Positive Parental History Research Articles

Parental history of premature coronary heart disease mortality and signs of ischemia on the resting electrocardiogram

OBJECTIVESHere we explore the association between a family history of premature coronary heart disease (CHD) death and ischemic electrocardiogram (ECG) findings in the offspring.BACKGROUNDIn the general population, signs of ischemia are found on the resting ECG in about 10% of middle-aged men and women. Their independent predictive value for CHD morbidity and mortality has been shown in several studies.METHODSOur results are based on cross-sectional data from three large epidemiological studies performed in Belgium during the past two decades: the Belgian Heart Disease Prevention Project (n = 8,145), the Belgian Interuniversity Research on Nutrition and Health survey (n = 7,625) and the MONICA project (n = 3,193). A parental history of fatal CHD was considered premature if the father died from CHD before age 60 or the mother before age 70. Ischemic ECG findings were defined according to Minnesota Code criteria I1–3, IV1–3, V1–3or VII1.RESULTSSubjects with a parental history of premature CHD death were found to have experienced significantly more frequently symptomatic CHD. After exclusion of symptomatic individuals, no major differences in lifestyle-related risk factors were found between the groups with and without a parental history of premature fatal CHD. After multivariate adjustment for age, smoking, body mass index and sex, the odds ratios (and 95% confidence interval [CI]) for ECG ischemia associated with a positive parental history of premature death were 1.42 (1.10–1.82), 1.47 (1.16–1.88) and 1.37 (0.78–2.41) in the three studies. Additional adjustment for systolic blood pressure, total cholesterol and, if available, lifestyle-related factors did not alter the magnitude of the odds ratios. Overall, in men aged 45 to 64 years, ECG ischemia was significantly more frequent (36% excess) in those with positive parental history.CONCLUSIONSSubjects in whom one or both parents died prematurely from cardiac-related diseases have signs of ischemia more frequently on their electrocardiogram, and this is independent of other risk factors.

CARDIORESPIRATORY FITNESS AND 24-H AMBULATORY BLOOD PRESSURE IN WOMEN WITH FAMILY HISTORY OF HYPERTENSION.

1701 We investigated the relationship between cardiorespiratory fitness and 24-h ambulatory blood pressure in women who have a family history of hypertension. Women (n=5) with positive parental family history of hypertension (+FH) were matched on age (18-47 y) and percent body fat (dual-energy x-ray absorptiometry) with women (n=5) with negative family history of hypertension(-FH). Subjects performed a maximal cycle exercise test to determine VO2peak and wore an ambulatory blood pressure monitor for 24 h on each of two occasions separated by 7 d. Subjects also kept a daily diary which recorded physical activity, postural changes, and sleep. A median split on VO2peak yielded groups of low (29.85ml·kg-1) and moderate(36.89ml·kg-1) levels of fitness. VO2peak did not differ between the +FH and -FH women (p=.306), though there were more -FH women than+FH women in the low fitness group. Ambulatory data were analyzed for 24-h averages, awake averages, and sleep averages. Comparisons were made separately in the fitness and family history classification groups on resting systolic(SBP) and diastolic (DBP) blood pressure and on 24-h ambulatory SBP and DBP. Moderately fit women had lower resting SBP (p=.027), 24-h SBP (p=.034), awake SBP (p=.027), and sleeping SBP (p=.048) when compared to the low fit group. The -FH women had significantly lower awake SBP (p=.04) than +FH women. Results from this study suggest that there is a positive relationship between cardiorespiratory fitness and lower SBP in women differing in family history of hypertension.

Apolipoprotein E genotypes in offspring with a positive and negative family history of premature myocardial infarction.

Apolipoprotein E (apo-E) allele and genotype frequencies were evaluated in offspring with positive (MI-offspring) and negative (control-offspring) parental history of myocardial infarction (MI). The apo-E allele frequencies in MI- and control-offspring were as follows: epsilon2: 9.04 and 2.08% (p < 0.02), epsilon3: 84.04 and 87.5%, epsilon4: 6.91 and 10.41%, respectively. The frequencies of the E2-genotypes were significantly lower in offspring of controls (4.2%, 17.0%, respectively, p < 0.03). The epsilon2-allele is associated with raised plasma triglyceride concentrations in subjects on a diet high in saturated fat. We therefore hypothesize that offspring carrying an epsilon2-allele are predisposed to develop disturbance of plasma triglyceride metabolism when exposed to a traditional Slovak high-fat diet and/or weight gain, resulting in altered lipid levels and increased predisposition to atherosclerosis.

