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Familial risk assessment for early-onset coronary heart disease
Scheuner, Maren T. MD, MPH11,2; Whitworth, William C. MPH2; McGruder, Henraya PhD, MS2
Yoon, Paula W. ScD, MPH2; Khoury, Muin J. MD, PhD2

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Tables

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TABLE 1:Characteristics of respondents overall and by familial coronary heart disease risk categories (HealthStyles 2003 Survey of Health-related Attitudes and Behaviors
Among the U.S. Adult Population)a

 
Familial risk
Characteristic
Total
(n = 4035)
N (%)
Strong
(n = 1273)
N (%)
Moderate
(n = 471)
N (%)
Weak
(n = 2291)
N (%)
Sex        
  Female
2427 (60.1)
784 (61.6)
274 (58.2)
1369 (59.8)
  Male
1608 (39.9)
489 (38.4)
197 (41.8)
922 (40.2)
Age groupb
  18–34 y
700 (17.3)
122 (9.6)d
39 (8.3)d
539 (23.5)
  35–44 y
1104 (27.4)
293 (23.0)
130 (27.6)
681 (29.7)
  45–54 y
1010 (25.0)
353 (27.7)
143 (30.4)
514 (22.4)
  55–64 y
558 (13.8)
234 (18.4)d
69 (14.6)
255 (11.1)
  65+ y
663 (16.4)
271 (21.3)d
90 (19.1)
302 (13.2)
Race/ethnicity
  White
2901 (71.9)
979 (76.9)d
368 (78.1)d
1554 (67.8)d
  African American
493 (12.2)
124 (9.7)
38 (8.1)
331 (14.4)
  Hispanic
449 (11.1)
115 (9.0)
45 (9.6)
289 (12.6)
  Asian
139 (3.4)
35 (2.7)
13 (2.8)
91 (4.0)
  Other
53 (1.3)
20 (1.6)
7 (1.5)
26 (1.1)
Educationc
  ≤High school graduate
1317 (32.6)
457 (35.9)
120 (25.5)
740 (32.3)
  Some college
1318 (32.7)
398 (31.3)
165 (35.0)
755 (33.0)
  ≥College graduate
1128 (28.0)
346 (27.2)
156 (33.1)
626 (27.3)
Income
  ≥$35,000
2290 (56.8)
703 (55.2)
303 (64.3)
1284 (56.0)
  <$35,000
1745 (43.2)
570 (44.8)
168 (35.7)
1007 (44.0)
Marital status
  Ever married or cohabitating
3508 (86.9)
1142 (89.7)
427 (90.7)
1939 (84.6)
  Never married
527 (13.1)
131 (10.3)
44 (9.3)
352 (15.4)
Early-onset CHD
178 (4.4)
122 (9.6)d
16 (3.4)
40 (1.7)d
Late-onset CHD
79 (2.0)
43 (3.4)
13 (2.8)
23 (1.0)
Early-onset stroke
121 (3.0)
65 (5.1)d
18 (3.8)
38 (1.7)
Late-onset stroke
50 (1.2)
28 (2.2)
2 (0.4)
20 (0.9)
Diabetes
495 (12.3)
213 (16.7)d
50 (10.6)
232 (10.1)
Obesity
700 (17.3)
274 (21.5)d
82 (17.4)
344 (15.0)
Hypertension
1336 (33.1)
539 (42.3)d
158 (33.5)
639 (27.9)d
Hypercholesterolemia
1376 (34.1)
548 (43.0)d
193 (41.0)
635 (27.7)d

CHD, coronary heart disease.
a Early-onset CHD, disease at or before age 60 years; late-onset CHD, disease after age 60 years.
b Mean age (standard deviation) for total population, 48.4 years (14.4); for strong familial risk, 52.2 years (13.7), P<.0001; moderate familial risk, 51.0 years (13.6),
P < .0001; and weak familial risk, 45.7 (14.5), P < .0001. P values compared mean values with the mean age (48.4 years) among all respondents.
c Educational status missing for 272 respondents.
d Significant (<.05) P values corrected for 81 comparisons of frequencies of characteristics with frequencies among all respondents.

