-onset hypertension (age <55 years) as the primary exposure. In multinomial logistic regression models adjusting for standard risk factors as well as physical activity and daily intake of dietary sodium, risk for hypertension in the Third Generation was conferred simultaneously by presence of early-onset hypertension in parents [OR 2.10 (95% CI, 1.66-2.67), P < 0.001] as well as in grandparents [OR 1.33 (95% CI, 1.12-1.58), P < 0.01]. Conclusion Early-onset hypertension in grandparents raises the risk for hypertension in grandchildren, even after adjusting for early-onset hypertension in parents and lifestyle factors. These results suggest that a substantial familial predisposition for hypertension exists, and this predisposition is not identical when assessed from one generation to the next. Additional studies are needed to elucidate the mechanisms underlying transgenerational risk for hypertension and its clinical implications.
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Affiliation(s)
- Teemu J Niiranen
- Department of Health, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.,National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702, USA
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Martin G Larson
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702, USA.,Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Mir Henglin
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Ramachandran S Vasan
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702, USA.,Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.,Section of Cardiology, Department of Medicine, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Susan Cheng
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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20
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Lix LM, Leslie WD, Yang S, Yan L, Walld R, Morin SN, Majumdar SR, Roos LL. Accuracy of Offspring-Reported Parental Hip Fractures: A Novel Population-Based Parent-Offspring Record Linkage Study. Am J Epidemiol 2017; 185:974-981. [PMID: 28430851 DOI: 10.1093/aje/kww197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/18/2016] [Indexed: 12/18/2022] Open
Abstract
The objective of this study was to test the validity of offspring-reported parental hip fracture in a unique bone mineral density (BMD) registry linked to administrative databases spanning 4 decades. Population-based data were from Manitoba, Canada, and included hospital abstracts, health insurance registrations, and the provincewide BMD registry. The cohort included individuals aged ≥40 years with BMD tests and self-reports of parental hip fracture between 2006 and 2014. Population registry data for 1966-2014 were used to link offspring with their parents, and hospital records were used to ascertain parental fractures. Overall, 8,112 offspring met the inclusion criteria; 13.6% had a parental hip fracture diagnosis in administrative data during an average of 32.9 years of follow-up. Agreement between parental hip fracture from offspring reports and diagnoses in administrative data was good (κ = 0.68). The sensitivity of offspring reports was 0.70 (95% confidence interval: 0.67, 0.73), and specificity was 0.96 (95% confidence interval: 0.96, 0.97). Offspring characteristics associated with disagreement included male sex, northern rural residence, early BMD test year, and longer interval between BMD test and parental hip fracture diagnosis. This proof-of-concept study focused on hip fractures, but use of record linkage techniques to validate offspring-reported parental information can be extended to other conditions.
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21
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Niiranen TJ, McCabe EL, Larson MG, Henglin M, Lakdawala NK, Vasan RS, Cheng S. Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study. BMJ 2017; 357:j1949. [PMID: 28500036 PMCID: PMC5430541 DOI: 10.1136/bmj.j1949] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death.Design Multigenerational, prospective cohort study.Setting Framingham Heart Study.Participants Two generations of community dwelling participants with blood pressure measurements performed at serial examinations spanning six decades: 3614 first generation participants with mortality data and 1635 initially non-hypertensive second generation participants with data available on parental blood pressure.Main outcome measures The main outcome measures were relation of parental early onset hypertension (age <55 years) with incidence of hypertension in offspring, using regression analyses, and relation of age at hypertension onset with cause specific mortality using a case (cardiovascular death) versus control (non-cardiovascular death) design.Results In second generation participants, having one or both parents with late onset hypertension did not increase the risk of hypertension compared with having parents with no hypertension; by contrast, the hazard ratios of hypertension were 2.0 (95% confidence interval 1.2 to 3.5) and 3.5 (1.9 to 6.1) in participants with one and both parents with early onset hypertension, respectively. In first generation decedents, 1151 cardiovascular deaths occurred (including 630 coronary deaths). The odds of cardiovascular death increased linearly with decreasing age of hypertension onset (P<0.001 for trend). Compared with non-hypertensive participants, hypertension onset at age <45 years conferred an odds ratios of 2.2 (1.8 to 2.7) for cardiovascular death and 2.3 (1.8 to 2.9) for coronary death, whereas hypertension onset at age ≥65 years conferred a lower magnitude odds ratios of 1.5 (1.2 to 1.9) for cardiovascular death and 1.4 (0.98 to 1.9) for coronary death (P≤0.002 for differences in odds ratios between hypertension onset at age <45 and age ≥65).Conclusions Early onset and not late onset hypertension in parents was strongly associated with hypertension in offspring. In turn, early onset compared with late onset hypertension was associated with greater odds of cardiovascular, and particularly coronary, death. These findings suggest it may be important to distinguish between early onset and late onset hypertension as a familial trait when assessing an individual's risk for hypertension, and as a specific type of blood pressure trait when estimating risk for cardiovascular outcomes in adults with established hypertension.
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Affiliation(s)
- Teemu J Niiranen
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Martin G Larson
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Mir Henglin
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Susan Cheng
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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22
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Lin J, Marcum CS, Myers MF, Koehly LM. Put the Family Back in Family Health History: A Multiple-Informant Approach. Am J Prev Med 2017; 52:640-644. [PMID: 28062275 PMCID: PMC5401648 DOI: 10.1016/j.amepre.2016.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/21/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION An accurate family health history is essential for individual risk assessment. This study uses a multiple-informant approach to examine whether family members have consistent perceptions of shared familial risk for four common chronic conditions (heart disease, Type 2 diabetes, high cholesterol, and hypertension) and whether accounting for inconsistency in family health history reports leads to more accurate risk assessment. METHODS In 2012-2013, individual and family health histories were collected from 127 adult informants of 45 families in the Greater Cincinnati Area. Pedigrees were linked within each family to assess inter-informant (in)consistency regarding common biological family member's health history. An adjusted risk assessment based on pooled pedigrees of multiple informants was evaluated to determine whether it could more accurately identify individuals affected by common chronic conditions, using self-reported disease diagnoses as a validation criterion. Analysis was completed in 2015-2016. RESULTS Inter-informant consistency in family health history reports was 54% for heart disease, 61% for Type 2 diabetes, 43% for high cholesterol, and 41% for hypertension. Compared with the unadjusted risk assessment, the adjusted risk assessment correctly identified an additional 7%-13% of the individuals who had been diagnosed, with a ≤2% increase in cases that were predicted to be at risk but had not been diagnosed. CONCLUSIONS Considerable inconsistency exists in individual knowledge of their family health history. Accounting for such inconsistency can, nevertheless, lead to a more accurate genetic risk assessment tool. A multiple-informant approach is potentially powerful when coupled with technology to support clinical decisions.
