Screening family members could prevent 4 in 10 premature heart attacks

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Screening and treating middle-aged adults with a family history of coronary heart disease could prevent more than 4 in 10 premature heart attacks, according to an article in this week's BMJ.

Researchers from the University of Glasgow looked at data from previous studies which show that immediate family members of patients with premature coronary heart disease (CHD) are at significantly increased risk of developing the disease.

Siblings are twice as likely to have a heart attack compared to the general population. Partners are also known to be at greater risk, due to shared risk factors in their lifestyle. The risk to family members increases further if more than one member of the immediate family has coronary heart disease.

Family history, the researchers say, can identify a large proportion of people at high overall risk of developing coronary heart disease. They point to one study which found that the 14% of families with a positive family history accounted for 48% of all CHD events and 72% of all premature deaths.

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Using data from previous studies they estimate that in England and Scotland alone 7,369 premature heart attacks occur each year in people with a family history of premature heart attacks. Of those 6,485 might be preventable.

Once the risk of having a family member with CHD was taken into account they calculated that screening and treating middle aged adults with a family history could have prevented 42% of premature heart attacks and 8% of all heart attacks.

Many of the factors which increase the chances of developing CHD are modifiable, for example, smoking or having high blood pressure. So the researchers argue that family members would benefit from effective interventions to reduce these risks.

There have been attempts to identify high risk families via school, work or on-line questionnaires in the past, but the researchers believe "wide coverage could be achieved by identifying relatives whenever someone is admitted to hospital for premature heart attack. Furthermore they may be motivated by their relative's illness, thereby improving the attainment and maintenance of risk factor control."

Patients with CHD usually present acutely to A&E or are referred to an outpatient clinic. These patients, they say, could be flagged as requiring family counselling. They conclude immediate family are an obvious, but neglected group at which primary prevention should be targeted.

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