Exercise training in female patients with a family history of hypertension.

The purpose of this study was to determine whether there are differences in the effects of exercise training between those with a parental history of hypertension and those without such a history. A group of 39 middle-aged hypertensive women were submitted to a 4-month exercise training programme. On the basis of their family histories, 18 individuals were classified as those having a positive parental history of hypertension (group P) and 21 individuals as those without such a history (group N). Both groups participated in a supervised training programme with the intensity set at the level producing the threshold lactate concentration for 90-120 min twice a week, together with self-determined aerobic exercise three times a week. Vital age was estimated to determine the health-fitness status. At the end of the training, group N exhibited reductions in the systolic and diastolic blood pressures at rest (12.6/ 8.0 mmHg) and increases in the peak oxygen uptake [VO2peak 21.1 (SD 5.2) vs 25.2 (SD 5.7) ml x kg(-1) x min(-1)] and oxygen uptake corresponding to lactate threshold [13.7 (SD 2.4) vs 17.0 (SD 2.0) ml x kg(-1) min(-1); P < 0.05]. Group P also showed reductions in the resting blood pressures (8.9/2.9 mmHg; P < 0.05), with no change in VO2peak (P > 0.05). There were no changes in the blood lipid and haematocrit variables in either group. The vital age decreased by approximately 4 and 7 years (P < 0.05) for groups P and N, respectively. These results would indicate that exercise training is a useful, nonpharmacological tool for the treatment of essential hypertension, especially in patients with no family history of arterial hypertension.

Effects of parental history of hypertension and urbanization on blood pressure in zimbabweans

The increasing prevalence of essential hypertension is a growing public health concern for Zimbabwe and other African countries. Two important risk factors for hypertension are urbanization and parental history of hypertension. The relations among parental history of hypertension, urbanization, and blood pressures (BPs) are poorly understood. The objective of this study is to clarify these relations in a population of urbanized, African, young adults. The relation between parental history of hypertension and urbanization on resting BP's and Bp responses to a mental arithmetic stressor was examined in a group of normotensive, Black medical students with (n = 36) and without (n = 34) a parental history of high BP, and with (n = 49) and without (n = 19) a parental history of urbanization. Results indicate that those with a positive parental history counterparts. Further, those with parents residing in urban areas had higher resting SBPs than those with parents residing in rural areas. However, no reactivity differences were apparent between the urban and rural parent groups. These data suggest that although parental history for hypertension influences both resting and reactivity BP's parental history of urbanization may influence only resting BP.

Anger expression and incident hypertension.

It has long been thought that anger is important in the development of essential hypertension. However, tests of this hypothesis have yielded conflicting findings. This study prospectively examined the relationship between anger expression style and incident hypertension in a population sample of middle-aged men. Participants were 537 initially normotensive men from eastern Finland, who completed a medical examination and series of psychological questionnaires at baseline and at 4-year follow-up. Anger expression was assessed by Spielberger's Anger-out and Anger-in scales. At follow-up, 104 men (19.4%) were hypertensive (blood pressure > or = 165 mm Hg systolic and/or 95 mm Hg diastolic). Age-adjusted logistic regression analyses revealed that each 1-point increase in Anger-out was associated with a 12% increase in risk of hypertension after 4 years of follow-up (p < .002), which corresponded to a two-fold increased risk of hypertension among men with scores in the top tertile of the Anger-out scale, relative to those with scores in the bottom tertile (odds ratio = 2.00, 95% confidence interval 1.20-3.38). Each 1-point increase on the Anger-in scale also was related to a 12% increased risk of hypertension (p < .01). Adjustments for body mass index, smoking, alcohol consumption, physical activity, a positive parental history of hypertension, and baseline resting diastolic blood pressure had little impact on the findings. These data provide strong epidemiological evidence for a positive relationship between anger expression style and subsequent hypertension, independent of known risk factors. Findings support the hypothesis that extreme expression of anger in either direction has adverse cardiovascular consequences.

