BackgroundFamily history of atherosclerotic cardiovascular disease (ASCVD) is easily accessible and captures genetic cardiovascular risk, but its prognostic value in secondary prevention is unknown.Methods and ResultsWe followed 25 615 patients registered in SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) from their 1‐year revisit after a first‐time myocardial infarction during 2005 to 2013, until December 31, 2018. Data on relatives, diagnoses and socioeconomics were extracted from national registers. The association between family history and recurrent ASCVD was studied with Cox proportional‐hazard regression, adjusting for risk factors and socioeconomics. A family history of ASCVD was defined as hospitalization due to myocardial infarction, angina with coronary revascularization, stroke, or cardiovascular death in ≥1 parent or full sibling, with early‐onset defined as disease‐onset before 55 years in men and 65 in women. The additional discriminatory value of family history to Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was assessed with Harrell’s C‐index difference and reclassification was studied with continuous net reclassification improvement. Family history of early‐onset ASCVD in ≥1 first‐degree relative was present in 2.3% and was associated with recurrent ASCVD (hazard ratio [HR] 1.31; 95% CI, 1.17–1.47), fully adjusted for risk factors (HR, 1.22; 95% CI, 1.05–1.42). Early‐onset family history improved the discriminatory ability of the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, with Harrell’s C improving 0.003 points (95% CI, 0.001–0.005) from initial 0.587 (95% CI, 0.576–0.595) and improved reclassification (continuous net reclassification improvement 2.1%, P<0.001).ConclusionsFamily history of early‐onset ASCVD is associated with recurrent ASCVD after myocardial infarction, independently of traditional risk factors and improves secondary risk prediction. This may identify patients to target for intensified secondary prevention.

中文翻译：

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心血管家族史增加第一次心肌梗死后疾病复发的风险

背景动脉粥样硬化性心血管疾病 (ASCVD) 的家族史很容易获得并捕捉到遗传性心血管风险，但其在二级预防中的预后价值尚不清楚。方法和结果我们跟踪了在 SWEDEHEART（瑞典网络增强和发展证据系统）中注册的 25 615 名患者根据推荐疗法评估的心脏病基础护理）从 2005 年至 2013 年首次心肌梗死后的 1 年复诊，直至 2018 年 12 月 31 日。亲属、诊断和社会经济学的数据来自国家登记册。使用 Cox 比例风险回归研究了家族史与复发性 ASCVD 之间的关联，并根据风险因素和社会经济学进行了调整。ASCVD家族史定义为因心肌梗塞住院，≥1 名父母或同胞的心绞痛伴冠状动脉血运重建、卒中或心血管死亡，早发定义为男性 55 岁之前发病，女性 65 岁之前发病。使用 Harrell 的 C 指数差异评估家族史对二级预防的心肌梗死风险评分的溶栓的额外鉴别价值，并通过持续净重新分类改进研究重新分类。≥1 名一级亲属的早发性 ASCVD 家族史占 2.3%，并且与复发性 ASCVD 相关（风险比 [HR] 1.31；95% CI，1.17-1.47），完全调整了风险因素（HR， 1.22；95% CI，1.05–1.42）。早发家族史提高了二级预防的心肌梗塞溶栓风险评分的鉴别能力，Harrell's C 提高了 0。P <0.001)。结论早发性 ASCVD 家族史与心肌梗死后复发性 ASCVD 相关，独立于传统危险因素，并提高了继发性风险预测。这可以确定患者以加强二级预防。