Management of Individuals with Family History of Premature Cardiovascular Disease

Definition and Risk Assessment

Family history of premature CVD is defined as CVD occurring in a first-degree male relative <55 years of age or a first-degree female relative <65 years of age 1, 2
The strength of risk increases with younger age of onset, increasing number of affected relatives, and closer genealogical proximity 2, 3
Family history of premature CVD is an independent risk factor that increases baseline CVD risk by 1.5-2.0 fold, even after adjusting for other risk factors 1, 2
Almost 75% of individuals with premature coronary heart disease (CHD) have a positive family history, highlighting opportunities for prevention 2, 3
Canadian Cardiovascular Society guidelines recommend doubling a person's estimated risk when they have a family history of premature ASCVD 4
Family history modestly improves risk stratification and is most useful for reclassifying individuals at intermediate risk 2, 3

Adults with a family history of premature CVD should begin lipid screening at age 20 rather than waiting until age 40 5
Coronary artery calcium scoring (CACS) is considered appropriate for patients with a family history of premature CAD and a low global CAD risk score 6
Children and adolescents with a family history of early CVD should have their blood pressure measured annually from age 3 and undergo lipid screening if family history is positive 7
Intensive risk factor modification should be implemented for individuals with a family history of premature CVD 1