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Affiliation(s)
- Jielu Lin
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland.
| | - Christopher S Marcum
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Melanie F Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
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Yang S, Leslie WD, Walld R, Roos LL, Morin SN, Majumdar SR, Lix LM. Objectively-Verified Parental Non-Hip Major Osteoporotic Fractures and Offspring Osteoporotic Fracture Risk: A Population-Based Familial Linkage Study. J Bone Miner Res 2017; 32:716-721. [PMID: 27859612 DOI: 10.1002/jbmr.3035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 11/08/2022]
Abstract
Parental hip fracture (HF) is associated with increased risk of offspring major osteoporotic fractures (MOFs; comprising hip, forearm, clinical spine or humerus fracture). Whether other sites of parental fracture should be used for fracture risk assessment is uncertain. The current study tested the association between objectively-verified parental non-hip MOF and offspring incident MOF. Using population-based administrative healthcare data for the province of Manitoba, Canada, we identified 255,512 offspring with linkage to at least one parent (238,054 mothers and 209,423 fathers). Parental non-hip MOF (1984-2014) and offspring MOF (1997-2014) were ascertained with validated case definitions. Time-dependent multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). During a median of 12 years of offspring follow-up, we identified 7045 incident MOF among offspring (3.7% and 2.5% for offspring with and without a parental non-hip MOF, p < 0.001). Maternal non-hip MOF (HR 1.27; 95% CI, 1.19 to 1.35), paternal non-hip MOF (HR 1.33; 95% CI, 1.20 to 1.48), and any parental non-hip MOF (HR 1.28; 95% CI, 1.21 to 1.36) were significantly associated with offspring MOF after adjusting for covariates. The risk of MOF was even greater for offspring with both maternal and paternal non-hip MOF (adjusted HR 1.61; 95% CI, 1.27 to 2.02). All HRs were similar for male and female offspring (all pinteraction >0.1). Risks associated with parental HF only (adjusted HR 1.26; 95% CI, 1.13 to 1.40) and non-hip MOF only (adjusted HR 1.26; 95% CI, 1.18 to 1.34) were the same. The strength of association between any parental non-hip MOF and offspring MOF decreased with older parental age at non-hip MOF (ptrend = 0.028). In summary, parental non-hip MOF confers an increased risk for offspring MOF, but the strength of the relationship decreases with older parental age at fracture. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Shuman Yang
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Randy Walld
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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24
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Campbell M, Humanki J, Zierhut H. A novel approach to screening for familial hypercholesterolemia in a large public venue. J Community Genet 2017; 8:35-44. [PMID: 27889901 PMCID: PMC5222759 DOI: 10.1007/s12687-016-0285-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
The primary aim of this study was to test the feasibility of a public health screening program to identify individuals at high risk of familial hypercholesterolemia through a novel screening approach at a large public venue. A finger-prick, non-fasting lipid panel was obtained, and a survey which consisted of 44 open- and close-ended questions divided into four sections: medical and family history of FH, opinions of cascade genetic testing, patient activation, and demographics was completed. A total of 971 participants met criteria and completed a cholesterol screen. In total, five individuals met either the Simon Broome Register or the Dutch Lipid Clinic Network criteria for possible familial hypercholesterolemia. Participants were generally positive towards genetic testing, and the vast majority listed they had no barriers to communication of genetic testing information to family members. However, the most common barrier listed was lack of communication skills. Our results suggest that a public health screening program for FH is viable at a large public venue. We argue that further research is needed to expand this study to a fully operational screening program.
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Affiliation(s)
- Megan Campbell
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, 320 Church Street SE, 6-160 Jackson Hall, Minneapolis, MN, 55455, USA
| | - Jessa Humanki
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, 320 Church Street SE, 6-160 Jackson Hall, Minneapolis, MN, 55455, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, 320 Church Street SE, 6-160 Jackson Hall, Minneapolis, MN, 55455, USA.
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25
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Moon JH, Roh E, Oh TJ, Kim KM, Moon JH, Lim S, Jang HC, Choi SH. Increased risk of metabolic disorders in healthy young adults with family history of diabetes: from the Korea National Health and Nutrition Survey. Diabetol Metab Syndr 2017; 9:16. [PMID: 28265302 PMCID: PMC5333414 DOI: 10.1186/s13098-017-0210-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/03/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We assessed the impact of a family history of diabetes on type 2 diabetes, metabolic syndrome, and behavioral traits in young Korean adults. METHODS Subjects aged 25-44 years were included, and the presence of a family history of diabetes was obtained by a self-reported questionnaire (the Korea National Health and Nutrition Survey 2010). We compared the prevalence of type 2 diabetes and metabolic syndrome, and other metabolic parameters, including blood pressure and lipid profile. RESULTS Of 2059 participants, those with a family history of diabetes involving first-degree relatives (n = 489, 23.7%) had a significantly higher prevalence of impaired fasting glucose (14.3 vs. 11.7%) and type 2 diabetes (6.7 vs. 1.8%), compared to those without a family history (P < 0.001). The prevalence of metabolic syndrome (21.3 vs. 12.1%, P < 0.001) and its components (except for high-density lipoprotein cholesterol) were greater in subjects with a family history of diabetes. Among subjects exhibiting normal glucose tolerance (n = 1704), those with a family history of diabetes had higher fasting glucose (89.0 vs. 87.8 mg/dL, P < 0.001) and triglyceride (100.5 vs. 89.0 mg/dL, P < 0.001), and lower beta cell function by the homeostasis model assessment (HOMA-β; 134.2 vs. 137.5, P = 0.020). The obesity indices (body mass index, waist circumference, and triglyceride) were significantly correlated with those of both parents (P < 0.01 for all variables). Risk-reducing behavior, including regular exercise (18.2 vs. 19.7%, P = 0.469) and calorie intake (2174.8 vs. 2149.1 kcal/day, P = 0.636), did not markedly differ according to a family history of diabetes. CONCLUSIONS Young adults with a family history of diabetes had an increased risk of type 2 diabetes and metabolic syndrome, even though they currently exhibited a normal glycemic profile. Proactive lifestyle consultation is requested especially among healthy young population with a family history of diabetes.
