Relation of familial patterns of coronary heart disease, stroke, and diabetes to subclinical atherosclerosis: The multi-ethnic study of atherosclerosis

Purpose: To investigate the possibility that family history beyond early-onset coronary heart disease might contribute to coronary heart disease susceptibility, we studied associations between additional family history and the coronary artery calcium score. Methods: Associations between coronary artery calcium score and self-reports of coronary heart disease, stroke, and diabetes in first-degree relatives of 5264 nondiabetic subjects were assessed using logistic and linear regression adjusting for risk factors; adjusted mean coronary artery calcium score estimates were determined by pooling results. Results: Family history of coronary heart disease alone and in combination with diabetes and/or stroke was significantly associated with a positive coronary artery calcium score compared with no family history with odds ratios ranging from 1.7 (95% CI: 1.3-2.3) to 1.9 (95% CI: 1.6-2.3) and adjusted mean coronary artery calcium score estimates ranging from 137 (95% CI: 101-173) to 184 (95% CI: 143-226). Associations between family history of coronary heart disease and coronary artery calcium score were significant regardless of age at onset, sex, lineage, or number of relatives with coronary heart disease. The association between family history of diabetes only and coronary artery calcium score was also significant (OR, 1.3; 95% CI: 1.1-1.7) with an adjusted mean coronary artery calcium score estimate of 122 (95% CI: 93-151). Generally, family history of stroke had nonsignificant associations with coronary artery calcium score. Conclusions: Numerous family history variables in addition to early-onset coronary heart disease are associated with subclinical atherosclerosis. Our results have implications for improving coronary heart disease risk assessment.