A Systematic Literature Review

Familial aggregation of coronary heart disease (CHD) is thought to account for 50% to 60% of total documented CHD before the age of 60 years.1 First-degree relatives of people with premature CHD (proband) exhibit a risk that is 2 to 12 times greater than that of the general population.2 The National Cholesterol Education Program’s Adult Treatment Panel recommends screening patients with a recognized family history of premature CHD, defined as heart disease in men 55 years and women 65 years.3 However, a number of recent surveys have demonstrated that these guidelines are not widely implemented.4–6 Reasons for lack of screening based on family history are thought to exist at both the individual and provider levels. On the individual level, family members deny or are unaware of the familial aggregation of CHD and its risk factors. On the provider level, healthcare providers may not be engaged to identify high-risk families, conduct the screening, and intervene with relatives. To better understand the impact of a proband’s premature CHD on first-degree relatives, we conducted a literature review to assess relatives’ knowledge of CHD risk factors, risk perception, and implementation of and adherence to riskreducing behaviors and their management by healthcare providers. The goal of this review is to identify gaps in the literature and provide recommendations for future research.