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Affiliation(s)
- Joon Ho Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Present Address: Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 463-707 South Korea
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26
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Yang S, Leslie WD, Yan L, Walld R, Roos LL, Morin SN, Majumdar SR, Lix LM. Objectively Verified Parental Hip Fracture Is an Independent Risk Factor for Fracture: a Linkage Analysis of 478,792 Parents and 261,705 Offspring. J Bone Miner Res 2016; 31:1753-9. [PMID: 27061748 DOI: 10.1002/jbmr.2849] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/11/2022]
Abstract
Parental hip fracture (HF) is considered a major risk factor for offspring major osteoporotic fracture (MOF), but all studies to date have relied on self-reported information of uncertain accuracy. We tested the association of objectively verified parental HF with offspring MOF and HF. We used a population-based historical cohort study of 261,705 offspring (age ≥40 years) with at least one linked parent (total 478,792 parents) for the province of Manitoba, Canada. Cox proportional hazards models were developed to test hazard ratio (HR) for offspring MOF and HF for 1997 to 2014 according to prior parental HF dating back to 1970. The median age of offspring at study entry was 40 years (range, 40 to 50 years), and 48.3% were women. During 2.9 million person-years of offspring follow-up (median per offspring, 12 years), we identified 7323 incident MOF (4.4% versus 2.7% for those with and without a parental HF, p < 0.001), including 331 HF (0.3% versus 0.1%, p < 0.001). Parental HF was independently associated with increased risk of offspring MOF (HR, 1.30; 95% confidence interval [CI], 1.20 to 1.41). The strength of the association decreased with older parental age at HF (ptrend < 0.001), and was no longer significant if parental HF occurred after age 80 years (adjusted HR, 1.07; 95% CI, 0.96 to 1.19). The relationship between parental HF and offspring HF was even stronger than for MOF (adjusted HR, 1.64; 95% CI, 1.21 to 2.23). Associations with MOF or HF were not affected by either the gender of the parent with HF or the gender of the offspring. Parental HF increased the risk for offspring MOF and HF but not when parental HF occurred after age 80 years. This suggests a more nuanced approach for clinicians trying to stratify fracture risk, and illustrates the enormous potential of parent-offspring record linkage for other familial disorders. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Shuman Yang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Walld
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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27
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Giordimaina AM, Sheldon JP, Kiedrowski LA, Jayaratne TE. Searching for the Kinkeepers: Historian Gender, Age, and Type 2 Diabetes Family History. HEALTH EDUCATION & BEHAVIOR 2015; 42:736-41. [PMID: 25842388 PMCID: PMC4592797 DOI: 10.1177/1090198115578749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kinkeepers facilitate family communication and may be key to family medical history collection and dissemination. Middle-aged women are frequently kinkeepers. Using type 2 diabetes (T2DM) as a model, we explored whether the predicted gender and age effects of kinkeeping can be extended to family medical historians. Through a U.S. telephone survey, nondiabetic Mexican Americans (n = 385), Blacks (n = 387), and Whites (n = 396) reported family histories of T2DM. Negative binomial regressions used age and gender to predict the number of affected relatives reported. Models were examined for the gender gap, parabolic age effect, and gender-by-age interaction predicted by kinkeeping. Results demonstrated support for gender and parabolic age effects but only among Whites. Kinkeeping may have application to the study of White family medical historians, but not Black or Mexican American historians, perhaps because of differences in family structure, salience of T2DM, and/or gender roles.
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28
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Völzke H, Fung G, Ittermann T, Yu S, Baumeister SE, Dörr M, Lieb W, Völker U, Linneberg A, Jørgensen T, Felix SB, Rettig R, Rao B, Kroemer HK. A new, accurate predictive model for incident hypertension. J Hypertens 2015; 31:2142-50; discussion 2150. [PMID: 24077244 DOI: 10.1097/hjh.0b013e328364a16d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Data mining represents an alternative approach to identify new predictors of multifactorial diseases. This work aimed at building an accurate predictive model for incident hypertension using data mining procedures. METHODS The primary study population consisted of 1605 normotensive individuals aged 20-79 years with 5-year follow-up from the population-based study, that is the Study of Health in Pomerania (SHIP). The initial set was randomly split into a training and a testing set. We used a probabilistic graphical model applying a Bayesian network to create a predictive model for incident hypertension and compared the predictive performance with the established Framingham risk score for hypertension. Finally, the model was validated in 2887 participants from INTER99, a Danish community-based intervention study. RESULTS In the training set of SHIP data, the Bayesian network used a small subset of relevant baseline features including age, mean arterial pressure, rs16998073, serum glucose and urinary albumin concentrations. Furthermore, we detected relevant interactions between age and serum glucose as well as between rs16998073 and urinary albumin concentrations [area under the receiver operating characteristic (AUC 0.76)]. The model was confirmed in the SHIP validation set (AUC 0.78) and externally replicated in INTER99 (AUC 0.77). Compared to the established Framingham risk score for hypertension, the predictive performance of the new model was similar in the SHIP validation set and moderately better in INTER99. CONCLUSION Data mining procedures identified a predictive model for incident hypertension, which included innovative and easy-to-measure variables. The findings promise great applicability in screening settings and clinical practice.
