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Family History Gets a Boost

Alfred O. Berg, MD, MPH
[+] Article, Author, and Disclosure Information

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0060.

Requests for Single Reprints: Alfred O. Berg, MD, MPH, University of Washington, Box 354696, Seattle, WA 98195; e-mail, mailto:aberg@uw.edu.

From University of Washington, Seattle, WA 98105.

Ann Intern Med. 2012;156(4):315-316. doi:10.7326/0003-4819-156-4-201202210-00012
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In this issue, Qureshi and colleagues report on the value of adding systematic collection of family history data to routine cardiovascular risk assessment. The editorialist discusses the study's findings and asks whether the promising intervention should change practice.

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Family History Received Unfair Boost
Posted on February 24, 2012
Ralph, Stern, MD
Conflict of Interest: None Declared

To the editor:

We would counsel Dr. Berg not to give up his skepticism (1). The family history received unfair boosts in the research of Quereshi et al. (2) First, the JBS did not use a factor of 1.5, but 1.3, to adjust for a positive family history. Moreover the JBS did not provide any explanation of this number and it may well refer to the ratio of the risk of a patient with a positive family history versus the risk of a patient with a negative family history, other risk factors being equivalent. This is not the same as a multiplier that can be applied to a risk estimate calculated without family history information. Such a magic number does not exist (3). The authors should have used a multivariate method including family history.

Second, it should be obvious that a policy of increasing the risk of patients with a positive family history without decreasing the risk of patients with a negative family history will spuriously increase the predicted risk (3,4). With a boost like this, the family history was guaranteed a win.

Ralph Stern


1. Berg AO. Family History Gets a Boost. Ann Intern Med. 2012;156:315-316.

2. Quereshi N, Armstrong S, Dhiman P, Saukko P, Middlemass J, Evans PH, et al; ADDFAM (Added Value of Family History in CVD Risk Assessment) Study Group. Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care. A matched-pair, cluster randomized trial. Ann Intern Med. 2012;156;253-62.

3. Kooter AJ, Kostense PJ, Groenewold J, Thijs A, Sattar N, Smulders YM. Integrating Information From Novel Risk Factors With Calculated Risks: The Critical Impact of Risk Factor Prevalence. Circulation. 2011;124:741-745.

4. Stern RH. Individual Risk. J Clin Hypertension. 2012; published online. DOI 10.1111/j.1751-7176.2012.00592.x. [accessed February 24, 2012]

Conflict of Interest:

None declared

Medical History
Posted on March 17, 2012
Bruce L., Ring, physician
Conflict of Interest: None Declared

To The Editor: In this day of high technology oriented medical practice I still do not feel "old School" when I cling to the belief that the key to diagnosis rests predominantly on the history; the whole history. Qureshi and colleagues (1) show the utility of a self-administered family history questionnaire compared to the family history documented in the patient's medical record. Srivastava (2) realizes, 20 years after being a medical student, the importance of a thorough social history. It is really very simple. To take care of patients well, a physician needs to obtain a good history; a comprehensive history. That has always included family and social history. Bruce L. Ring, MD


1. Qureshi N, Armstrong S, Dhiman P, et al; Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care. Ann Intern Med.2012;156:253-262.

2. Srivastava R; Complicated Lives- Taking the Social History. N Engl J Med. 2012;365:587-589.

Conflict of Interest:

None declared

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