Apr. 24, 2002 HONOLULU, April 24 – Being the firstborn child in a family may make a person more likely to develop coronary disease, according to a study presented today at the American Heart Association’s Asia Pacific Scientific Forum.
The study authors speculate that firstborns may have a more coronary-prone, type-A - personality, marked by increased competitiveness, although the study did not look at that factor directly.
“After many years of practice, we noticed a prevalence of firstborns among people affected by coronary heart disease (CHD). Primogeniture, a term for the eldest child, has been considered a possible determinant of various diseases but, to the best of our knowledge, its association with CHD has never been investigated,” says Maurizio Ferratini, M.D., head of the cardiovascular rehabilitation unit of Fondazione Don Carlo Gnocchi in Milan, Italy.
“Biological factors, social and environmental variables and educational opportunities are different in firstborns than those of higher birth order subjects. This may influence the incidence of acute and chronic diseases in adulthood. Consequently, we decided to explore this relationship,” he adds.
Researchers conducted a prospective study of 348 people with CHD who had been admitted to the Cardiovascular Rehabilitation Unit of Fondazione Don Carlo Gnocchi in Milan. They also looked for other risk factors linked to being firstborn. They recorded birth order, age, gender, family history of CHD and the presence of other major risk factors.
Researchers found that 46.7 percent of the CHD patients were firstborn, almost double the prevalence of 29.3 percent in the reference population.
Primogeniture was unrelated to age, gender and all but one of the major risk factors considered. There were no significant differences between firstborns and their sisters and brothers in terms of family history of CHD, hypertension, dyslipidemia or diabetes. But cigarette smoking was lower among the firstborns.
The cumulative number of risk factors per patient was almost identical between the firstborns and their younger siblings. “Because we found the same kinds of risk factors in both groups, we suspect primogeniture is the likely explanation and should be regarded as a determinant of CHD that is independent of other risk factors studied,” says Ferratini.
The study was not designed to identify the reasons for the prevalence of firstborns among CHD patients, but researchers say that personality may play a role because of the particular psychogenesis of firstborns.
“The family context frequently orients them along a perfectionist path, giving them a determined, competitive, winning and aggressive attitude – aspects frequently observed in subjects with a type A personality also known as “coronary-prone.” Type A personality is characterized as being hard-driven, easy to anger and highly motivated.
“The study suggests that primogeniture may be an independent predisposing determinant of CHD that should be taken into account when assessing global patient risk,” he says. How much being the eldest contributes to the onset of CHD remains to be clarified in further studies,” he adds.
Co-authors are Rosa Spezzaferri, M.D.; Elisabetta Gara, M.D.; Monica Tavanelli, M.D.; Joanna Heyman, M.D; Gabriella Brambilla, M.D.; Vittorio Racca, M.D.; Antonio Pezzano, M.D.; Gabriella Comerio, M.D.; Paolo Castiglioni, MSc.; Marco Di Rienzo, MSc.
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