Family history of heart attack as an independent predictor of death due to cardiovascular disease.

Although a family history of ischemic heart disease is a well-accepted risk factor for cardiovascular disease, only three prospective studies--all in men--have examined the predictive strength of a positive family history after adjusting for other heart disease risk factors. The present analysis is based on a 9 year follow-up of 4014 men and women from 40 to 79 years old who resided in Rancho Bernardo, CA, and who reported no known cardiovascular disease in response to a standardized interview. At baseline 38% of this group reported a family history of a heart attack in a parent, sibling, or child; 15% of those with a positive family history in a first-degree relative indicated that the heart attack had occurred before the relative was 50 years old. Younger men (less than 60 years) with a positive family history at any age had significantly higher mean blood pressures and total plasma cholesterol levels; older men were more likely to have diabetes mellitus. Younger women with a positive family heart attack to subsequent cardiovascular death was determined by the Cox model after adjusting for age, systolic blood pressure, total plasma cholesterol level, obesity, cigarette smoking, personal history of diabetes, and estrogen use (in women). In men, but not in women, a positive family history of heart attack was independently predictive of death from all causes and from cardiovascular and ischemic heart disease. (ABSTRACT TRUNCATED AT 250 WORDS)