ObjectiveThe risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD.MethodsWe used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn’t experience onset of CVD) and Cox proportional regression analysis, with offspring’s age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD.ResultsParental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders.ConclusionsOffspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.

Racial disparities in breast cancer mortality continue, partly due to higher prevalence of an aggressive breast cancer subtype called basallike breast cancer (BBC) in African-Americans. Health care providers (HCPs) are uniquely positioned to discuss cancer risk and prevention with patients. We investigated breast cancer knowledge and risk communication among HCPs to identify factors that influenced communication with patients. Interviews were conducted with 34 HCPs in North Carolina. We found limited evidence of breast cancer risk education, and specific subtypes of breast cancer were not discussed. Barriers to communication about prevention include limited time, perceived patient receptivity and education level, and scientific misinformation. Factors that prompted discussions included patient characteristics (age, race, and socioeconomic status). To broaden the conversation, HCPs must receive and communicate more accurate information on breast cancer risk. Given these barriers to breast cancer education, additional opportunities to intervene with high-risk populations must be identified. Keywords:breast cancer, basal-like breast cancer, health communication, risk factors, health disparity Word count: 3917

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