This observation has considerable public health significance, the study’s authors note, given that cardiovascular disease often begins early in life and is the leading cause of death and disability in the United States.
Researchers led by Kevin E. Kip, Ph.D., from the University of Pittsburgh Graduate School of Public Health, followed almost 4,000 young adults enrolled in a large-scale study of cardiovascular disease risk development. The research team evaluated each participant’s risk level for heart attack and stroke at the start of the study by examining such risk factors as weight, smoking and blood cholesterol. This evaluation was repeated twice at five-year intervals.
At each assessment, the researchers also determined which participants had a close family member -- either a parent or a sibling – who suffered a heart attack or stroke.
The investigators expected to observe more healthy behaviors and improvements in indicators of risk among those young adults whose family history had taken a turn for the worse. However, their findings, published in the May issue of the American Journal of Preventive Medicine, strongly contradict this assumption.
Rates of smoking and smoking cessation are no different among young adults who see a change in family history and those who do not, the researchers found. Nor are young adults whose family members suffer strokes or heart attacks any more likely to see changes in physical activity level, weight, blood pressure or blood chemistry that would indicate reduced cardiovascular risk.
“Not only was a change in family history unrelated to improved risk-factor behavior and control, but also the overall picture of observed risk-factor change was slanted opposite to the hypothesized direction,” Kip reports. His team found that those young adults whose family histories indicated an increased risk for themselves are most likely to experience undesirable decreases in their blood HDL cholesterol levels and worsening obesity.
Several factors could explain why events with the potential to trigger positive changes in health behaviors have no apparent effect, he observes.
One possibility, according to Kip, is that young adults don’t realize that a heart attack or stroke in a close family member signals increased personal risk. “Our study did not … measure perceived risk of disease following a change in family history,” he notes.
An alternative explanation is that overt signs of cardiovascular disease are virtually absent in young adulthood. Kip proposes that “Without physical manifestations of disease, young adults who experience a change in family history … may not adequately acknowledge their heightened future risk of disease.”
Overall, Kip concludes, the results indicate that health professionals need to better communicate the well-documented association between family history of heart attack and stroke and increased personal risk when working with young adults. “Perhaps greater emphasis on this strategy at the teachable moment when a family event has occurred may help to influence … preventive health behaviors among young adults,” he suggests.
The research was supported by grants from the National Heart, Lung, and Blood Institute.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.
Posted by the Center for the Advancement of Health. For more research news and information, go to our special section devoted to health and behavior in the “Peer-Reviewed Journals” area of Eurekalert!, http://www.eurekalert.org/jrnls/cfah/. For information about the Center, call Ira Allen, (202) 387-2829. To request a copy of this or any other article we have distributed, please E-mail press@cfah.org.
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American Journal of Preventive Medicine