Coping and Parental History of Cardiovascular Disorders Influence Blood Pressure in Women Tested During Different Phases of Their Menstrual Cycles

An anger-provocation paradigm was used to assess coping and stress reactivity in 20 women with a positive parental history of cardiovascular disorders and 14 women whose parents had no cardiovascular disease. Frequency of seeking social support in the natural environment was assessed, as were systolic and diastolic blood pressures, while the women performed anger-inducing arithmetic and speech-stressor tasks during the premenstrual and post-menstrual phases. Premenstrually, the women with a positive cardiac history sought support less frequently than those with a negative history. No differences were found between the groups postmenstrually. When the women were identified according to the frequency with which they sought social support, those who more often sought support registered lower baseline blood pressure levels than those women who less often sought support during both cycle phases. Extending the stress-buffering effects of social support to include efforts at seeking support is discussed.

Longitudinal Changes in Cardiovascular Risk From Childhood to Young Adulthood in Offspring of Parents With Coronary Artery Disease

Although the association between parental coronary artery disease (CAD) and its risk factors in the offspring is known, the timing and the course of development of risk factors from childhood to adulthood in the offspring is not known. To examine the association between parental CAD and longitudinal changes in risk factor profile from childhood to young adulthood in offspring. Cohort study. Bogalusa, La, a semirural, biracial community. Individuals with clinically verified parental history of CAD (n=271) vs those without such a history (n = 1253) Mean age at first CAD event was 50 years for fathers and 52 years for mothers. Body mass index, subscapular skinfolds, blood pressure, and triglyceride, cholesterol (total, very low-density lipoprotein [VLDL-C], low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C] cholesterols), glucose, and insulin levels. The offspring of parents with CAD were consistently overweight beginning in childhood. Their levels of total serum cholesterol, LDL-C, plasma glucose, and insulin became significantly higher at older ages, because of a higher rate of increase in these risk factors over time. In adulthood, the offspring with a positive parental history had a higher prevalence of obesity (body mass index >85th percentile in the National Health and Nutrition Examination Survey I, 35% vs 26%, P=.01), elevated total cholesterol (>6.2 mmol/L [240 mg/dL], 8.4% vs 4.8%, P=.05) and LDL-C levels (>4.1 mmol/L [160 mg/dL], 12.4% vs 4.7%, P=.05), and hyperglycemia (glucose, >6.6 mmol/L, 2.7% vs 0.4%, P<.001), as well as a higher coexistence of these conditions (P=.01). Further, the prevalence of dyslipidemia, either involving only LDL-C or LDL-C in combination with HDL-C or triglycerides or both, was significantly higher in the adult offspring with parental CAD. Offspring of parents with early CAD were overweight beginning in childhood and developed an adverse cardiovascular risk factor profile at an increased rate. These observations have important implications for prevention and intervention.

Myopia Development in Childhood

The Orinda Longitudinal Study of Myopia is a 12-year project examining predictive factors for the onset of myopia, the underlying etiologies of myopia, and normal eye growth in school children. This paper reports on all measurements made of the ocular components (cycloplegic refractive error, corneal curvature, crystalline lens power, and axial ocular dimensions), parental history of myopia, and near work activity in children participating in the Orinda Longitudinal Study of Myopia between 1989 and 1993. An analysis of the interaction between parental history of myopia and children's near work is conducted on the cross-sectional study data from 1993. The cross-sectional and longitudinal data show a gradual decrease in refractive error from low hyperopia toward emmetropia, no shift in corneal curvature, a gradual decrease in crystalline lens power, thinning of the crystalline lens, and elongation of the eye between the ages of 6 and 14 years. Parental history is more contributory to a statistical model predicting myopia than is near work, but near work is a significant factor as well. We can find no evidence of statistical interaction between parental history and near work in explaining the presence or absence of myopia. The emmetropization process is evident in the gradual decrease in refractive error toward emmetropia, the axial elongation of the eye, and the compensating decrease in crystalline lens power. Both nature and nurture play a role in the etiology of myopia, although the predominant role appears to belong to a positive parental history of myopia. This role does not appear to be through an interaction between parental myopia status and children's near work activity.

Parental history of cardiovascular disease and risk of stroke. A prospective follow-up of 14371 middle-aged men and women in Finland.

