Roncaglioni M C, Santoro L, D'Avanzo B, Negri E, Nobili A, Ledda A, Pietropaolo F, Franzosi M G, La Vecchia C, Feruglio G A
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italia.
Circulation. 1992 Jun;85(6):2065-72. doi: 10.1161/01.cir.85.6.2065.
A family history of heart disease has been reported to increase the risk of coronary heart disease. We examined the relation between family history of myocardial infarction (MI) and risk of acute MI to establish the independency of this association, the degree of risk in relation to the number and age of relatives affected, and the possible interaction between family history and other major risk factors for MI.
In a case-control study conducted in Italy within the framework of the GISSI-2 Trial, 916 cases of newly diagnosed MI and 1,106 hospital controls were identified. Using a structured questionnaire, data were collected on the history of MI in first-degree relatives and the age at which the event occurred. Compared with subjects without family history of MI in first-degree relatives, the relative risk (RR) of MI was 2.0 (95% confidence interval, CI, 1.6-2.5) in those with one and 3.0 (95% CI, 2.0-4.4) in those with two or more relatives affected (chi 2(1) test for trend, 54.1; p less than 0.001). Such an increase was not substantially affected by allowance for recognized risk factors. The risk related to family history involving at least two relatives was higher for early MI (less than 55 years) (RR, 20.0; 95% CI, 3.3-121.2) compared with later MI (less than or equal to 65 years) (RR, 3.5; 95% CI, 1.8-6.6). When known risk factors were considered for their interaction with family history, the effect on RR was approximately multiplicative for several variables, including smoking, serum cholesterol, hypertension, and hyperlipidemia but not for diabetes and body mass index. Thus, the presence of both family history and smoking and cholesterol levels greater than or equal to 226 mg/dl led to an RR of 14 (95% CI, 3.7-50.0) and 8.3 (95% CI, 1.8-38.7), respectively.
This study indicates that a family history of MI is an independent risk factor for MI, and that the number of relatives and the age at which they were affected is related to the strength of the association. There is a multiplicative effect on RR between family history and several major risk factors for MI.
据报道，心脏病家族史会增加冠心病风险。我们研究了心肌梗死（MI）家族史与急性心肌梗死风险之间的关系，以确定这种关联的独立性、与受影响亲属数量和年龄相关的风险程度，以及家族史与其他主要心肌梗死风险因素之间可能存在的相互作用。
在意大利进行的一项病例对照研究中，该研究是GISSI - 2试验框架的一部分，共确定了916例新诊断的心肌梗死病例和1106例医院对照。通过结构化问卷，收集了一级亲属的心肌梗死病史以及事件发生时的年龄数据。与一级亲属无心肌梗死家族史的受试者相比，有一名亲属患心肌梗死的受试者发生心肌梗死的相对风险（RR）为2.0（95%置信区间，CI，1.6 - 2.5），有两名或更多亲属患心肌梗死的受试者相对风险为3.0（95%CI，2.0 - 4.4）（趋势的卡方检验，54.1；p < 0.001）。这种增加并未因考虑公认的风险因素而受到实质性影响。与晚期心肌梗死（小于或等于65岁）（RR，3.5；95%CI，1.8 - 6.6）相比，家族史涉及至少两名亲属的早期心肌梗死（小于55岁）风险更高（RR，20.0；95%CI，3.3 - 121.2）。当考虑已知风险因素与家族史的相互作用时，对于包括吸烟、血清胆固醇、高血压和高脂血症在内的几个变量，对RR的影响大致呈相乘关系，但糖尿病和体重指数除外。因此，家族史与吸烟以及胆固醇水平大于或等于226mg/dl同时存在时，RR分别为14（95%CI，3.7 - 50.0）和8.3（95%CI，1.8 - 38.7）。
本研究表明，心肌梗死家族史是心肌梗死的独立危险因素，且亲属数量及其受影响的年龄与关联强度有关。家族史与几个主要心肌梗死风险因素之间对RR存在相乘效应。
