Blog | Monday, November 10, 2008

Don't forget your history


Twice today I've heard pleas for doctors to do a better job of collecting family histories. One came as an aside from an audience member at Dr. Oz's lecture, and another from Allen Taylor, MD, who spoke at a seminar about when to order various imaging tests. He was tasked with talking about patients with intermediate risk of heart disease.

Dr. Taylor noted that the classic definition of "intermediate risk" for CAD is 10%-20% on the Framingham, yet this misses some patients because the Framingham doesn't take family history into account. As such, his definition of "at risk" is a patient with a Framingham of 6% or greater and a family history of premature coronary artery disease.

When taking family history, you should go deep, he said. Ask about first and second degree relatives. Ask about the age that relatives developed CAD, and how many relatives had CAD. The more relatives, and the younger those relatives were when they developed CAD, the greater the risk. Especially if they are siblings.

Those deemed at risk by family history should undergo coronary artery calcium testing, he said, especially middle-aged and older patients, for whom it's been shown to be a stronger risk predictor than carotid IMT tests. IMT might make more sense for primary care offices, however, for practical/convenience reasons, he said.

It's really important to identify those at intermediate risk, he noted, because they are a big group-- and also the most likely to improve with therapeutic intervention. It's a message I've heard several times at this conference.