Studies on risk factors for stroke have been less intensive than those for coronary disease. Only a few studies have addressed the question of the role of heredity in the occurrence of stroke. We analyzed whether a positive parental history of cardiovascular disease predicts the risk of stroke independently from other risk factors and whether the role of parental history varies by age and stroke subtypes. This study was a prospective follow-up of 14371 middle-aged men and women. A positive parental history of cardiovascular disease was defined as either stroke or coronary disease before the age of 60 years. The end point of the follow-up was an incident case of stroke. Multivariate analyses were performed with the Cox proportional hazards model. The risk ratio of stroke after multifactorial adjustment (age, smoking, blood pressure, cholesterol, diabetes, and education) associated with a positive parental history of stroke was 1.89 (P = .004) in men and 1.80 (P = .007) in women. The association between parental history of stroke and the risk of stroke was stronger among subjects aged 25 to 49 years than among older subjects. Parental history of coronary disease was not associated with the risk of stroke in men, but in women it had a borderline significant association with the risk of ischemic stroke. A positive parental history of stroke predicted the risk of stroke independently from the other risk factors.

Diurnal blood pressure rhythm in hypertensives with parental history of stroke.

To investigate whether the lack of nocturnal decline of blood pressure (nondipper) is a primary cause of stroke or a secondary abnormality due to stoke, we examined the relation between the blood pressure variation and parental history of stroke in 110 hypertensive patients. In nondippers (n = 54), the frequency of positive parental history of stroke was significantly higher than in dippers (n = 56) (53.7% v 33.9%, chi2 = 4.37, P = .0366). We observed a significant increase in the incidence of positive parental history of stroke in nondippers, suggesting that some genetic factors may regulate blood pressure profiles before stroke develops.

HEMODYNAMIC RESPONSES TO EXERCISE IN CHILDREN OF HYPERTENSIVE PARENTS 91

This study was designed to investigate whether children with a positive parental history of hypertension exhibit an elevated resting blood pressure(BP) or an exaggerated BP response during dynamic submaximal exercise. We studied 11 children (12.0 ± 2.4 yrs) of at least one hypertensive parent and 11 children (12.2 ± 1.8 yrs; M ± SE) of normotensive parents who served as the control group. On separate days, each subject completed a graded cycle test to maximal effort and a submaximal exercise bout consisting of 6 min each of steady state cycling at 50 and 80% of maximal heart rate reserve. BP, cardiac output (CO), and total peripheral resistance(TPR) were measured at rest and during the last 3 min of each submaximal exercise stage. CO was determined using transthoracic impedance cardiography, BP was measured by auscultation, and TPR was calculated as mean arterial pressure (MAP) divided by CO. The data were analyzed using an independent t-test and a 2-way (group x intensity) ANOVA. The groups were similar in age, weight, height, and body fatness (p<0.05). At rest, the positive history group had higher systolic BP, diastolic BP (DBP), and MAP (p<0.05). MAP and DBP remained significantly higher throughout exercise. Although differences between groups were not statistically significant, TPR was consistently higher(15-20%) in the positive history group at rest and during exercise, while CO tended to be slightly lower during exercise (p>0.05). In conclusion, children of at least one hypertensive parent exhibit a significantly higher MAP and DBP at rest and during submaximal exercise. The elevated BP in the positive history group may be due to an early trend towards a higher TPR at rest and during exercise.

Verification of parental history of coronary artery disease and associations with adult offspring risk factors in a community sample: the Bogalusa Heart Study.

Positive parental history of coronary artery disease (CAD) (myocardial infarction, angina, angioplasty, bypass surgery) reported by 371 of 1,930 black and white adults aged 18 to 31 years in 1988 to 1991 in the Bogalusa Heart Study was verified by interviewing parents or next-of-kin. Error rates in reporting information concerning parental CAD and risk factors in offspring with a positive and negative parental history of CAD were examined. The 371 subjects who reported a positive parental history represented 304 families. Parental CAD could not be verified in 43 (14.1%) instances, and false-positive reports occurred in 45 (14.8%) cases. Among 216 families with confirmed CAD histories, the father had CAD in 175 (81.0%) cases and the mother in 70 (32.4%) cases. Both parents had CAD in 29 (13.4%) families. Of the parents with CAD, 46% of the fathers and 25% of the mothers died. The mean age at clinical onset of CAD was 51 years. Offspring with a confirmed positive parental history (n = 271) had significantly higher (P < 0.05) adjusted serum total and low-density lipoprotein cholesterol, plasma insulin and glucose, body mass index, and triceps and subscapular skinfolds than subjects with a negative parental history (n = 1,253). Those with an unconfirmed positive parental history (n = 51) had higher mean plasma insulin and serum high-density lipoprotein levels than those with a negative parental history; low-density lipoprotein levels were similar. Family history of CAD remains a useful indicator for screening adults at risk of developing CAD. An unverified family history may underestimate the importance of particular risk factors in epidemiologic studies.

