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Previous Volume 330:1041-1046 April 14, 1994 Number 15 Next

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ABSTRACT

Background A family history of premature coronary heart disease has long been thought to be a risk factor for coronary heart disease. Using data from 26 years of follow-up of 21,004 Swedish twins born between 1886 and 1925, we investigated this issue further by assessing the risk of death from coronary heart disease in pairs of monozygotic and dizygotic twins.

Methods The study population consisted of 3298 monozygotic and 5964 dizygotic male twins and 4012 monozygotic and 7730 dizygotic female twins. The age at which one twin died of coronary heart disease was used as the primary independent variable to predict the risk of death from coronary heart disease in the other twin. Information about other risk factors was obtained from questionnaires administered in 1961 and 1963. Actuarial life-table analysis was used to estimate the cumulative probability of death from coronary heart disease. Relative-hazard estimates were obtained from a multivariate survival analysis.

Results Among the men, the relative hazard of death from coronary heart disease when one's twin died of coronary heart disease before the age of 55 years, as compared with the hazard when one's twin did not die before 55, was 8.1 (95 percent confidence interval, 2.7 to 24.5) for monozygotic twins and 3.8 (1.4 to 10.5) for dizygotic twins. Among the women, when one's twin died of coronary heart disease before the age of 65 years, the relative hazard was 15.0 (95 percent confidence interval, 7.1 to 31.9) for monozygotic twins and 2.6 (1.0 to 7.1) for dizygotic twins. Among both the men and the women, whether monozygotic or dizygotic twins, the magnitude of the relative hazard decreased as the age at which one's twin died of coronary heart disease increased. The ratio of the relative-hazard estimate for the monozygotic twins to the estimate for the dizygotic twins approached 1 with increasing age. These relative hazards were little influenced by other risk factors for coronary heart disease.

Conclusions Our findings suggest that at younger ages, death from coronary heart disease is influenced by genetic factors in both women and men. The results also imply that the genetic effect decreases at older ages. .

Source Information

From the Departments of Epidemiology and Public Health (M.E.M., N.R., L.F.B.) and Genetics (N.R.), Yale University School of Medicine, New Haven, Conn.; and the Department of Environmental Hygiene, Karolinska Institute (B.F.), and the Division of Cardiovascular Medicine, Department of Internal Medicine, Karolinska Hospital, and Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute (U.F.), Stockholm, Sweden. Presented in part at the American Heart Association Cardiovascular Epidemiology Meetings, Memphis, Tenn., March 18-19, 1992.

Address reprint requests to Dr. Marenberg at the Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College St., New Haven, CT 06510.

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