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Family history of stroke may increase risk for ACS in women
Banerjee A. Circ Cardiovasc Genet. 2011;doi:10.1161/CIRCGENETICS.110.957688.
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Researchers of a new study have found that stroke in female first-degree relatives was a risk factor for acute coronary syndrome in women and that maternal stroke was significantly more common than paternal. Data on male probands, however, did not result in the same associations.
The prospective, population-based study included patients with ACS (n=942; 33.3% women) or stroke/transient ischemic attack (n=1,015; 52.3% women). Investigators reviewed family history information for stroke and MI by sex of proband and first-degree relatives.
Overall, a history of stroke in one or more first-degree relatives was found in 24.1% of ACS probands and 24.3% of stroke/TIA probands. Among female ACS probands, maternal stroke was more common than paternal stroke (OR=2.53, 95% 1.39-4.61), as were strokes in female than male first-degree relatives (OR=2.09, 95% CI, 1.29-3.37).
For male ACS probands, however, maternal stroke was not more common than paternal stroke (OR=0.92; 95% CI, 0.64-1.32) nor were strokes among female first-degree relatives (OR=0.69; 95% CI, 0.50-0.97).
“Traditional risk factors do not explain all coronary events in women, and even tools designed for risk prediction in women do not identify all women who subsequently go on to have MI,” the researchers wrote. “Therefore, sex-specific differences in family of MI and stroke may contribute to this unmet need for improved risk prediction in women.”
Future analysis, they added, should consider sex-of-parent/sex-of-offspring associations in prospective studies to better understand how sex-specific differences in family history lead to sex-specific differences in pathogenesis — such as localization of disease on coronary angiography and prothrombotic — and outcomes of CHD.
These findings add to mounting literature demonstrating important sex differences in CVD expression. Ischemic stroke, which is most frequently lacunar and related to the microvasculature, is a relatively higher percentage of overall CVD in women, particularly young women. ARIC data demonstrate that evidence of microvascular dysfunction measured in the retina is a strong predictor of CVD events in women but not men. The Women’s Health Study data indicate that low-dose aspirin reduces first stroke in women after the age of 50 years, but not in men. Personalized medicine, in the form of careful family history taking and attention to the sex of the patient, can be used now while we await clinical application of the human genome project.
– C. Noel Bairey Merz, MD
Cardiology
Today Editorial Board
Disclosure: Dr. Merz reported no relevant financial disclosures.
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