Context Whether parental cardiovascular disease confers increased risk independent
of other risk factors remains controversial. Prior studies relied on offspring
report, without complete validation of parental events.
Objective To determine whether parental cardiovascular disease predicts offspring
events independent of traditional risk factors, using a prospective design
for both parents and offspring, and uniform criteria to validate events.
Design Inception cohort study.
Setting Framingham Heart Study, a US population-based epidemiologic cohort begun
in 1948 with the offspring cohort established in 1971.
Participants All Framingham Offspring Study participants (aged ≥30 years) who
were free of cardiovascular disease and both parents in the original Framingham
Main Outcome Measures We examined the association of parental cardiovascular disease with
8-year risk of offspring cardiovascular disease, using pooled logistic regression.
Results Among 2302 men and women (mean age, 44 years), 164 men and 79 women
had cardiovascular events during follow-up. Compared with participants with
no parental cardiovascular disease, those with at least 1 parent with premature
cardiovascular disease (onset age <55 years in father, <65 years in
mother) had greater risk for events, with age-adjusted odds ratios of 2.6
(95% confidence interval [CI], 1.7-4.1) for men and 2.3 (95% CI, 1.3-4.3)
for women. Multivariable adjustment resulted in odds ratios of 2.0 (95% CI,
1.2-3.1) for men and 1.7 (95% CI, 0.9-3.1) for women. Nonpremature parental
cardiovascular disease and parental coronary disease were weaker predictors.
Addition of parental information aided in discriminating event rates, notably
among offspring with intermediate levels of cholesterol and blood pressure,
as well as intermediate predicted multivariable risk.
Conclusions Using validated events, we found that parental cardiovascular disease
independently predicted future offspring events in middle-aged adults. Addition
of parental information may help clinicians and patients with primary prevention
of cardiovascular disease, when treatment decisions may be difficult in patients
at intermediate risk based on levels of single or multiple risk factors. These
data also support further research into genetic determinants of cardiovascular