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Affiliation(s)
- Henry Völzke
- aInstitute for Community Medicine, Ernst Moritz Arndt University, Greifswald, Germany bSiemens Healthcare, Malvern, Pennsylvania, USA cClinic of Internal Medicine B, Ernst Moritz Arndt University, Greifswald dInstitute of Epidemiology, Christian Albrechts University, Kiel eInterfaculty Institute of Functional Genomics, Ernst Moritz Arndt University, Greifswald, Germany fResearch Centre for Prevention and Health, Glostrup University Hospital, Glostrup gFaculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark hInstitute of Physiology, University Medicine, Ernst Moritz Arndt University, Greifswald iUniversity Medical Center, Göttingen, Germany *Henry Völzke and Glenn Fung contributed equally to the writing of this article
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29
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Øygarden H, Fromm A, Sand KM, Eide GE, Thomassen L, Naess H, Waje-Andreassen U. Can the cardiovascular family history reported by our patients be trusted? The Norwegian Stroke in the Young Study. Eur J Neurol 2015; 23:154-9. [PMID: 26293608 PMCID: PMC5049640 DOI: 10.1111/ene.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/02/2015] [Indexed: 11/28/2022]
Abstract
Background and purpose Family history (FH) is used as a marker for inherited risk. Using FH for this purpose requires the FH to reflect true disease in the family. The aim was to analyse the concordance between young and middle‐aged ischaemic stroke patients' reported FH of cardiovascular disease (CVD) with their parents' own reports. Methods Ischaemic stroke patients aged 15–60 years and their eligible parents were interviewed using a standardized questionnaire. Information of own CVD and FH of CVD was registered. Concordance between patients and parents was tested by kappa statistics, sensitivity, specificity, predictive values and likelihood ratios. Regression analyses were performed to identify patient characteristics associated with non‐concordance of replies. Results There was no difference in response rate between fathers and mothers (P = 0.355). Both parents responded in 57 cases. Concordance between patient and parent reports was good, with kappa values ranging from 0.57 to 0.7. The patient‐reported FH yielded positive predictive values of 75% or above and negative predictive values of 90% or higher. The positive likelihood ratios (LR+) were 10 or higher and negative likelihood ratios (LR−) were generally 0.5 or lower. Interpretation regarding peripheral arterial disease was limited due to low parental prevalence. Higher age was associated with impaired concordance between patient and parent reports (odds ratio 1.05; 95% confidence interval 1.01–1.09; P = 0.020). Conclusions The FH provided by young and middle‐aged stroke patients is in good concordance with parental reports. FH is an adequate proxy to assess inherited risk of CVD in young stroke patients.
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Affiliation(s)
- H Øygarden
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Fromm
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - K M Sand
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - G E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Lifestyle Epidemiology Research Group, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - L Thomassen
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - H Naess
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - U Waje-Andreassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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30
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Patel J, Al Rifai M, Blaha MJ, Budoff MJ, Post WS, Polak JF, Bluemke DA, Scheuner MT, Kronmal RA, Blumenthal RS, Nasir K, McEvoy JW. Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results From Multiethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015; 8:e003186. [PMID: 26047825 DOI: 10.1161/circimaging.115.003186] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prognostic value of coronary artery calcium (CAC) or carotid intima-media thickness (CIMT) among asymptomatic adults with a family history (FH) of premature coronary heart disease is unclear. METHODS AND RESULTS Multiethnic Study of Atherosclerosis enrolled 6814 adults without known atherosclerotic cardiovascular disease (ASCVD). Hard ASCVD events were ascertained over a median follow-up of 10.2 years. We estimated adjusted-hazard ratios for CAC and CIMT categories using Cox regression, both within and across FH status groups. Improvement in discrimination with CAC or CIMT added to variables from the ASCVD pooled cohort equation was also evaluated using receiver-operating characteristic curve and likelihood ratio analysis. Of 6125 individuals (62±10 years; 47% men) who reported information on FH, 1262 (21%) had an FH of premature coronary heart disease. Among these, 104 hard ASCVD events occurred. Crude incidence rates (per 1000 person-years) for hard ASCVD were 4.4 for CAC, 0 (n=574; 46% of the sample); 8.8 for CAC, 1 to 99 (n=368); 14.9 for CAC, 100 to 399 (n=178); and 20.8 for CAC, ≥400 (n=142). Relative to CAC=0, adjusted hard ASCVD hazard ratios for each CAC category among persons with an FH were 1.64 (95% confidence interval, 0.94-2.87), 2.45 (1.31-4.58), and 2.80 (1.44-5.43), respectively. However, there was no increased adjusted hazard for hard ASCVD in high versus low CIMT categories. In participants with an FH of premature coronary heart disease, CAC improved discrimination of hard ASCVD events (P<0.001). However, CIMT did not discriminate ASCVD (P=0.70). CONCLUSIONS Nearly half of individuals reporting FH have zero CAC and may receive less net benefit from aspirin or statin therapy. Among persons with an FH, CAC is a robust marker of absolute and relative risk of ASCVD, whereas CIMT is not.
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Affiliation(s)
- Jaideep Patel
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Mahmoud Al Rifai
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Michael J Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Matthew J Budoff
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Wendy S Post
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Joseph F Polak
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - David A Bluemke
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Maren T Scheuner
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Richard A Kronmal
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Roger S Blumenthal
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - Khurram Nasir
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.)
| | - John W McEvoy
- From the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.P., M.A.R., M.J. Blaha, W.S.P., R.S.B., K.N., J.W.M.); Division of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (J.P.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J. Budoff); Department of Radiology Cardiovascular Center, Tufts Medical Center, Boston, MA (J.F.P.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); Division of Medical Genetics, Department of Medicine, Veterans Administration, Greater Los Angeles Healthcare System, CA (M.T.S.); Department of Medicine, David Geffen School of Medicine at UCLA (M.T.S.); Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle (R.A.K.); Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami (K.N.); and the Departments of Medicine, Herbert Wertheim College of Medicine, and Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.).
