Page 779 - Cardiac Nursing

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C HAPTER 32 / Coronary Heart Disease Risk Factors 755
Surveillance data from the BRFSS suggest that marked disparities (lifestyle) and genetic factors. A history of MI in one first-degree
continue to exist in the overall prevalence, morbidity, and mortality relative doubles, and in two or more first-degree relatives triples
associated with CVD and major CVD risk factors. 11 This report MI risk. 15,17 MI risk is strongest when MI in relatives occurs be-
noted that the population subgroups most affected by disparity in- fore age 55 years but is still present when MI occurs after age 55
15
clude those who are black, Hispanics/Mexican-Americans, persons years. The risk associated with a positive family history is inde-
with low socioeconomic status, and residents of the southeastern pendent of other known CHD risk factors.
United States and the Appalachians. Furthermore, those with less Twin studies shed further light on the influence of family history
than a high school education tend to have a higher burden of CVD on CHD risk. In a study of male and female Swedish monozygotic
and related risk factors regardless of race/ethnicity. and dizygotic twins, among male twins the relative risk of CHD for
monozygotic twins was 8.1, and the relative risk for dizygotic twins
was 3.8 when one twin died of CHD before 55 years of age. 18
FAMILY HISTORY OF Among female twins, the relative risk of CHD for monozygotic
CARDIOVASCULAR DISEASE twins was 15, and the relative risk for dizygotic twins was 2.6 when
one twin died of CHD before 55 years of age. In monozygotic and
dizygotic twins, as the age at which one twin died increased, the risk
A family history of CHD puts women and men at increased risk for CHD among the remaining twin decreased.
for CHD, probably from a combination of genetic and environ-
mental factors. 12–15 This concept is reinforced in the findings
from the INTERHEART study in which the odds ratio for an
acute MI in people with a family history was about 1.5. 16 The CIGARETTE SMOKING
population attributable risk rose from 90% with the other poten-
tially modifiable risk factors under study (such as smoking, hy- In 2006, 45.3 million adults were current smokers, that is, 20.8% of
pertension, etc.) to 91% with the addition of family history. Thus, the adult U.S. population (23.5% of men and 18.0% of women). 19
a good portion of the effect of family history may be based on risk Smoking prevalence varies markedly by race/ethnicity and age (Fig.
factors, which could be influenced by both environmental 32-3). In 2006, smoking rates for adults by race/ethnicity were as
Women
Caucasian African-American Mexican-American
60
Percent current smokers 40
50
30
20
10
0
■ Figure 32-3 Prevalence of current smoking among U.S. 20–29 30–39 40–49 50–59 60–69 70+
women (A) and men (B) by age and race/ethnicity. (From A Age
National Center for Health Statistics. National Health and
Nutrition Examination Survey, III, 1988–1994.) Men
Caucasian African-American Mexican-American
60
50
Percent current smokers 40
30
20
10
0
20–29 30–39 40–49 50–59 60–69 70+
B Age