Murabito Joanne M, Nam Byung-Ho, D'Agostino Ralph B, Lloyd-Jones Donald M, O'Donnell Christopher J, Wilson Peter W F
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts 01702-5827, USA.
Ann Intern Med. 2004 Mar 16;140(6):434-40. doi: 10.7326/0003-4819-140-6-200403160-00010.
Family history is used to infer the risk for heart disease; however, little is known about the accuracy of family history reports.
To examine the accuracy of offspring reports of parental cardiovascular disease.
Validation study.
Framingham Heart Study.
Offspring participants of the multigenerational Framingham Heart Study with both parents in the original cohort.
791 men and 837 women (mean age, 57 years) completed a family history questionnaire from 1995 to 1998. Offspring reports were compared with confirmed medical evidence of parental status, and positive and negative predictive values and likelihood ratios were calculated.
Positive reports of high blood pressure, diabetes, and high cholesterol levels in fathers were accurate: Positive predictive values were 83% (95% CI, 80% to 86%), 76% (CI, 70% to 82%), and 78% (CI, 73% to 83%), respectively. Corresponding positive predictive values for reports in mothers were 91% (CI, 89% to 93%), 79% (CI, 73% to 85%), and 88% (CI, 84% to 92%), respectively. Positive predictive values for reports of paternal heart attack occurring before 55 years of age and for stroke occurring before 65 years of age were 28% (CI, 22% to 34%) and 43% (CI, 33% to 53%), respectively, whereas the positive likelihood ratios were 8.6 (CI, 6.8 to 10.9) and 11.2 (CI, 9.2 to 13.6), respectively. Negative predictive values for parental history reports were greater than 90%, except for high blood pressure and high cholesterol level (negative predictive values, 33% to 55%, and negative likelihood ratios, 0.47 to 0.88).
This study does not determine whether more accurate measures of family history would meaningfully improve estimation of cardiovascular risk.
Negative parental history reports were reliable, except for hypertension and high cholesterol levels. Although reports of parental premature heart attack and stroke had high likelihood ratios, their predictive values were low because the prevalence of these conditions was low in parents. If patients were more aware of their parents' medical illnesses, they might be able to estimate their risk for disease more accurately and perhaps motivate themselves to follow a healthy lifestyle.
家族病史用于推断患心脏病的风险；然而，对于家族病史报告的准确性知之甚少。
检验子女报告的父母心血管疾病情况的准确性。
验证性研究。
弗雷明汉心脏研究。
弗雷明汉心脏研究多代队列中父母均在原始队列中的子女参与者。
1995年至1998年，791名男性和837名女性（平均年龄57岁）完成了一份家族病史问卷。将子女报告与父母状况的确诊医疗证据进行比较，并计算阳性和阴性预测值以及似然比。
父亲高血压、糖尿病和高胆固醇水平的阳性报告准确：阳性预测值分别为83%（95%可信区间，80%至86%）、76%（可信区间，70%至82%）和78%（可信区间，73%至83%）。母亲报告的相应阳性预测值分别为91%（可信区间，89%至93%）、79%（可信区间，73%至85%）和88%（可信区间，84%至92%）。父亲55岁之前发生心脏病发作以及65岁之前发生中风的报告的阳性预测值分别为28%（可信区间，22%至34%）和43%（可信区间，33%至53%），而阳性似然比分别为8.6（可信区间，6.8至10.9）和11.2（可信区间，9.2至13.6）。父母病史报告的阴性预测值大于90%，高血压和高胆固醇水平除外（阴性预测值，33%至55%，阴性似然比，0.47至0.88）。
本研究未确定更准确的家族病史测量方法是否会显著改善心血管风险的估计。
除高血压和高胆固醇水平外，父母病史的阴性报告是可靠的。尽管父母过早心脏病发作和中风的报告似然比很高，但由于这些情况在父母中的患病率较低，其预测值较低。如果患者更了解父母的疾病，他们可能能够更准确地估计自己的患病风险，或许还能促使自己遵循健康的生活方式。
