Division of Cardiology Department of Clinical Science and Education Karolinska InstitutetSödersjukhuset Stockholm Sweden.
Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden.
J Am Heart Assoc. 2021 Dec 7;10(23):e022264. doi: 10.1161/JAHA.121.022264. Epub 2021 Nov 30.
Background Family history of atherosclerotic cardiovascular disease (ASCVD) is easily accessible and captures genetic cardiovascular risk, but its prognostic value in secondary prevention is unknown. Methods and Results We followed 25 615 patients registered in SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) from their 1-year revisit after a first-time myocardial infarction during 2005 to 2013, until December 31, 2018. Data on relatives, diagnoses and socioeconomics were extracted from national registers. The association between family history and recurrent ASCVD was studied with Cox proportional-hazard regression, adjusting for risk factors and socioeconomics. A family history of ASCVD was defined as hospitalization due to myocardial infarction, angina with coronary revascularization, stroke, or cardiovascular death in ≥1 parent or full sibling, with early-onset defined as disease-onset before 55 years in men and 65 in women. The additional discriminatory value of family history to Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was assessed with Harrell's C-index difference and reclassification was studied with continuous net reclassification improvement. Family history of early-onset ASCVD in ≥1 first-degree relative was present in 2.3% and was associated with recurrent ASCVD (hazard ratio [HR] 1.31; 95% CI, 1.17-1.47), fully adjusted for risk factors (HR, 1.22; 95% CI, 1.05-1.42). Early-onset family history improved the discriminatory ability of the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, with Harrell's C improving 0.003 points (95% CI, 0.001-0.005) from initial 0.587 (95% CI, 0.576-0.595) and improved reclassification (continuous net reclassification improvement 2.1%, <0.001). Conclusions Family history of early-onset ASCVD is associated with recurrent ASCVD after myocardial infarction, independently of traditional risk factors and improves secondary risk prediction. This may identify patients to target for intensified secondary prevention.
家族史中的动脉粥样硬化性心血管疾病（ASCVD）易于获取，可反映遗传心血管风险，但在二级预防中的预后价值尚不清楚。
我们对 2005 年至 2013 年间首次心肌梗死后 1 年内参加 SWEDEHEART（瑞典基于推荐治疗的心脏病循证治疗增强和发展网络系统）的 25615 例患者进行了随访，随访至 2018 年 12 月 31 日。从国家登记处提取亲属、诊断和社会经济数据。使用 Cox 比例风险回归研究家族史与复发性 ASCVD 之间的关联，调整危险因素和社会经济状况。家族史中的 ASCVD 定义为≥1 名父母或全兄弟姐妹因心肌梗死、冠状动脉血运重建后的心绞痛、中风或心血管死亡而住院，早发定义为男性 55 岁前和女性 65 岁前发病。使用 Harrell's C 指数差异评估家族史对二级预防的溶栓治疗心肌梗死风险评分的附加判别价值，并使用连续净重新分类改善来研究重新分类。≥1 位一级亲属的早发 ASCVD 家族史的发生率为 2.3%，与复发性 ASCVD 相关（风险比[HR] 1.31；95%CI，1.17-1.47），完全调整危险因素后（HR，1.22；95%CI，1.05-1.42）。早发家族史提高了溶栓治疗心肌梗死风险评分对二级预防的判别能力，Harrell's C 提高了 0.003 分（95%CI，0.001-0.005），从初始的 0.587（95%CI，0.576-0.595）和改善的重新分类（连续净重新分类改善 2.1%，<0.001）。
早发 ASCVD 的家族史与心肌梗死后的复发性 ASCVD 相关，独立于传统危险因素，并改善了二级风险预测。这可能会识别出需要强化二级预防的患者。
