Family history of cardiometabolic diseases and
its association with arterial stiffness in the
Malmo
«
Diet Cancer cohort
Abd al-Hakim Fatehali
a,b
, Mikael Gottsa ¨ ter
a,b
, and Peter M. Nilsson
a,b
Objective: Arterial stiffening increases with age and is
associated with increased cardiovascular risk. Several risk
factors have been shown to predict the development of
arterial stiffening; however, a positive family history (FHR)
of cardiometabolic disease (CMD) and hypertension has
not been extensively studied. We hypothesize that FHR of
CMD plays a significant role in the development of arterial
stiffening in offspring.
Methods: We used data from the population-based
Malmo ¨ Diet Cancer study (n ¼ 3056) examined in 1992–
1996 and again in 2007–2012. Several variables were
analysed, including anthropometrics, carotid–femoral pulse
wave velocity and FHR. The association between FHR of
CMD and arterial stiffening in the offspring was analysed
with analysis of covariance in SPSS. FHR was subdivided
into three categories: family history for cardiovascular
events (FH-CVEs), family history for diabetes mellitus type
2 (FH-DM2) and family history for hypertension (FH-HT).
The first analysis of covariance-model was adjusted for
age, sex, mean arterial pressure and heart rate; the second
model additionally adjusted for self-reported medical
history in the offspring.
Results: Data indicated that FH-CVE (F ¼ 14.64,
P < 0.001), FH-DM2 (F ¼ 18.57, P < 0.001) and FH-HT
(F ¼ 13.92, P < 0.001) all significantly increased carotid–
femoral pulse wave velocity levels. The results remained
when additional adjustment was made for confounders
and for self-reported CMD in the index participants,
respectively, for FH-CVE (F ¼ 12.47, P < 0.001), FH-DM2
(F ¼ 7.62, P ¼ 0.006) as well as for FH-HT (F ¼ 7.30,
P ¼ 0.007).
Conclusion: These findings indicate that a FHR of
cardiometabolic conditions and hypertension affects
arterial stiffness in offspring independently of
haemodynamic factors and self-reported CMD in the
offspring without sex differences.
Keywords: arteriosclerosis, cardiovascular, diabetes, family
history, hypertension, offspring, pulse wave velocity,
stiffness, vascular
Abbreviations: AS, arterial stiffening; c–f PWV, carotid–
femoral pulse wave velocity; CMD, cardiometabolic
disease; CVD, cardiovascular disease; CVE, cardiovascular
event; DM2, diabetes mellitus type 2; EVA, early vascular
ageing; FH, family history; HT, hypertension; MAP, mean
arterial pressure; MDC-CV, Malmo ¨ Diet Cancer study’s
cardiovascular arm; OGTT, oral glucose tolerance test
INTRODUCTION
C
ardiovascular diseases (CVDs) have in the past
decades developed to become the most common
cause of mortality in the Western world and cause
millions of deaths every year [1]. The disease panorama is
complex, multifaceted and is strongly associated with West-
ern lifestyle, such as dietary habits and smoking. An illustra-
tive example is that the risk of developing atherosclerosis is
higher in the United States than in Japan, but Japanese
immigrants to the United States gain, during their lives in the
new country, a similar degree of risk as the majority
population [2]. Other factors which affect the risk of devel-
oping CVDs include genetics, risk factors (hypertension,
hyperlipidaemia and diabetes) and a positive family history
(FHþ) of CVD.
Because of this public health problem, much effort has
been invested in research in prevention, physiology and
haemodynamic changes to increase our understanding of
the multifaceted causality of CVD. In particular, research-
ers have developed an interest in atherosclerosis as this is
the main contributing cause for ischaemic heart disease,
which is an important contribution to CVD mortality [3].
Factors such as hypertension, hyperlipidaemia, smoking,
obesity, lack of physical exercise and FHþ (genetic and
nongenetic aspects) have been thoroughly studied and
much of the prevention programs of today revolve
around limiting the clinical consequences of atheroscle-
rosis [4].
Journal of Hypertension 2017, 35:000–000
a
Department of Clinical Sciences, Lund University, Lund and
b
Department of Internal
Medicine, Ska ˚ ne University Hospital, Malmo ¨ , Sweden
Correspondence to Peter M. Nilsson, Professor, MD, PhD, Department of Clinical
Sciences, Lund University, IM Nilssons gata 32, 2nd Floor, Lund, Sweden; Department
of Internal Medicine, Ska ˚ ne University Hospital, S-205 02 Malmo ¨ , Sweden.
E-mail: Peter.Nilsson@med.lu.se
Received 16 December 2016 Revised 20 March 2017 Accepted 1 June 2017
J Hypertens 35:000–000 Copyright ß 2017 Wolters Kluwer Health, Inc. All rights
reserved.
DOI:10.1097/HJH.0000000000001457
Journal of Hypertension www.jhypertension.com 1
Original Article
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.