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TABLE 2: Associations between familial coronary heart disease risk categories and early-onset coronary heart disease

 
Early-onset
CHD (n = 178)
Familial risk level
Adjusted for
demographics only or (95% CI)a
Adjusted for
demographics and stroke or (95% CI)b
Adjusted for
demographics and related conditions or (95% CI)c
Adjusted for demographics,
stroke, and related conditions or (95% CI)d
Strong (n = 1273)
4.9 (3.3–7.2)
4.6 (3.1–6.8)
4.3 (2.9–6.5)
4.0 (2.7–6.0)
Moderate (n = 471)
2.0 (1.1–3.6)
1.9 (1.0–3.5)
1.8 (1.0–3.3)
1.7 (0.9–3.2)
Weak (n = 2291)
1.0
1.0
1.0
1.0

CHD, coronary heart disease; early-onset CHD, disease at or before age 60 years; late-onset CHD, disease after age 60 years; OR, odds ratio; CI, confidence interval.
aAdjusted for age, sex, ethnicity, marital status, education, and income.
bAdjusted for age, sex, ethnicity, marital status, education, income, and personal history of stroke at any age of onset.
cAdjusted for age, sex, ethnicity, marital status, education, income, and personal history of obesity, hypertension, hypercholesterolemia, and diabetes.
dAdjusted for age, sex, ethnicity, marital status, education, income, and personal history of stroke, obesity, hypertension, hypercholesterolemia, and diabetes.

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TABLE 3: Associations between familial coronary heart disease risk categories and the related conditions of obesity, hypertension, hypercholesterolemia, and diabetes

Familial risk level
Obesity
(n = 700)
or (95% CI)
Hypertension
(n = 1336)
or (95% CI)
Hypercholesterolemia
(n = 1376)
or (95% CI)
Diabetes
(n = 495)
or (95% CI)
Strong (n = 1273)
1.5 (1.3–1.8)a
1.5 (1.3–1.8)a
1.4 (1.6–1.9)a
1.6 (1.3–2.0)a
 
1.4 (1.2–1.7)b
1.4 (1.2–1.6)b
1.4 (1.2–1.7)b
1.4 (1.1–1.7)b
Moderate (n = 471)
1.2 (0.9–1.6)a
1.2 (0.9–1.5)a
1.5 (1.2–1.9)a
1.0 (0.7–1.4)a
 
1.2 (0.9–1.6)b
1.1 (0.9–1.4)b
1.5 (1.2–1.9)b
1.0 (0.6–1.3)b
Weak (n = 2291)
1.0
1.0
1.0
1.0

CHD, coronary heart disease; OR, odds ratio; CI, confidence interval.
aAdjusted for age, sex, ethnicity, marital status, education, and income.
bAdjusted for age, sex, ethnicity, marital status, education, income, and personal history of CHD at any age of onset and stroke at any age of onset.

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TABLE 4: Early-onset coronary heart disease associated with weak, moderate, and strong familial coronary heart disease risk and increasing number of related conditions including obesity, hypertension, hypercholesterolemia, and diabetes

 
Early-onset CHD (n = 178)
Number of
related
conditions
Weak
familial risk
(n = 2291)
or (95% CI)a
Moderate
familial risk
(n = 471)
or (95% CI)a
Strong
familial risk
(n = 1273)
or (95% CI)a
0 (n = 1716
1.0 (referent)
3.6 (0.6–21.9)
4.3 (1.1–17.6)
1 (n = 1203)
3.7 (1.0–13.9)
2.1 (0.21–20.0)
17.9 (5.3–61.0)
2 (n = 740)
12.6 (3.6–44.4)
27.8 (7.2–106.8)
48.6 (14.8–160.0)
≥3 (n = 376)
16.5 (4.4–61.2)
24.9 (5.2–119.7)
62.2 (18.5–209.1)

CHD, coronary heart disease; early-onset CHD, disease at or before age 60 years; OR, odds ratio; CI, confidence interval. Related conditions indicate obesity, hypertension, hypercholesterolemia, and diabetes.
aAdjusted for age, sex, ethnicity, marital status, education, and income.

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TABLE 5: Ability of different coronary heart disease risk assessment models to identify people with early-onset coronary heart disease

Risk assessment model AUC (%)
1. Familial risk + demographics + related conditions 87.2
2. Familial risk + related conditions 84.6
3. Demographics + related conditions 84.6
4. Familial risk + demographics 82.3
5. Related conditions only 80.1
6. Demographics only 76.7
7. Familial risk only 70.9

CHD, coronary heart disease; early-onset CHD, disease at or before age 60 years; AUC, area under the curve.
Demographics include age, sex, ethnicity, marital status, education, and income. Related conditions include diabetes, hypercholesterolemia, hypertension, and obesity. AUC statistics were calculated for each risk assessment model using multivariate logistic regression with personal history of earlyonset CHD as the outcome of interest. AUC values greater than 70% suggest good discriminatory ability. Model 1 includes familial risk assessment for CHD, demographic factors, and related conditions. Model 2 includes familial risk assessment and related conditions. Model 3 includes demographics and related conditions. Model 4 includes familial risk assessment and demographics. Model 5 includes only related conditions. Model 6 includes only demographic factors. Model 7 includes only familial risk assessment.

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Page last reviewed: August 22, 2006 (archived document)
Page last updated: December 11, 2007
Content Source: National Office of Public Health Genomics