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Family History as a Tool for Detecting Children at Risk for Diabetes and Cardiovascular Disease

Diabetes and most types of cardiovascular disease typically emerge in adulthood, but studies have shown that the risk for these diseases might be apparent in childhood. Family history might be a useful tool in assessing and reducing that risk.

  • Based on 2007 estimates, in the United States, more than 23 million adults (older than 20 years of age) and more than 186,000 young people have diabetes. About 1.6 million individuals with diabetes are newly diagnosed each year.

  • Cardiovascular disease (CVD)—which includes heart disease and stroke—affects about 81 million adults, according to estimates published in 2010 by the American Heart Association. Heart disease is the leading cause of death overall; stroke is the third leading cause. About 10% of adolescents 12–19 years of age have a high overall cholesterol level, a risk factor for CVD.

  • Several studies show that risk factors for type 2 diabetes or CVD can be found in childhood, even though these disorders usually do not emerge until adulthood. The number of children with type 2 diabetes and distinctly elevated risk factors for CVD is rising.

  • Diabetes and CVD share risk factors. So, increased risk for one disease might mean higher risk for the other. Shared risk factors such as overweight and impaired glucose metabolism are growing more and more common among children and adolescents.

  • For both diseases, among adults, onset might be prevented or delayed with changes in diet and physical activity and use of medication. Among children, several programs have changed knowledge, attitudes, and behaviors that might reduce risk factors for diabetes and CVD.

  • Guidelines from the American Diabetes Association, American Heart Association, and National Cholesterol Education Program include family history among the factors to consider in assessing disease risk and deciding about screening and treatment.

  • Several studies have shown family history to be an independent risk factor for diabetes. People who have one or more parents, siblings, or children with diabetes are 2 to 6 times more likely to have the disease than are people with no affected relatives.

  • Family history is also an established risk factor for CVD. In one large study, the 14% of families that had a known family history for heart disease accounted for 72% of cases of early heart disease (before age 55).

  • Strong evidence shows that youth with a family history of CVD and diabetes already show signs of the diseases. Family history can be part of the approach to screening for children at risk of CVD and diabetes and should be part of prevention campaigns aimed at reducing the burden of these diseases and their risk factors in children.

  • Much research is needed to find the most effective ways to use family history in strategies to screen for and prevent diabetes and CVD, particularly among children and young adults. Questions remain about practical, ethical, and legal aspects of screening for diseases that, in children, might take many years to emerge. If family history improves risk assessment, and if studies show that screening and early intervention can prevent these diseases, clinicians and parents might be more willing to view family history as an important risk factor in children and start intervening earlier.

For More Information

For more information, please see the following Pediatrics supplement article:

Is Family History a Useful Tool for Detecting Children at Risk for Diabetes and Cardiovascular Diseases? A Public Health Perspective

 

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