Family history of premature cardiovascular disease: blood pressure control and long-term mortality outcomes in hypertensive patients

Williamson, C. et al. (2014) Family history of premature cardiovascular disease: blood pressure control and long-term mortality outcomes in hypertensive patients. European Heart Journal, 35(9), pp. 563-570. (doi:10.1093/eurheartj/eht539)

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Publisher's URL: http://dx.doi.org/10.1093/eurheartj/eht539

Abstract

<b>Aims</b> Current guidelines recommend early referral and initiation of intensive cardiovascular (CV) risk reduction in individuals with a positive family history of coronary heart disease (CHD). We hypothesized that a family history of premature CHD and stroke [CV disease (CVD)] would lead to earlier referral of hypertensive patients to secondary care clinic, leading to better control of risk factors, mitigating the excess risk seen in these individuals.<p></p> <b>Methods and results</b> We studied the association of a positive family history of CVD in 10 787 individuals with longitudinal changes in risk factors and long-term cause-specific mortality in the Glasgow Blood Pressure Clinic using generalized estimating equations and the Cox proportional hazard models, respectively. The total time at risk was 193 756 person-years with a median survival time of 29.2 years. A positive family history of CVD was associated with an earlier presentation to the clinic, a lower burden of traditional CV risk factors, and similar longitudinal blood pressure reduction and drug adherence compared with those without. But despite these positive features, all-cause [hazard ratio (HR) = 1.12, 95% confidence interval 1.01–1.25] and CV (HR = 1.20, 1.04–1.38) mortality independent of baseline risk factors were worse. Consistent results were observed in propensity score-matched analysis. Inclusion of family history of CVD did not improve mortality risk discrimination over and above traditional risk factors.<p></p> <b>Conclusion</b> Our study suggests that despite earlier referral and treatment of individuals with a positive family history of premature CVD, excess risk persists, indicating the need for continued and sustained efforts to reduce risk factors and drug adherence in these individuals.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hastie, Dr Claire and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna and Williamson, Miss Catherine and Morrison, Dr David and Sloan, Mr William and Pell, Professor Jill and Mccallum, Dr Linsay and Dawson, Professor Jesse and Muir, Dr Scott and Walters, Professor Matthew
Authors: Williamson, C., Jeemon, P., Hastie, C. E., Mccallum, L., Muir, S., Dawson, J., Walters, M., Sloan, W., Morrison, D., Dominiczak, A. F., Pell, J., and Padmanabhan, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal
Journal Abbr.:Eur. heart j.
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
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