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Patients with family history of Ml (FH) are often referred for coronary artery calcium (CAC) scanning. Both markers are strongly associated with each other and with CHD. The significance of FH once CAC values are known is unclear.
Among 2390 participants without CHD enrolled in the Dallas Heart Study, we assessed FH and prevalent CAC (>10) using CT. The primary outcome was a composite of CHD death, non-fatal Ml and coronary revascularization. The individual and joint associations of FH and CAC were assessed using Cox models adjusted for traditional risk factors (TRF).
After a mean follow up of 8 years 76 CHD events occurred. FH and CAC were additive such that the highest CHD event rate was in those with both FH and CAC (15%) compared to those with CAC alone (8%, p=0.013), followed by FH alone (2.5%) and those with neither (0.7%, p<0.001) (Figure). In multivariable models adjusting for TRF, FH was independently associated with CHD (HR 2.6, 95% Cl 1.6-4.2; p<0.001). Adjustment for CAC scores did not diminish this association (HR 2.5, 95% Cl 1.5-4.1). Among those without CAC, FH remained associated with CHD (HRadj 2.5, 95% Cl (1.05-6.1). In this group FH was associated with markers of obesity, LVH, insulin resistance, and inflammation.
FH provides prognostic information that is independent and additive to CAC. Among those with CAC it identifies subjects at particularly high short term risk, and among those without it selects a group with an adverse risk factor profile.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: CT/Multimodality V
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1228M-351
- 2013 American College of Cardiology Foundation