Family History-Taking Still a Keystone in Identifying High-Risk Patients

Johns Hopkins researchers report that a new analysis of health information drawn from a national database reaffirms the missed opportunity doctors have in recommending lifestyle interventions to people with a family history of diabetes and cardiovascular disease (CVD).

Using data on nearly 11,000 adults 18 and older from the National Health and Nutrition Examination Survey 2009–2012, the investigators concluded that people with a family history of diabetes and/or CVD are more likely to be current smokers and overweight compared with those without such history.

The investigators, however, found no such correlations between family history of CVD and/or diabetes and lack of exercise, or excessive intake of dietary salt and cholesterol. The analysis is summarized in the March edition of Preventive Medicine.

"The results emphasize the continuing value of using family history to identify high-risk patients and proactively counseling them to adopt healthier lifestyles because nothing can be done to change the genetic predispositions for heart disease and diabetes reflected in family history," says Eboselume Akhuemonkhan, MD, MPH, a postdoctoral gastroenterology research fellow at the Johns Hopkins University School of Medicine and the study's lead author.

She notes that although many physicians calculate lifetime CVD risk with an assessment tool called the Framingham Risk Score, the tool does not incorporate family history, which may exclude high-risk individuals from potential preventive behavioral interventions.

Obtaining family history is also easier to obtain than complex risk scores while still leading to similar recommendations—ie, increasing physical activity, decreasing smoking—adds Mariana Lazo, MD, PhD, ScM, an assistant professor of medicine at the Johns Hopkins University School of Medicine and the paper's senior author.

As far as the researchers are aware, she says, their analysis is the first attempt using information from a national database to examine the prevalence of family history of diabetes and CVD and the corresponding prevalence of healthy lifestyle factors.

The data included responses to questionnaires and physical examinations for 10,988 participants who had an average age of 47; 51% (5,656) were female and 49% (5,332) were male.

The researchers found that 30% (3,596), 6% (548), and 7% (739) of the US adult civilian population self-reported a family history of diabetes, and both diabetes and CVD, respectively.

Compared with individuals with no family history, those with family history of diabetes were more commonly non-Hispanic blacks (16%) and Mexican-Americans (11%). Conversely, those with family history of CVD were more commonly non-Hispanic whites (83%).

The researchers found no associations between family history and levels of physical activity or cholesterol and sodium consumption. Regardless of family history, they report, two-thirds of all participants failed to meet the threshold for government-recommended weekly physical activity of at least 150 minutes per week, and there were no significant differences in cholesterol and sodium intake.

The analysis specifically found that the prevalence of overweight or obesity was higher among those with family history of diabetes (74%), CVD (66%), or both (80%), as compared to those without family history (65%).

Similar results were observed for smoking, with those with family history of either diabetes (21%), CVD (27%), or both (28%) having a higher prevalence of current smoking compared with those without family history (18%). The same trend held true for former smokers. Those with a family history of diabetes (26%), CVD (24%), or both (24%) had a higher prevalence of past smoking compared with those without a family history (24%).

To reduce the likelihood that their results were skewed by patients who had previously been diagnosed with diabetes or CVD, and therefore presumably counseled about lifestyle changes, Akhuemonkhan and her coauthor ran an additional analysis that excluded such participants. The secondary analysis, which consisted of 6,966 participants, showed no differences in trends compared to the primary analysis.

"Family history has been shown time and time again to be an important predictive factor in determining who is likely to develop cardiovascular disease and diabetes," she says. "These results highlight how important it is for health care providers to ask their patients about family history from the very first visit, and if a history exists, to tailor counseling to address the patient's increased risk. Health care providers can only do so much, but more often than not, education is key."

Source: Johns Hopkins Medicine