Familial clustering of myocardial infarction in first-degree relatives: a nationwide study

AIMS: Family history is an established risk factor for myocardial infarction (MI), but it is not clear how this risk changes with number and gender of first-degree relatives with MI. We used the entire Danish population to examine the importance of MI in siblings and parents. METHODS AND RESULTS: This study is a retrospective nationwide register-based cohort study including registered relatives to all Danish citizens diagnosed with MI in the period 1978-2010. In the entire Danish population we identified siblings to 7552 patients with a first-time MI. The rate ratios (RR) calculated by Poisson models showed an RR of 4.30 (95% confidence interval 3.53-5.23) for siblings of a patient with MI. Children of parents with MI also showed high risk: for children of a maternal case RR 2.40 (2.20-2.60), and of a paternal case RR 1.98 (1.98-2.09), respectively; P value for gender interaction <0.0001. A paternal case with MI at an age <50 years was associated with an RR of 3.30 (2.92-3.72) while a case >50 years was associated with a risk of 1.83 (1.73-1.93). For maternal cases below and above 50 years of age the risks were 3.23 (2.56-4.10) and 2.31 (2.11-2.52), respectively. CONCLUSION: First-degree relatives of a patient with myocardial infarction themselves have a substantial higher risk of myocardial infarction. The risk is particularly elevated when the MI case is the mother or a sibling, and when the MI case has the infarction before the age of 50 years.