Background: Family history of cardiovascular disease (CVD) is an independent risk factor for CVD. Therefore, efforts to prevent CVD among asymptomatic persons with a family history are warranted. Little is known about preventive recommendations clinicians offer their patients with a family history of CVD, and adherence to preventive recommendations by patients at risk for CVD has not been well described. Methods: We used the 2007 Oregon Behavioral Risk Factor Surveillance System to evaluate among 2,566 adults without CVD associations between family history of CVD and (a) clinician recommendations; (b) perceived risk of developing CVD; (c) adoption of preventive and screening behaviors; and (d) risk factors of CVD. Results: Compared with adults with no family history of CVD, those with a family history reported that their clinician was more likely to ask about their family history information (OR = 2.6; 95% CI, 1.9–3.4), discuss the risk of developing CVD (OR = 2.0; 95% CI, 1.6–2.5), and make recommendations to prevent CVD (OR = 2.1; 95% CI, 1.7–2.7). Family history and clinician recommendations were associated with a higher likelihood of reported changes in diet or physical activity to prevent CVD (OR = 2.7; 95% CI, 2.3–3.2). Persons with a family history of CVD were more likely to report having high cholesterol, having high blood pressure, taking aspirin, and having had their cholesterol checked. Conclusion: The presence of a family history of CVD appears to prompt clinicians to recommend preventive changes and may motivate patients without CVD to adopt these recommendations.

1.
American Heart Association: Heart disease and stroke statistics. 2008. Available at http://americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdf.
2.
Oregon Department of Human Services: The burden of heart disease and stroke in Oregon. 2007. Available at http://www.oregon.gov/DHS/ph/hdsp/docs/2007BurdenReport.pdf.
3.
Friedlander Y, Kark JD, Stein Y: Family history of myocardial infarction as an independent risk factor for coronary heart disease. Br Heart J 1985;53:382–387.
4.
Hoseini K, Sadeghian S, Mahmoudian M, Hamidian R, Abbasi A: Family history of cardiovascular disease as a risk factor for coronary artery disease in adult offspring. Monaldi Arch Chest Dis 2008;70:84–87.
5.
Leander K, Hallqvist J, Reuterwall C, Ahlbom A, de Faire U: Family history of coronary heart disease, a strong risk factor for myocardial infarction interacting with other cardiovascular risk factors: results from the Stockholm Heart Epidemiology Program (SHEEP). Epidemiology 2001;12:215–221.
6.
Lloyd-Jones DM, Nam BH, D’Agostino RB, Levy D, Murabito JM, Wang TJ, Wilson PW, O’Donnell CJ: Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA 2004;291:2204–2211.
7.
Nora JJ, Lortscher RH, Spangler RD, Nora AH, Kimberling WJ: Genetic–epidemiologic study of early-onset ischemic heart disease. Circulation 1980;61:503–508.
8.
Scheuner MT, Wang SJ, Raffel LJ, Larabell SK, Rotter JI: Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood. Am J Med Genet 1997;71:315–324.
9.
Scheuner MT, Whitworth WC, McGruder H, Yoon PW, Khoury MJ: Familial risk assessment for early-onset coronary heart disease. Genet Med 2006;8:525–531.
10.
McCusker ME, Yoon PW, Gwinn M, Malarcher AM, Neff L, Khoury MJ: Family history of heart disease and cardiovascular disease risk-reducing behaviors. Genet Med 2004;6:153–158.
11.
Oregon Department of Human Services: Oregon BRFSS–behavioral risk factor surveillance system. 2007. Available at http://www.dhs.state.or.us/dhs/ph/chs/brfs/brfss.shtml.
12.
CDC: U.S. physical activity statistics – definitions. 2007. Available at http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm.
13.
U.S. Preventive Services Task Force: Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. AHRQ publication No 08-05114-EF-2. 2008. Available at http://www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm.
14.
StataCorp: Stata statistical software for professionals. 2008. Available at http://www.stata.com/
15.
Hunt SC, Gwinn M, Adams TD: Family history assessment: strategies for prevention of cardiovascular disease. Am J Prev Med 2003;24:136–142.
16.
Swanson JR, Pearson TA: Screening family members at high risk for coronary disease. Why isn’t it done? Am J Prev Med 2001;20:50–55.
17.
Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA: AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and coordinating committee. Circulation 2002;106:388–391.
18.
National Cholesterol Education Program (NCEP): Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III), final report. Circulation 2002;106:3143–3421.
19.
Ridker PM, Buring JE, Rifai N, Cook NR: Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA 2007;297:611–619.
20.
Harris EL, McMullen C: Family history in clinical practice. 2006. Available at http://egov.oregon.gov/DHS/ph/genetics/docs/Family_History.pdf.
21.
Walter FM, Emery J: Perceptions of family history across common diseases: a qualitative study in primary care. Fam Pract 2006;23:472–480.
22.
DiLorenzo TA, Schnur J, Montgomery GH, Erblich J, Winkel G, Bovbjerg DH: A model of disease-specific worry in heritable disease: the influence of family history, perceived risk and worry about other illnesses. J Behav Med 2006;29:37–49.
23.
Marteau TM, Lerman C: Genetic risk and behavioural change. BMJ 2001;322:1056–1059.
24.
