Having a family history of heart disease can feel like a heavy weight — a source of worry as you think about your health and your future. Unfortunately, there is no way to change your genetics. But there are ways you can understand and manage your risks. If you have a family member with heart disease, I suggest thinking about these five things to put your mind at ease and help reshape your risk.
1. Genes do not guarantee the future; they suggest a path. For some genetic diseases we hear about (such as cystic fibrosis and Marfan syndrome), having the genes means having the disease. But because the kind of heart disease that causes heart attacks (coronary atherosclerosis) is a complex mix of genes and the environment, a family history or a genetic predisposition does not seal your fate. In fact, in most cases, it provides you with an early warning sign — a chance to change your risk. Changing your risk does require effort and continuous attention, but it’s possible in most cases.
[See: 17 Ways Heart Health Varies in Women and Men.]
2. Get the right testing (for most people, it’s no testing). One of the most common conversations I have in my office is with someone who wants to make sure they don’t have blockages in the arteries going to the heart. Unfortunately, everything we know about heart disease tells us that the presence or absence of blockages is not a good predictor of a future heart attack. The reason is that a minimal narrowing (one we cannot see) can be just as likely to cause a heart attack as a severe blockage. Much more important in predicting your risk of a heart attack is family history, smoking history, diet, high blood pressure, cholesterol level, diabetes and a sedentary lifestyle. These influence the biologic processes that result in a heart attack significantly and should be the focus of most conversations around the risk of a heart attack.
3. Attend to your symptoms (and discuss with your doctor). For people without any symptoms, risk factor control is the focus. But certain symptoms should warrant a conversation with your doctor, as they may suggest the early signs of a problem with your heart. If you’re getting chest pain or shortness of breath while walking or exercising (especially walking up stairs), you may have a particular type of severe narrowing of the heart arteries that does increase your risks. This may require additional testing, but only you and your doctor can figure out the best way to evaluate your condition. Another important symptom, but one that gets less attention, is a change in your exertional tolerance. You may not be getting chest pain because you’ve made an effort to reduce your activity over time. This is why I suggest all my patients establish a walking or exercise regimen that they do at least once a week — an early detection system of sorts — to establish and check in on their exercise tolerance. If they notice a change, they let me know, and we can consider formal stress testing.
[See: The 12 Best Heart-Healthy Diets.]
4. Address your personal risk factors. These include smoking, cholesterol, diabetes, high blood pressure and diet. For patients with a family history of heart disease, these five factors are crucial to mitigating your own risks. If you smoke cigarettes, quit. Importantly, if other people in your household or workplace smoke, get them to quit, too ( secondhand smoke affects your risk of heart disease at least as much as firsthand smoke). Get your cholesterol checked and treat it (either with changes in diet/exercise or with medications). Make sure your blood sugars and blood pressure are under control. Though there is not one perfect diet, make sure your diet is focused on fruits, vegetables and non-terrestrial meats (chicken and fish); is low in salt; and only sparingly features prepared or away-from-home meals. And importantly, make changes you can stick to. The protective effect of these changes only exist as long as you continue to do them. So pick changes you can live with forever, and commit to them.
5. Outrun your genetics. When recommending exercise to my patients with a family history of heart disease, I often say that you should think of it as literally trying to outrun your genetics. There are many powerful positive effects of aerobic exercise. For those with a family history of heart disease, one key benefit is that exercise will often counteract some of the biology that causes heart attacks: stabilize coronary plaques and reduce your risks. Also, if you do have a heart attack, a history of aerobic exercise trains your heart to minimize the damage, so the size and consequences of the heart attack are often smaller than it would have been otherwise.
[See: The Facts on Heart Disease.]
When heart disease strikes close to home, it’s natural to fear what lies ahead for you. But a clear focus on risk factors and exercise, close attention to your symptoms and a frank conversation with your doctor will go a long way toward helping you change the course initially set by your genes.
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Navigating Your Family Tree: How to Deal With a Family History of Heart Disease originally appeared on usnews.com
