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.
Stroke. 2014 Aug;45(8):2252-6. doi: 10.1161/STROKEAHA.114.006245. Epub 2014 Jul 8.
We investigated whether family history of stroke or coronary heart disease (CHD) is associated with presence of carotid artery stenosis (CAS).
The study cohort included 864 patients (72±8 years; 68% men) with CAS and 1698 controls (61±11 years; 55% men) referred for noninvasive vascular testing. CAS was defined as ≥70% stenosis in the internal carotid artery on ultrasound or history of carotid revascularization. Controls did not have CAS or history of cerebrovascular disease or CHD. Family history of stroke and CHD was defined as having ≥1 first-degree relative who had stroke or CHD before age 65 years. Logistic regression analysis was used to evaluate whether family history of stroke or CHD was associated with presence of CAS, independent of conventional risk factors.
Family history of stroke and CHD was present more often in patients with CAS than in controls, with a resulting odds ratios (95% confidence interval) of 2.02 (1.61-2.53) and 2.01 (1.70-2.37), respectively. The associations remained significant after adjustment for age, sex, body mass index, smoking, diabetes mellitus, hypertension, and dyslipidemia; odds ratios: 1.41 (1.06-1.90) and 1.69 (1.35-2.10), respectively. A greater number of affected relatives with stroke or CHD was associated with higher odds of CAS; adjusted odds ratios: 1.25 (0.91-1.72) and 1.46 (1.14-1.89) versus 2.65 (1.35-5.40) and 2.13 (1.57-2.90) for patients with 1 and ≥2 affected relatives with stroke and CHD, respectively.
Family history of stroke, and of CHD were each associated with CAS, suggesting that shared genetic and environmental factors contribute to the risk of CAS. We show that (1) family history of stroke or CHD is independently associated with presence of CAS; (2) sibling history of stroke or CHD confers greater risk than parental history; and (3) the magnitude of the association is greater in those with greater number of affected relatives, independent of the size of the family [corrected].
本研究旨在探讨中风或冠心病（CHD）家族史与颈动脉狭窄（CAS）的相关性。
研究队列纳入 864 例 CAS 患者（72±8 岁，68%为男性）和 1698 例对照者（61±11 岁，55%为男性），这些患者均因非侵入性血管检查而就诊。CAS 定义为颈动脉超声检查显示内颈动脉狭窄≥70%或有颈动脉血运重建史。对照者不存在 CAS 或脑血管疾病或 CHD 病史。中风和 CHD 的家族史定义为在 65 岁前有≥1 位一级亲属发生中风或 CHD。采用 logistic 回归分析评估中风或 CHD 的家族史与 CAS 之间的相关性，这种相关性独立于传统的危险因素。
与对照者相比，CAS 患者的中风和 CHD 家族史更为常见，其比值比（95%置信区间）分别为 2.02（1.61-2.53）和 2.01（1.70-2.37）。调整年龄、性别、体重指数、吸烟、糖尿病、高血压和血脂异常后，这些关联仍然显著；比值比分别为 1.41（1.06-1.90）和 1.69（1.35-2.10）。与中风或 CHD 相关的受影响亲属数量较多与 CAS 的发生风险较高相关；调整后的比值比分别为 1.25（0.91-1.72）和 1.46（1.14-1.89），而与中风和 CHD 分别有 1 位和≥2 位受影响亲属的患者的比值比分别为 2.65（1.35-5.40）和 2.13（1.57-2.90）。
中风和 CHD 的家族史均与 CAS 相关，提示共同的遗传和环境因素可能会增加 CAS 的发病风险。本研究表明：（1）中风或 CHD 的家族史与 CAS 的发生独立相关；（2）与父母的病史相比，同胞的病史会带来更大的风险；（3）在存在更多受影响亲属的情况下，关联的程度更大，且独立于家族规模。
