Elsevier

American Heart Journal

Volume 162, Issue 2, August 2011, Pages 317-323
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Familiar transmission of coronary heart disease: A cohort study of 80,214 Swedish adoptees linked to their biological and adoptive parents

https://doi.org/10.1016/j.ahj.2011.05.013Get rights and content

Background

Studies of adoptees have the potential to disentangle the contributions of genetic versus family environmental factors in the familiar transmission of coronary heart disease (CHD) because adoptees do not share the same family environment as their biological parents. The aims of this study were as follows: (1) to examine the risk of CHD in adopted men and women with at least one biological parent with CHD and (2) to examine the risk of CHD in adopted men and women with at least one adoptive parent with CHD.

Methods

The Swedish Multigenerational register was used to follow all Swedish-born adoptees (born in or after 1932, n = 80,214) between January 1, 1973, and December 31, 2008, for CHD. The risk of CHD was estimated in adopted men and women with at least one biological parent with CHD and adopted men and women with at least one adoptive parent with CHD. The control groups consisted of adopted men or women without a biological parent with CHD or adopted men or women without an adoptive parent with CHD.

Results

Adopted men and women with at least one biological parent with CHD (n = 749) were 1.4 to 1.6 times (statistically significant, 95% CI) more likely to have CHD than adoptees without a biological parent with CHD. In contrast, men and women with at least one adoptive parent with CHD (n = 1,009) were not at increased risk of the disease.

Conclusions

These findings (based on validated hospital diagnoses unbiased by recall) suggest that the familiar transmission of CHD from parents to offspring is more related to genetic factors than to family environmental factors.

Section snippets

MigMed research database

Data used in this study were retrieved from the MigMed Database, located at the Center for Primary Health Care Research at Lund University. MigMed is a single, comprehensive database that has been constructed using several national Swedish data registers, including the Total Population Register, the Multigeneration Register, and the Swedish Hospital Discharge Register (1973 through 2008).21, 22, 23

Information from the various registers in the database is linked at the individual level via the

Results

Of the 80,214 adoptees, there were 3,410 who had a first hospitalization for CHD during the study period (1973 through 2008) (Table I). The age-adjusted CHD rates were higher among both men and women with at least one biological parent with CHD. Overall, the CHD rates were 242.5 among adoptees with at least one biological parent with CHD compared with 165.2 per 100,000 person-years among adoptees without a biological parent with CHD. Table II shows the distribution of the entire population of

Discussion

This follow-up study of 80,214 Swedish adoptees linked to both their biological and adoptive parents shows that men and women with at least one biological parent with CHD were 1.4 to 1.6 times more likely to have CHD than adoptees without a biological parent with CHD. In contrast, men and women with at least one adoptive parent with CHD were not at increased risk of the disease. This was the case even among those adoptees where both the adoptive mother and the adoptive father had been diagnosed

Conclusions

The findings of the present study of the entire Swedish population of adoptees (born in or after 1932) show that genetic/biological factors are strongly related to CHD, whereas family environmental factors do not appear to play an important role in the familiar transmission of CHD. These findings represent new knowledge that is applicable for the entire population, that is, not only the population of adoptees. A stronger emphasis on familial history may be needed to apply appropriate preventive

Disclosures

There are no conflicts of interest among the authors.

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    Specific author contributions. The first author of the manuscript had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. K.S.: conception and design, acquisition of data, and interpretation of data and drafting the article and revising it critically for important intellectual content. M.W.: conception and design, interpretation of data, and revising the article critically for important intellectual content. X.L.: analysis and interpretation of data and revising the article critically for important intellectual content. J.J.: analysis and interpretation of data and revising the article critically for important intellectual content. K.H.: conception and design, interpretation of data, and revising the article critically for important intellectual content. J.S.: conception and design, acquisition of data, and interpretation of data and revising the article critically for important intellectual content.

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