Parental history, aversive exposure and the development of snake and spider phobia in women

Parental history and experiential factors in the development of snake and spider phobia were studied. Phobic women (DSM-IV, n = 158) reported on family history of animal phobia and whether direct (being frightened by the phobic object) or indirect (seeing someone else being frightened by and/or being warned of the phobic object) fear exposure predated phobia development. Fifty-nine mothers (37%) and 11 fathers (7%) had snake or spider phobia, which is higher than the upper 95% confidence interval in the population (Fredrikson, Annas, Fischer & Wik, Behavior Research and Therapy, 34, 33–39). Lifetime Relative Risk, RR, of animal phobia in probands' mothers and fathers as a function of at least one phobic grandparent was 3.3 and 13.7 respectively. Indirect fear exposures were more common in snake (45%) than spider (27%) phobics (RR = 1.4). Indirect fear exposures were more common among probands with a positive parental history, the RRs being 3.6 and 2.1 as a function of maternal and paternal family history. Direct exposures were unrelated to parental history. The familial resemblance and transmission of specific phobia could be experiential in origin mediated by indirect exposures or of hereditary origin mediated by genetic factors. It may represent genetically facilitated learning and exemplify imprinting in humans.

Identification of two novel LDL receptor gene defects in French-Canadian pediatric population: Mutational analysis and biochemical studies

Familial hypercholesterolemia (FH) is at least twofold more prevalent in French Canadians from Québec than in most Western populations. Although our recent data confirmed this high frequency of heterozygous FH in our pediatric population with hypercholesterolemia, none of the five established molecular defects for the French-Canadian population was detected in 29% of the unrelated French-Canadian children characterized by a persistent increase in LDL (low density lipoprotein receptor) cholesterol and a positive parental history of hyperlipidemia (Assouline et al., 1995). To probe for new mutations, six of these molecularly undiagnosed children were investigated as index patients. By using single-strand conformation polymorphism analysis and DNA sequencing, two novel mutations were identified in two of these subjects: (1) 7-base pair (bp) duplication following nucleotide 681 (according to the cDNA sequence) in exon 4 (681ins7), which causes a frameshift, the introduction of a stop at codon 208, and premature chain termination, and (2) A to G change in exon 8 substituting a tyrosine for a cysteine at amino acid 354 (Y354C). A third subject carried the recently reported exon 10 mutation (Y468X), whereas the remaining three patients demonstrated various known polymorphisms with no effect on gene product. Rapid molecular assays were developed to detect the two new mutations as well as the Y468X mutation. Screening of our cohort showed heterozygosity in 1/88, in 2/88, and in 2/88 of patients for the 681ins7, the Y354C, and the Y468X mutations, respectively.

Pain perception and cardiovascular responses in men with positive parental history for hypertension.

Evidence suggests a reduced pain sensitivity in hypertensive individuals. This study sought to extend this work to normotensive individuals with hypertensive parents. Men with a positive (PH+) or negative (PH-) parental history for hypertension rated their pain every 15 s during a 90-s hand cold pressor test and for 90 s after the cold pressor test. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate were measured throughout. After the cold pressor test, the men recalled their pain using the McGill Pain Questionnaire. PH+ men showed greater SBP and DBP responses to the cold pressor test. Although pain ratings during the cold pressor test did not differ between groups, posttest reported pain receded faster in the PH+ than in the PH- men. The PH+ men also reported less total pain on the McGill. These findings support the hypothesis that risk for hypertension may be associated with attenuated pain responses to nociceptive stimuli.

Racial differences in minimum lower leg vascular resistance in normotensive young adults with positive and negative parental histories of hypertension.

