Addition of a novel, protective family history category allows better profiling of cardiovascular risk and atherosclerotic burden in the general population. The Asklepios Study

Shift work, parental cardiovascular disease and myocardial infarction in males

Background

Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers.

Aims

To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men.

Methods

A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI).

Results

There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02‒5.6 and AP = 0.4; 95% CI 0.08‒0.73].

Conclusions

Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.

The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania

AIM

To evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men.

METHODS

The association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972-1974 and 1976-1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality.

RESULTS

After adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09-1.42) and for CHD mortality 1.20 (1.02-1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality.

CONCLUSIONS

Family history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.

The Ten-Year History of the Asklepios Study: An Interview with Professor Ernst R. Rietzschel, Primary Investigator and Leader of the Asklepios Study

The Asklepios study started 10 years ago when 2,500 subjects were screened between 2002 and 2004. And all of the 90+ publications we have for the moment are from those cross-sectional data. This is called round 1. Since 2011, in round 2, all of those patients have started to come back for a 10-year follow-up. At this moment, approximately 1,750 of those patients have been seen. The patients were followed by general practitioners (GP), and the GP again provided the information about what has happened with the medical status in the past 10 years including drug therapy: not only the drugs that they are taking at the moment were evaluated, but, because patients often use many drugs, the chronicles of drugs for major risk factors, for hypertension, lipids, contraceptives and more. Then, patients come to the study center where the same cluster of examinations are undertaken by one single doctor, Prof. Ernst R. Rietzschel and one study nurse, just like 10 years ago. Again, using a single observer at the two time frames has kept the methodology very strict.

The relation between the presence of cardiovascular disease and vascular risk factors in offspring and the occurrence of new vascular events in their parents already at high vascular risk

BACKGROUND

For parents at high risk for cardiovascular events, presence of cardiovascular disease or risk factors in their offspring may be an indicator of their genetic load or exposure to (unknown) risk factors and might be related to the development of new or recurrent vascular events.

METHODS

In 4,267 patients with vascular disease, hypertension, diabetes, or hypercholesterolemia enrolled in the SMART cohort, the presence of cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking, or overweight) and cardiovascular disease (coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysm) was assessed in their 10,564 children. The relation between presence of cardiovascular disease or cardiovascular risk factors in their offspring and new or recurrent vascular events was determined by Cox proportional hazard analyses.

RESULTS

Of the patients, 506 (12%) had offspring with cardiovascular disease, hypertension, hypercholesterolemia, or diabetes. Smoking in offspring was present in 1,972 patients (46%), and overweight in 845 patients (20%). During a median follow-up of 7.0 years (interquartile range 3.7-10.4), the composite outcome of myocardial infarction (MI), stroke, or vascular mortality occurred in 251 patients. Patients with offspring with cardiovascular disease, hypertension, hypercholesterolemia, or diabetes had an increased risk of vascular mortality (hazard ratio [HR] 2.9, 95% CI 1.2-7.1), MI (HR 1.6, 95% CI 1.1-2.5), and the composite outcome (HR 1.5, 95% CI 1.1-2.2). Diabetes in offspring was related to an increased risk of the composite outcome (HR 2.7, 95% CI 1.5-5.0), MI (HR 3.3, 95% CI 1.7-6.6), and vascular mortality (HR 3.4, 95% CI 0.8-14.8). Smoking and overweight in offspring were not related to increased vascular risk in parents.

CONCLUSIONS

Presence of cardiovascular disease, hypertension, hypercholesterolemia, and diabetes in offspring, with diabetes mellitus being the most contributing cardiovascular risk factor, is related to an increased risk of developing new or subsequent vascular events in patients already at high vascular risk.

Family history of cardiovascular disease and offspring echocardiographic left ventricular structure and function: the Asklepios Study

BACKGROUND

Moderate to small heritability has been observed for left ventricular (LV) structure and function in genetic epidemiology and genomewide association studies. The aim of this study was to explore whether this would be mirrored in an independent association between LV structure and function and a family history (FH) of cardiovascular disease (CVD) in a large population of middle-aged adults.

METHODS

Subjects enrolled in the Asklepios Study, a population-based sample of 2,524 male and female volunteers, aged 35 to 55 years, free of overt CVD at baseline, were studied. LV structure and function were assessed using transthoracic echocardiography (by a single sonographer). FH data spanning 4 generations were acquired using a questionnaire.

RESULTS

In unadjusted analyses, only small effects of FH of CVD on LV structure (relative wall thickness, P = .042; interventricular septal thickness, P = .002; LV mass, P = .038; allometrically adjusted LV mass, P = .014) and diastolic function (mitral annular e', P = .02) were observed. After adjusting for the more adverse risk factor profile associated with FH, no significant associations persisted. These results did not appreciably change using a more extended definition of FH of CVD or FH of hypertension.

CONCLUSIONS

A positive FH for CVD was associated with differences in offspring cardiac structure and function, largely mediated by (but not independent from) a more adverse risk profile in those subjects with positive FH.