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Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention

BMJ 2007; 335 doi: (Published 06 September 2007) Cite this as: BMJ 2007;335:481
  1. C K Chow, cardiology research fellow1,
  2. A C H Pell, consultant cardiologist2,
  3. A Walker, health economist3,
  4. C O'Dowd, health economist3,
  5. A F Dominiczak, professor of cardiovascular medicine1,
  6. J P Pell, professor of epidemiology1
  1. 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA
  2. 2Monklands Hospital, Airdrie
  3. 3Robertson Centre for Biostatistics, University of Glasgow
  1. Correspondence to: J Pell j.pell{at}
  • Accepted 12 June 2007

Risk of premature coronary heart disease is increased in the families of affected patients. C K Chow and colleagues argue that targeting relatives for primary prevention would be an effective policy

Summary box

  • Prevention of coronary heart disease is most effective if targeted at people with high overall risk

  • First degree relatives of patients with premature myocardial infarction have double the risk of the condition

  • In the UK, about 20% of all admissions for myocardial infarction occur in patients with premature myocardial infarction

  • More than a third of admissions for premature myocardial infarction could be prevented by screening and treating first degree relatives

First degree relatives of patients with premature coronary heart disease are at increased risk of the disease. Compared with the general population, siblings have at least double the risk, because of shared lifestyle risk factors and genetic predisposition. Offspring and partners are also at increased risk. Relatives have an increased prevalence of modifiable risk factors including hypertension, dyslipidaemia, and smoking. Some guidelines recommend screening of relatives, but surveys indicate that this does not occur in practice. We propose that first degree relatives of patients admitted for premature myocardial infarction should be identified and then offered screening and treatment for risk factors of coronary heart disease.

Sources and selection

We searched OVID, Medline, and PubMed databases using combinations of the terms “family history”, “coronary heart disease”, “sibling”, “relative”, “premature coronary heart disease”, and “cardiovascular risk factors”. We cross checked the reference lists of papers identified as relevant. We undertook a web search using the same terms and searched the publication lists of relevant organisations such as the British Heart Foundation, European Society of Cardiology, and American Heart Association.

Increased risk of coronary heart disease

Coronary heart disease aggregates in families.1 In a cross sectional European survey (Euroaspire II), 10% of the siblings of 1289 patients with premature coronary …

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