To determine whether peripheral hemodynamic differences exist in young adult normotensive African Americans and white Americans with a positive and negative parental history of hypertension. The participants were healthy men of whom 13 were African Americans and nine white Americans with a positive parental history and 19 were African Americans and 13 white Americans with a negative parental history. Lower leg blood flows were obtained at rest and during reactive hyperemia. Lower leg minimum vascular resistance (Rmin) was computed from reactive hyperemic blood flow measured by venous occlusion plethysmography, and mean arterial blood pressure was determined by auscultation of the brachial artery. Resting blood flow and mean arterial pressure were similar in all groups. A significant race x parental history interaction effect was observed for lower leg Rmin. In the white men the lower leg Rmin was significantly greater in the positive than the negative parental group (P < 0.05). Lower leg Rmin was significantly greater in African Americans than in white men without a parental histoy (P < 0.05). Mean arterial blood pressure and heart rate were similar among the groups. This study demonstrates that lower leg Rmin is greater in young white men with a positive parental history of hypertension than those with a negative parental history. In African Americans with either positive or negative parental histories, lower leg Rmin is not different. This finding suggests that heredity may have a greater influence in white populations than in African Americans on the structural changes in resistance vessels. The study also suggests that African Americans have an earlier structural change in the resistance vessels compared with white people, regardless of a parental history of hypertension. This suggests that factors other than heredity are of importance in changing the structure of the resistance vessels.

Racial differences in minimum lower leg vascular resistance in normotensive young adults with positive and negative parental histories of hypertension

Racial differences in minimum lower leg vascular resistance in normotensive young adults with positive and negative parental histories of hypertension

Moderately Intense Physical Activities and High Levels of Cardiorespiratory Fitness Reduce the Risk of Non-Insulin-Dependent Diabetes Mellitus in Middle-aged Men

Physical activity has been advocated as an important factor in the primary prevention of non-insulin-dependent diabetes mellitus (NIDDM), but information concerning the specific intensities and durations that are protective has been unavailable. To examine prospectively the association between self-reported levels of the intensity and duration of physical activities, and cardiorespiratory fitness (assessed by respiratory gas exchange) and incident cases of NIDDM (assessed by the oral glucose tolerance test) in a population-based sample of 897 middle-aged Finnish men. After adjustment for age, baseline glucose values, body mass index, serum triglyceride levels, parental history of diabetes, and alcohol consumption, moderately intense physical activities (> or = 5.5 metabolic units) that were undertaken for at least a 40-minute duration per week were associated with a reduced risk of NIDDM (odds ration [OR], 0.44; 95% confidence interval [CI], 0.22-0.88). Activities with less than an intensity of 5.5 metabolic units, regardless of their duration, were not protective. Cardiorespiratory fitness levels greater than 31.0 mL of oxygen per kilogram per minute were protective against NIDDM (OR, 0.26; 95% CI, 0.08-0.82). A subgroup of men at high risk of NIDDM, because they were overweight and were hypertensive and had a positive parental history of NIDDM, who engaged in moderately intense physical activities above the 40-min/wk duration reduced their risk of NIDDM by 64% compared with men who did not participate in such activities. After adjustment for age, baseline glucose levels, and known risk factors, physical activities with an intensity of 5.5 metabolic units or greater and a duration of 40 minutes or greater per week protected against the development of NIDDM. These protective effects were even more pronounced in a subgroup of men who were at high risk for the development of the disease.

Parental history of premature coronary heart disease: An independent risk factor of myocardial infarction

We assessed the role of parental history of premature coronary heart disease (CHD) in the risk of acute myocardial infarction (AMI) and the extent to which the risk associated with positive parental history was independent of other risk factors: smoking, high serum cholesterol, elevated blood pressure, diabetes and obesity, and of socioeconomic status. The study is a prospective 12-year follow-up of 15,620 men and women aged from 30 to 59 years in eastern Finland. Parental history of premature CHD was defined as either fatal or nonfatal myocardial infarction or angina pectoris before the age of 60 years. The end point of the follow-up was either nonfatal AMI or coronary death. The risk ratio (RR) of AMI associated with positive family history of either parent was 1.61 in men and 1.85 in women. The risk decreased only slightly when an adjustment was made for other risk factors, and did not change at all when an adjustment was made for the indicators of socioeconomic status. The risk was slightly higher for early AMI (<55 years) compared with later AMI (≥55 years), RR 1.71 versus 1.50, among men and markedly higher, RR 2.87 versus 1.49, among women. These results from this population with an exceptionally high risk of CHD support the hypothesis that positive family history is an independent risk factor of AMI.