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Age and sex differences in the effect of parental stroke on the progression of carotid intima-media thickness. Atherosclerosis 2015; 241:229-33. [DOI: 10.1016/j.atherosclerosis.2015.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
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Kelly KM, Shedlosky-Shoemaker R, Atkins E, Tworek C, Porter K. Improving family history collection. JOURNAL OF HEALTH COMMUNICATION 2015; 20:445-452. [PMID: 25763471 DOI: 10.1080/10810730.2014.977470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Family history is important for assessing risk of cancer. This study aimed to improve cancer family history communication and collection by training and motivating lay individuals to construct pedigrees. The authors' ultimate goal is to improve identification of familial cancer. Participants (n = 200) completed preintervention, postintervention, and 1-week follow-up surveys to assess pedigree construction. The intervention reviewed basic construction and interpretation of a pedigree for familial cancer. As a result of intervention, individuals reported more positive attitudes about collecting family history, were more likely to intend to speak to family and physicians about cancer risk, better understood a sample pedigree, and constructed more detailed pedigrees of their family history. At follow-up, 25% of the sample had spoken with their families about cancer risk. For those individuals who had not spoken with family, higher postintervention pedigree knowledge was associated with greater intentions to speak with family in the future. The intervention improved the communication and collection of pedigrees and communication about cancer risk, which could be used to improve the identification of individuals with familial cancers and awareness of family cancer risk.
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Affiliation(s)
- Kimberly M Kelly
- a School of Pharmacy, Robert C. Byrd Health Sciences Center , West Virginia University , Morgantown , West Virginia , USA
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Hovick SR, Yamasaki JS, Burton-Chase AM, Peterson SK. Patterns of family health history communication among older African American adults. JOURNAL OF HEALTH COMMUNICATION 2015; 20:80-7. [PMID: 25174859 DOI: 10.1080/10810730.2014.908984] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This qualitative study examined patterns of communication regarding family health history among older African American adults. The authors conducted 5 focus groups and 6 semi-structured interviews with African Americans aged 60 years and older (N = 28). The authors identified 4 distinct patterns of family health history communication: noncommunication, open communication, selective communication (communication restricted to certain people or topics), and one-way communication (communication not reciprocated by younger family members). In general, participants favored open family health history communication, often resulting from desires to change patterns of noncommunication in previous generations regarding personal and family health history. Some participants indicated that they were selective about what and with whom they shared health information in order to protect their privacy and not worry others. Others described family health history communication as one-way or unreciprocated by younger family members who appeared uninterested or unwilling to share personal and family health information. The communication patterns that the authors identified are consistent with communication privacy management theory and with findings from studies focused on genetic testing results for hereditary conditions, suggesting that individuals are consistent in their communication of health and genetic risk information. Findings may guide the development of health message strategies for African Americans to increase family health history communication.
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Lamina C, Linsenmeyer J, Weissensteiner H, Kollerits B, Meisinger C, Rantner B, Stöckl D, Stadler M, Klein-Weigel P, Peters A, Fraedrich G, Kronenberg F. Correlation between a positive family risk score and peripheral artery disease in one case-control and two population-based studies. Atherosclerosis 2014; 237:243-50. [DOI: 10.1016/j.atherosclerosis.2014.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/16/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
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Mudd-Martin G, Rayens MK, Lennie TA, Chung ML, Gokun Y, Wiggins AT, Biddle MJ, Bailey AL, Novak MJ, Casey BR, Moser DK. Fatalism moderates the relationship between family history of cardiovascular disease and engagement in health-promoting behaviors among at-risk rural Kentuckians. J Rural Health 2014; 31:206-16. [PMID: 25252080 DOI: 10.1111/jrh.12094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE In rural communities that experience high rates of cardiovascular disease (CVD) morbidity and mortality, family history education may enhance risk awareness and support engagement in healthy behaviors but could also engender fatalism. This study was conducted to assess if the relationship between family history and adherence to healthy lifestyle behaviors is moderated by fatalism. METHODS Baseline data were obtained from 1,027 adult participants in the HeartHealth in Rural Kentucky study. Multiple linear regression was used to determine whether fatalism moderated the relationship between high-risk family history of CVD and adherence to healthy lifestyle behaviors, controlling for sociodemographic variables and CVD risk factors. The relationship between family history and healthy behaviors was assessed for subgroups of participants divided according to the upper and lower quartiles of fatalism score. FINDINGS The relationship between high-risk family history of CVD and adherence to healthy behaviors was moderated by fatalism. Among those with the highest quartile of fatalism scores, high-risk family history predicted greater adherence to healthy behaviors, while among those in the lowest quartile, and among those with the middle 50% of fatalism scores, there was no association between family history and healthy behavior scores. CONCLUSIONS Family history education can provide people at increased risk for CVD important information to guide health practices. This may be particularly relevant for those with a high degree of fatalistic thinking. In rural communities with limited health resources, family history education, combined with assessment of fatalism, may support better targeted interventions to enhance engagement in healthy behaviors.
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Affiliation(s)
- Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
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36
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Khaleghi M, Isseh IN, Bailey KR, Kullo IJ. Family history as a risk factor for peripheral arterial disease. Am J Cardiol 2014; 114:928-32. [PMID: 25107577 PMCID: PMC4206951 DOI: 10.1016/j.amjcard.2014.06.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
The association of a family history of peripheral arterial disease (PAD) with the presence of PAD is largely unknown. We conducted a case-control study of 2,296 patients with PAD (69 ± 10 years, 64% men) and 4,390 controls (66 ± 11 years, 62% men) identified from noninvasive vascular and stress testing laboratories at Mayo Clinic, Rochester, Minnesota, from October 2006 through June 2012. PAD was defined as an ankle brachial index of ≤ 0.9 at rest and/or after exercise, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients with normal ankle brachial index or without a history of PAD. Family history of PAD was defined as having at least 1 first-degree relative who had undergone revascularization or stent placement for PAD before the age of 65 years. Logistic regression analyses were used to evaluate whether a family history of PAD was associated with the presence of PAD, independent of conventional risk factors. A family history of PAD was present more often in patients with PAD than in controls, with a resulting odds ratio (OR) of 2.20 (95% confidence interval [CI] 1.82 to 2.67). The association remained significant after adjustment for conventional risk factors (OR 1.97, 95% CI 1.60 to 2.42). The association was stronger in younger subjects (age <68 years; adjusted OR 2.46, 95% CI 1.79 to 3.38) than in older subjects (adjusted OR 1.61, 95% CI 1.22 to 2.12). A greater number of affected relatives with PAD was also associated with greater odds of presence of PAD (adjusted OR 1.86, 95% CI 1.48 to 2.33 and adjusted OR 2.56, 95% CI 1.60 to 4.11 for patients with 1 and ≥ 2 affected relatives with PAD, respectively). In conclusion, individuals with a family history of PAD have nearly double the odds of having PAD relative to those without such a history.
