Say your grandfather recently had a stroke, your mother takes cholesterol-lowering medications and your cousin has high blood pressure. You might be wondering if you’re at risk of heart disease — and for good reason.
A family history of heart disease, meaning one or more of your blood relatives has or has had heart disease, is one of the primary risk factors in experiencing cardiovascular issues, according to the National Institutes of Health. And if one of your parents experienced cardiovascular disease at a young age (before 55 or 65), your risk of developing heart disease is 60 to 75 percent higher than it would be otherwise, according to a 2014 paper published in the journal Canadian Family Physician. According to the study, having a sibling with CVD raises that risk by 40 percent.
[See: 17 Ways Heart Health Varies in Women and Men.]
The reason largely comes down to genetics, explains Cleveland Clinic cardiologist Dr. Haitham Ahmed. “Genetics can impact the cardiovascular system in profound ways and influence many of our cardiac risk factors, ranging from lipid levels to our predisposition for obesity and Type 2 diabetes,” he says. In fact, a 2016 article published in the New England Journal of Medicine found that having unlucky genetics can double your risk of heart disease.
However, it’s important to realize that genes don’t act alone. The emerging field of epigenetics studies how your lifestyle, including diet, exercise, weight and even pollution and exposure to pesticides can influence if and how genes express themselves, says Dr. Regina Druz, a board-certified cardiologist in Mineola, New York. “These environmental interactions with genes are more powerful that simply having a ‘blueprint’ genetic makeup that predisposes you to heart disease,” she says.
Case in point: A 2018 article published in Cell Symptoms reveals that gaining as little as 6 pounds can significantly alter how thousands of genes express themselves. The article found that some genes turn on while others turn off, and those genetic effects are linked to inflammation as well as cardiomyopathy, or an enlarged heart.
Epigenetics may explain why the New England Journal of Medicine study found that a healthful lifestyle was more important than genetics in determining overall risk for heart disease. In the study, people with the highest genetic predisposition for heart disease were able to cut their risk of CVD in half through simple healthy lifestyle modifications.
“You have immense power to overcome your family history,” Ahmed says. Below, cardiologists explain a step-by-step plan.
1. Find out the full extent of your family history. A comprehensive family history spans three generations and comprises children, siblings, parents, aunts and uncles, nieces and nephews, grandparents and cousins. It also includes all of their past or current cardiovascular conditions and at what age they experienced those issues, Druz says. You may not be able to get ahold of information for all of these people, but that’s OK. Talk to everyone you can and write down all pertinent information, she says.
[See: The 13 Best Diets For Your Heart.]
2. Seek early and comprehensive testing. Talk to your doctor about your family history and discuss the need for any testing above and beyond your annual cholesterol and blood pressure checks. “[A] strong family history pushes me to do more testing to further stratify their risk,” says Dr. Aidan Raney, a cardiologist with St. Joseph Hospital of Orange in Orange County, California.
“We start with comprehensive testing to assess lipid parameters as well as some nontraditional risk markers such as lipoprotein(a), C-reactive protein and trimethylamine N-oxide if needed,” he says. Coronary calcium scans, electrocardiograms and ultrasounds are other options that can evaluate arterial buildup as well as heart function and structure. Genetic testing can also identify genetic disorders that, when treated, can help reduce your heart disease risk.
3. Consider targeted therapies. Depending on your family history and test results, your doctor may decide to take an aggressive approach to prevention. “If a calcium scan shows premature buildup in the coronary arteries, I discuss risks and benefits of starting statin therapy with my patients … even if their LDL levels are healthy,” Raney says.
What’s more, Druz explains that in rare cases, conditions such as homozygous familial hypercholesterolemia, a genetic disorder in which the the body cannot manage cholesterol, may require invasive treatment options at advanced stages. Fortunately, the majority of patients with familial heart disease do not fall into that group, she says.
4. Address your other risk factors, too. Family history is just one heart disease risk factor, and to best prevent CVD, it’s important to consider all of them, Raney says. According to the National Institutes of Health, high blood pressure, high blood cholesterol, diabetes and prediabetes, smoking, obesity or being overweight, physical inactivity, having a history of preeclampsia during pregnancy, an unhealthy diet and increasing age all raise your risk of heart disease.
[See: The Facts on Heart Disease.]
While you cannot change some risk factors, like experiencing preeclampsia in the past, addressing those over which you do have control carries a significant benefit. “In my patients with a family history of heart disease, we work together to tailor a specific plan to aggressively manage each of their risk factors,” Ahmed says. “I set targets with the patients for what their blood pressure should be, what LDL cholesterol and triglyceride levels should be, what they should eat, what their weight should be and how much they should exercise.”
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Family History of Heart Disease? Here’s What to Do About It originally appeared on usnews.com
