Sudden death and myocardial infarction in first degree relatives as predictors of primary cardiac arrest

The hypothesis that family history (FH) of myocardial infarction (MI) and FH of sudden death (SD) are both independent risk factors for primary cardiac arrest (PCA) was examined in a case-control study. PCA cases were attended by paramedics (1988-1994) and community-based age and sex matched controls were identified. Subjects (25-74 years) were free of prior clinically-recognized heart disease and major co-morbidity. Interviewers obtained a detailed history of MI and SD in first-degree relatives from spouses of 235 cases and 374 control subjects. A parental history of early-onset SD (age <65) was associated with an increased risk of PCA (odds ratio (OR) = 2.69, 95% CI = 1.35-5.36), after adjustment for parental history of MI and other risk factors. A parental history of late-onset SD was not associated with PCA risk (OR = 0.94, 95% CI = 0.55-1.62). Additionally, parental history of SD was related to early-onset PCA (OR = 1.89, 95% CI = 1.08-3.30) but not to late-onset PCA (OR = 0.89, 95% CI = 0.49-1.61). In contrast, parental MI (early/late) was related to PCA (early/late), after adjustment for other risk factors and parental history of SD. Similar results were observed in first-degree relatives. Findings suggest a potential role of familial factors related to both MI and SD in PCA. Stronger findings for a familial patterning of PCA were noted for early onset disease in cases and their relatives.