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CLINICAL STUDIES

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

Dirk De Bacquer, MSc^a, Guy De Backer, MD, PhD, FACC^a, Marcel Kornitzer, MD, PhD^* and Henry Blackburn, MD, PhD, FACC

^a Department of Public Health, University of Ghent, Ghent, Belgium
^* School of Public Health, Free University of Brussels, Brussels, Belgium
Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA

Manuscript received October 7, 1998; revised manuscript received January 8, 1999, accepted January 21, 1999.

Reprint requests and correspondence: Dr. Dirk De Bacquer, Department of Public Health, University of Ghent, De Pintelaan 185-Block A, B-9000 Gent, Belgium
dirk.debacquer{at}rug.ac.be

OBJECTIVES

Here we explore the association between a family history of premature coronary heart disease (CHD) death and ischemic electrocardiogram (ECG) findings in the offspring.

BACKGROUND

In 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.

METHODS

Our 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 I_1–3, IV_1–3, V_1–3 or VII₁.

RESULTS

Subjects 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.

CONCLUSIONS

Subjects 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.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BHDPP = Belgian Heart Disease Prevention Project   BIRNH = Belgian Interuniversity Research on Nutrition and Health   BMI = body mass index   CHD = coronary heart disease   ECG = electrocardiogram, electrocardiographic   HDL = high-density lipoprotein   ICD = International Classification of Diseases   MONICA = Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases

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