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Affiliation(s)
- Mahyar Khaleghi
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
| | - Iyad N Isseh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota.
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Khaleghi M, Isseh IN, Jouni H, Sohn S, Bailey KR, Kullo IJ. Family History as a Risk Factor for Carotid Artery Stenosis. Stroke 2014; 45:2252-6. [DOI: 10.1161/strokeaha.114.006245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahyar Khaleghi
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iyad N. Isseh
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Hayan Jouni
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Sunghwan Sohn
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Kent R. Bailey
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iftikhar J. Kullo
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
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Louwers YV, Roest-Schalken ME, Kleefstra N, Roeters van Lennep J, van den Berg M, Fauser BCJM, Bilo HJG, Sijbrands EJG, Laven JSE. Excess mortality in mothers of patients with polycystic ovary syndrome. Hum Reprod 2014; 29:1780-6. [DOI: 10.1093/humrep/deu107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Liu J, Sekine M, Tatsuse T, Hamanishi S, Fujimura Y, Zheng X. Family history of hypertension and the risk of overweight in Japanese children: results from the Toyama Birth Cohort Study. J Epidemiol 2014; 24:304-11. [PMID: 24857956 PMCID: PMC4074635 DOI: 10.2188/jea.je20130149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Family history can be a useful screening tool in the assessment and management of the risk for noncommunicable disease. However, no data have yet been reported on family history of hypertension and its effect on children’s overweight. Methods A total of 7249 Japanese children enrolled in the Toyama Birth Cohort Study were followed until 2002 (mean age: 12.3 years). Family history of hypertension was ascertained by asking children’s parents whether children’s biological parents or grandparents had doctor-diagnosed hypertension. Child overweight was defined according to international criteria for age- and sex-specific body mass index. Results The prevalence of child overweight at age 12 was 21.7% for males and 15.9% for females. After adjusting for family structure, parental employment status, and lifestyle factors, we found that a maternal family history of hypertension was positively associated with the risk of child overweight at age 12 (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 1.04–1.39). The adjusted OR increased from 1.16 (95% CI 0.99–1.35) to 1.42 (95% CI 1.04–1.92) to 4.75 (95% CI 1.35–16.69) as the number of family members with hypertension increased from 1 to 2 to 3, respectively. There was no significant difference in the prevalence of overweight between children with a paternal family history of hypertension and those without. Conclusions A maternal family history of hypertension was positively associated with the risk of overweight in children at age 12.
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Affiliation(s)
- Jufen Liu
- Institute of Reproductive and Child Health; Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health; Peking University
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Tabei SMB, Senemar S, Saffari B, Ahmadi Z, Haqparast S. Non-modifiable Factors of Coronary Artery Stenosis in Late Onset Patients with Coronary Artery Disease in Southern Iranian Population. J Cardiovasc Thorac Res 2014; 6:51-5. [PMID: 24753833 PMCID: PMC3992733 DOI: 10.5681/jcvtr.2014.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction:
Coronary Artery disease (CAD) is influenced by genetic factors, environment and culture behavior. The aim of the present study was to
evaluate some non-modifiable risk factors of coronary heart disease such as sex, age, family history and consanguineous marriage.
Methods: This is a case-control study. The study population consisted of 200 fifteen or more years old. Data were collected on 200
patients with positive angiography and 200 control subjects with negative angiography. Positive angiography was defined as coronary
diameter cut greater than 50%. Statistical analysis was conducted using SPSS 11.5. In this study, data were collected through a
checklist. Logistic regression and stratification were used to determine the impact of age, gender, family history, and consanguinity on
the risk of stenosis.
Results: The percentage of men in patients and controls were 89% and 29%, respectively. As to gender, a significant
association was found between patients and controls of CAD (CI 95%, 4.014-10.052, OR 6.352). Gender was determined as a risk factor for
CAD. Family history of myocardial infarction did not show a significant effect on the artery stenosis. As to consanguinity of the parents,
there was no significant association between patients and controls of CAD (P> 0.05).
Conclusion: These researches show that ageing
increases the risk of coronary heart stenosis; also, females are more than men protected against this disease. The impact of family
history of myocardial infarction and consanguineous marriage were not associated with of CAD.
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Affiliation(s)
| | - Sara Senemar
- Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Saffari
- Department of Biology, Tehran University of Medical Sciences, Tehran , Iran
| | - Zeinab Ahmadi
- Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Haqparast
- Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
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Pandey AK, Blaha MJ, Sharma K, Rivera J, Budoff MJ, Blankstein R, Al-Mallah M, Wong ND, Shaw L, Carr J, O'Leary D, Lima JAC, Szklo M, Blumenthal RS, Nasir K. Family history of coronary heart disease and the incidence and progression of coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2014; 232:369-76. [PMID: 24468150 PMCID: PMC4491495 DOI: 10.1016/j.atherosclerosis.2013.11.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/20/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated family history as a predictor of incident and progressive coronary artery calcium (CAC) using data from the Multi-Ethnic Study of Atherosclerosis (MESA). BACKGROUND MESA is a multi-center prospective study of 6814 asymptomatic individuals. The relationship between family history of coronary heart disease (CHD) and CAC incidence or progression has not been described previously. METHODS A total of 5099 participants had detailed information about family history of CHD (late versus premature and parental versus sibling history). The mean time between CAC scans was 3.1 ± 1.3 years. The association of late versus premature family history was assessed against CAC change using multivariate regression model adjusted for demographics and cardiac risk factors. RESULTS A family history of premature CHD was associated with an odds ratio (OR) of 1.55 (p < 0.01) for incident development of CAC after adjusting for risk factors and demographics. A premature family history was associated with 14.4 units (p < 0.01) greater volume scores compared to those with no family history in similarly adjusted models by median regression analysis. A combined parental and sibling family history was associated with the greatest incidence and progression in demographic-adjusted models. Caucasians demonstrated the most consistent predictive relationship between family history of premature CHD and incidence (p < 0.01) and progression (p < 0.05) of CAC, though no significant interaction with ethnicity was noted. CONCLUSIONS Family history of premature CHD is associated with enhanced development and progression of subclinical disease, independent of other risk factors, in a multiethnic, population-based study.
