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Risk factors in coronary heart disease environmental and hereditary influences

, : Risk factors in coronary heart disease environmental and hereditary influences. Israel J Med Sci 3(4): 594-606

In the search for risk factors toward the development of coronary heart disease and the transactions between environmental and genetic influences, epidemiological investigations were focused on the role of the environment while the scant knowledge of familial relationships has come largely from clinical studies among selected patients. In general, both epidemiological and clinical approaches were concerned with individuals rather than families. In this paper, current evidence relating to familial aggregations of coronary heart disease and familial resemblance in predisposing factors is reviewed. An attempt is made to assess the magnitude of the familial element, whether environmentally or genetically determined, in the common form of coronary heart disease as it presents in the general population. There is presently little support for the unqualified statement that "the family history is important" in predicting the risk of coronary disease in an individual. Familial clustering among the relatives of index cases with disease presenting in middle-age and beyond is, at best, modest. Relatives of young index cases, however, are more likely to be affected themselves though the more precise quantitative importance of such a "positive family history" cannot as yet be assessed from existing data. On the basis of calculations from a theoretical model, lacking actual data, the known degrees of familial resemblance of the 2 risk factors most strongly associated with coronary heart disease in individuals[long dash]serum cholesterol and blood pressure[long dash]fail to account for whatever clustering of disease occurs in families. Needs for further research and implications for community health are discussed.


PMID: 6060578

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