Becker DM, Levine DM: Risk perception, knowledge, and lifestyles in siblings of people with premature coronary disease. Am J Prev Med 1987;3:45–50.
25.
Kip KE, McCreath HE, Roseman JM, Hulley SB, Schreiner PJ: Absence of risk factor change in young adults after family heart attack or stroke: the CARDIA Study. Am J Prev Med 2002;22:258–266.
26.
Baptiste-Roberts K, Gary TL, Beckles GL, Gregg EW, Owens M, Porterfield D, Engelgau MM: Family history of diabetes, awareness of risk factors, and health behaviors among African Americans. Am J Public Health 2007;97:907–912.
27.
Harrison TA, Hindorff LA, Kim H, Wines RC, Bowen DJ, McGrath BB, Edwards KL: Family history of diabetes as a potential public health tool. Am J Prev Med 2003;24:152–159.
28.
Valdez R, Greenlund KJ, Khoury MJ, Yoon PW: Is family history a useful tool for detecting children at risk for diabetes and cardiovascular diseases? A public health perspective. Pediatrics 2007;120:S78–S86.
29.
Chen J, Millar WJ: Heart disease, family history and physical activity. Health Rep 2001;12:23–32.
30.
Martin S, Elosua R, Covas MI, Pavesi M, Vila J, Marrugat J: Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease. Am J Public Health 1999;89:383–385.
31.
Tonstad S, Sundfor T, Seljeflot I: Effect of lifestyle changes on atherogenic lipids and endothelial cell adhesion molecules in young adults with familial premature coronary heart disease. Am J Cardiol 2005;95:1187–1191.
32.
Hopkins PN, Williams RR, Hunt SC: Magnified risks from cigarette smoking for coronary prone families in Utah. West J Med 1984;141:196–202.
33.
Roncaglioni MC, Santoro L, D’Avanzo B, Negri E, Nobili A, Ledda A, Pietropaolo F, Franzosi MG, La Vecchia C, Feruglio GA: Role of family history in patients with myocardial infarction. An Italian case-control study. GISSI-EFRIM investigators. Circulation 1992;85:2065–2072.
34.
Ciruzzi M, Schargrodsky H, Rozlosnik J, Pramparo P, Delmonte H, Rudich V, Piskorz D, Negri E, Soifer S, La Vecchia C: Frequency of family history of acute myocardial infarction in patients with acute myocardial infarction. Argentine FRICAS (Factores de Riesgo Coronario en America del Sur) investigators. Am J Cardiol 1997;80:122–127.
35.
Khaw KT, Barrett-Connor E: Family history of heart attack: a modifiable risk factor? Circulation 1986;74:239–244.
36.
Health and Human Services: Dietary guidelines for Americans. 2005. Available at http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf.
37.
Zlot AI, Bland MP, Silvey K, Epstein B, Mielke B, Leman RF: Influence of family history of diabetes on health care provider practice and patient behavior among nondiabetic Oregonians. Prev Chronic Dis 2009;6:A27.
38.
U.S. Preventive Services Task Force: Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med 2002;136:157–160.
39.
O’Connor PJ, Pronk NP, Tan AW, Rush WA, Gray RJ: Does professional advice influence aspirin use to prevent heart disease in an HMO population? Eff Clin Pract 1998;1:26–32.
40.
Slattery ML, Schumacher MC, Hunt SC, Williams RR: The associations between family history of coronary heart disease, physical activity, dietary intake and body size. Int J Sports Med 1993;14:93–99.
41.
Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA: Reliability and validity of measures from the behavioral risk factor surveillance system (BRFSS). Soz Praventivmed 2001;46:S3–S42.
42.
Kee F, Tiret L, Robo JY, Nicaud V, McCrum E, Evans A, Cambien F: Reliability of reported family history of myocardial infarction. BMJ 1993;307:1528–1530.
43.
Murabito JM, Nam BH, D’Agostino RB, Lloyd-Jones DM, O’Donnell CJ, Wilson PW: Accuracy of offspring reports of parental cardiovascular disease history: the Framingham Offspring Study. Ann Intern Med 2004;140:434–440.
44.
Silberberg JS, Wlodarczyk J, Fryer J, Ray CD, Hensley MJ: Correction for biases in a population-based study of family history and coronary heart disease. The Newcastle Family History Study I. Am J Epidemiol 1998;147:1123–1132.
45.
Williams RR, Hunt SC, Heiss G, Province MA, Bensen JT, Higgins M, Chamberlain RM, Ware J, Hopkins PN: Usefulness of cardiovascular family history data for population-based preventive medicine and medical research (the Health Family Tree Study and the NHLBI Family Heart Study). Am J Cardiol 2001;87:129–135.
46.
Watt G, McConnachie A, Upton M, Emslie C, Hunt K: How accurately do adult sons and daughters report and perceive parental deaths from coronary disease? J Epidemiol Community Health 2000;54:859–863.
47.
Centers for Disease Control and Prevention (CDC): Behavioral risk factor surveillance system survey data. 2008. Available at http://apps.nccd.cdc.gov/brfss/index.asp.
48.
Tavani A, Augustin L, Bosetti C, Giordano L, Gallus S, Jenkins DJ, La Vecchia C: Influence of selected lifestyle factors on risk of acute myocardial infarction in subjects with familial predisposition for the disease. Prev Med 2004;38:468–472.
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