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Affiliation(s)
- Arvind K Pandey
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Kavita Sharma
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Juan Rivera
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Ron Blankstein
- Non-invasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Mouaz Al-Mallah
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, CA, USA
| | - Leslee Shaw
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Jeffery Carr
- Department of Radiology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | | | - Joao A C Lima
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
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Barton JC, Barton JC, Acton RT. Diabetes in first-degree family members: a predictor of type 2 diabetes in 159 nonscreening Alabama hemochromatosis probands with HFE C282Y homozygosity. Diabetes Care 2014; 37:259-66. [PMID: 23990522 DOI: 10.2337/dc13-0713] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to identify predictors of diabetes diagnosed before hemochromatosis. RESEARCH DESIGN AND METHODS We studied these 16 variables in 159 nonscreening hemochromatosis probands with HFE C282Y homozygosity: age; sex; BMI; diabetes reports in first-degree family members (dichotomous); heavy ethanol consumption; cigarette smoking; elevated serum alanine aminotransferase/aspartate aminotransferase levels; nonalcoholic fatty liver; chronic viral hepatitis; cirrhosis; hand arthropathy; iron removed by phlebotomy; and positivity for HLA-A*01, B*08; A*03, B*07; and A*03, B*14 haplotypes. We performed univariable and multivariable analyses. RESULTS Twenty-three probands (14.5%) had diabetes; 19 were men. Each of the 23 probands had type 2 diabetes. Mean BMI was greater in probands with diabetes (31.7 ± 8.5 [SD] kg/m(2) vs. 27.6 ± 5.1 kg/m(2); P = 0.032). Reports of any first-degree family member with diabetes were more prevalent in probands with than in probands without diabetes (69.6 vs. 17.6%; P < 0.0001). In probands with diabetes, the odds ratio (OR) of maternal diabetes was 6.7 (95% CI 2.3-19.7; P = 0.0005) and of sibling diabetes was 11.7 (3.0-45.5; P = 0.0004). In a logistic regression model, predictors of diabetes at hemochromatosis diagnosis in 159 probands were diabetes reports in family members (OR 8.5 [95% CI 2.9-24.8]; P < 0.0001) and BMI (1.1 [1.0-1.2]; P = 0.049). This model explained 26.0% of total deviance contributing to diabetes. CONCLUSIONS In nonscreening hemochromatosis probands with HFE C282Y homozygosity, a heritable factor(s) increases the risk of diabetes diagnosed before hemochromatosis.
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Family history of cardiovascular disease and offspring echocardiographic left ventricular structure and function: the Asklepios Study. J Am Soc Echocardiogr 2013; 26:1290-1297.e2. [PMID: 23993692 DOI: 10.1016/j.echo.2013.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Moderate to small heritability has been observed for left ventricular (LV) structure and function in genetic epidemiology and genomewide association studies. The aim of this study was to explore whether this would be mirrored in an independent association between LV structure and function and a family history (FH) of cardiovascular disease (CVD) in a large population of middle-aged adults. METHODS Subjects enrolled in the Asklepios Study, a population-based sample of 2,524 male and female volunteers, aged 35 to 55 years, free of overt CVD at baseline, were studied. LV structure and function were assessed using transthoracic echocardiography (by a single sonographer). FH data spanning 4 generations were acquired using a questionnaire. RESULTS In unadjusted analyses, only small effects of FH of CVD on LV structure (relative wall thickness, P = .042; interventricular septal thickness, P = .002; LV mass, P = .038; allometrically adjusted LV mass, P = .014) and diastolic function (mitral annular e', P = .02) were observed. After adjusting for the more adverse risk factor profile associated with FH, no significant associations persisted. These results did not appreciably change using a more extended definition of FH of CVD or FH of hypertension. CONCLUSIONS A positive FH for CVD was associated with differences in offspring cardiac structure and function, largely mediated by (but not independent from) a more adverse risk profile in those subjects with positive FH.
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Dunn KE, Caleshu C, Cirino AL, Ho CY, Ashley EA. A clinical approach to inherited hypertrophy: the use of family history in diagnosis, risk assessment, and management. ACTA ACUST UNITED AC 2013; 6:118-31. [PMID: 23424256 DOI: 10.1161/circgenetics.110.959387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kyla E Dunn
- Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Stanford, CA 94305-5406, USA
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Graubard BI, Sirken MG. Estimating sibling recurrence risk in population sample surveys. Hum Hered 2013; 76:18-27. [PMID: 23921823 DOI: 10.1159/000351737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Sibling recurrence risk (SRR) is a measure of familial aggregation of a disease and is often used in family-based studies in genetic epidemiology to indicate the existence of possible genes conferring susceptibility of disease. Estimating SRR requires information about the disease status of sibships of families with two or more siblings where at least one is affected. Since family-based studies are not usually random samples, estimates of SRR derived from these studies may be biased. Network sampling used in survey research offers a way to ascertain the disease status of sibships from interviewed individuals in household survey samples, in order to obtain (approximately) unbiased estimators of SRR and its related SRR ratio (SRR divided by the prevalence of disease). METHODS Two methods of ascertaining sibships of affected families are considered: in one method the siblings' affected status is reported by an individual, regardless of the individual's affected status, and in the other method only affected individuals can report their siblings' affected status. Network estimators of SRR and SRR ratio and estimators of their standard errors are provided. RESULTS Reported diabetes for siblings from the 1976 National Health Interview is used to illustrate the estimation methods. The SRR ratio for diabetes among living siblings was 5.79% [relative standard error (RSE) = 5.12%], and for living or deceased siblings, it was 7.66% (RSE = 3.76%). CONCLUSIONS Network sampling estimators can provide population estimates of SRR and SRR ratio for diseases such as diabetes.
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Affiliation(s)
- Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Md., USA
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Pandey AK, Pandey S, Blaha MJ, Agatston A, Feldman T, Ozner M, Santos RD, Budoff MJ, Blumenthal RS, Nasir K. Family history of coronary heart disease and markers of subclinical cardiovascular disease: Where do we stand? Atherosclerosis 2013; 228:285-94. [DOI: 10.1016/j.atherosclerosis.2013.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/13/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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Van daele CM, De Meyer T, De Buyzere ML, Gillebert TC, Denil SLIJ, Bekaert S, Chirinos JA, Segers P, De Backer GG, De Bacquer D, Rietzschel ER. Addition of a novel, protective family history category allows better profiling of cardiovascular risk and atherosclerotic burden in the general population. The Asklepios Study. PLoS One 2013; 8:e63185. [PMID: 23658806 PMCID: PMC3642069 DOI: 10.1371/journal.pone.0063185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Whereas the importance of family history (FH) is widely recognized in cardiovascular risk assessment, its full potential could be underutilized, when applied with its current simple guidelines-based definition (cFH): presence of premature cardiovascular disease (CVD) in a first-degree relative. We tested the added value of a new, extended family history definition (eFH), also taking into account later onset of disease, second-degree relatives and number of affected relatives, on profiling cardiovascular risk and atherosclerotic burden in the general population. Design longitudinal population study. Setting random, representative population sample from Erpe-Mere and Nieuwerkerken (Belgium, primary care). Subjects 2524 male/female volunteers, aged 35–55 years, free from overt CVD. Main outcome measures Subjects were extensively phenotyped including presence of atherosclerosis (ultrasound) and a newly developed FH questionnaire (4 generations). Results Compared to cFH, eFH was superior in predicting an adverse risk profile (glycemic state, elevated blood pressure, lipid abnormalities, presence of metabolic syndrome components) and presence of atherosclerosis (all age & sex-adjusted p<0.05). Unlike cFH, eFH remained a significant predictor of subclinical atherosclerosis after adjusting for confounders. Most relations with eFH were not graded but showed clear informational breakpoints, with absence of CVD (including late onset) in any first-degree relative being a negative predictor of atherosclerosis, and a particularly interesting phenotype for further study. Conclusions A novel, extended FH definition is superior to the conventional definition in profiling cardiovascular risk and atherosclerotic burden in the general population. There remain clear opportunities to refine and increase the performance and informational content of this simple, readily-available inexpensive tool.
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Affiliation(s)
- Caroline M Van daele
- Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium.
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Wahl S, Möhlenkamp S, Erbel R, Moebus S, Andrich S, Stang A, Jöckel KH, Dragano N. Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease. Eur J Epidemiol 2012; 28:301-10. [DOI: 10.1007/s10654-012-9743-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
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Katz EG, Stevens J, Truesdale KP, Cai J, North KE. Interactions between obesity, parental history of hypertension, and age on prevalent hypertension: the People's Republic of China Study. Asia Pac J Public Health 2012; 24:970-80. [PMID: 21653607 PMCID: PMC3298639 DOI: 10.1177/1010539511409393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Age, family history, and body mass index (BMI) influence the prevalence of hypertension, but very little is known about the interplay of these factors in Chinese populations. The authors examined this issue in Chinese adults (n = 4104) in the People's Republic of China Study. In young adults (24-39 years), the prevalence of hypertension/1000 persons (95% confidence interval [CI]) at the referent BMI was greater among subjects with a parental history of hypertension (35; 15-54) compared with those without (7; 3-11). Among middle-aged (40-71 years) adults, the prevalence of hypertension was similar regardless of parental history; however, the effect of BMI was modified by parental history status. For example, at BMI = 25 kg/m(2), the prevalence difference/1000 persons was 375 (95% CI = 245-506) and 97 (95% CI = 51-144) among subjects with and without a parental history, respectively. These large differences call for further investigation of the genetic and environmental factors that could be driving this interaction.
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Affiliation(s)
- Eva G Katz
- University of North Carolina at Chapel Hill, Chapel Hill, NC 08876, USA.
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De Meyer T, Van Daele CM, De Buyzere ML, Denil S, De Bacquer D, Segers P, Cooman L, De Backer GG, Gillebert TC, Bekaert S, Rietzschel ER. No shorter telomeres in subjects with a family history of cardiovascular disease in the Asklepios study. Arterioscler Thromb Vasc Biol 2012; 32:3076-81. [PMID: 23087363 DOI: 10.1161/atvbaha.112.300341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Shorter telomere length is associated with the occurrence of cardiovascular events, but the question of causality is complicated by the intertwined effects of inheritance, aging, and lifestyle factors on both telomere length and cardiovascular disease (CVD). Some studies indicated that healthy offspring of coronary artery disease patients exhibited shorter telomeres than subjects without a family history. Importantly, this result would imply that inheritance of shorter telomeres is a primary abnormality associated with an increased risk of CVD, the so-called Telomere Hypothesis of CVD. Therefore, we aimed at further validating the latter results in the large, population-representative Asklepios Study. METHODS AND RESULTS Peripheral blood leukocyte telomere length was measured using telomere restriction fragment analysis in the young to middle-aged (≈ 35-55 years old) Asklepios study population, free from overt CVD, and could be successfully combined with data from the Asklepios Family History Database for 2136 subjects. No shorter telomere length could be found in healthy subjects with a family history of CVD compared with those without. CONCLUSIONS These findings cast serious doubt on the hypothesis that telomere length is shorter in families with an increased risk of CVD and do not support the Telomere Hypothesis of CVD.
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Affiliation(s)
- Tim De Meyer
- Department of Mathematical Modelling, Ghent University, Ghent, Belgium.
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