Spotlight On: Hereditary Heart Disease

I know that some risk factors for heart disease are genetic. What can I do to protect my family?

Amy Tucker, M.D., a University of Virginia Health System cardiologist answers this month's question:

Which risk factors for heart disease can be hereditary?

Having a family history of early coronary artery disease (before age 55 in men or before age 65 in women) is an independent risk factor for heart disease, even after subtracting the effects of other major risk factors. Some studies suggest that the family history alone accounts for up to 15 percent of heart attacks.

Of the other major cardiovascular risk factors, cholesterol abnormalities (dyslipidemia), diabetes, high blood pressure (hypertension) and obesity are among those with the strongest hereditary components. Not all familial traits are genetic, though. Family members often share similar habits and lifestyles that can impact risk for heart disease.

How do I determine if I have a family history of heart disease?

Look to your parents and siblings. These relatives are most strongly linked to familial risk for heart disease. Several large clinical trials have examined the impact of premature cardiovascular disease in one or both parents on the risk of coronary heart disease in their offspring, including the Physician’s Health Study of over 22,000 men and the Women’s Health Study of over 39,000 women.

Each study showed that premature cardiovascular disease in either parent increases the risk of coronary heart disease for children of either sex. In each study, the risk to offspring was greater if the single affected parent was the mother. Both studies also demonstrated additional risk if both parents, rather than just one, have premature cardiovascular disease. The Framingham Offspring Study found that cardiovascular disease in siblings is a risk factor for cardiovascular disease in middle-aged adults. This study found that the sibling contribution to risk was higher than that of the parent.

If I have a family history of heart disease, when should I begin to monitor my own risk factors?

People with a positive family history, or who are at increased risk for heart disease because of other risk factors, should aggressively modify those risk factors that they can control. Everyone, especially those with increased risk, should follow a heart-healthy lifestyle, which includes: 

• getting regular exercise
• maintaining an ideal body weight
• abstinence from tobacco and
• eating 5 servings of fruit and vegetables daily. 

For people over 21, moderate consumption of alcohol may be of some benefit as well. High blood pressure, cholesterol abnormalities and diabetes should be controlled using an approach that combines a heart-healthy lifestyle with appropriate medical treatment and monitoring. Healthy lifestyle choices should begin in childhood for everyone, or as soon thereafter as possible.

Screening for high blood pressure, cholesterol abnormalities, and diabetes, should be discussed with your doctor, who can make a determination based on your level of risk.

What can I do to control risk factors that are genetic?

Family history and age cannot be modified. However, having a family history of premature cardiovascular disease or other heritable risk factors should raise the awareness of family members, so that they can commit to a heart-healthy lifestyle and to screening for high blood pressure, diabetes and high cholesterol—all risk factors that can be modified.

It is useful to know which risk factors run in your family and at what age they typically appear to help guide surveillance and screening.  

If I have heart disease, or am at high-risk for heart disease, what can I do to protect my daughter?

Establishing heart-healthy habits in childhood cannot be overemphasized. Children, adolescents and young adults should incorporate heart-healthy diet and regular exercise into their daily routines as early as possible, so that those become well-established aspects of their lives. They should understand the risks of tobacco use and be encouraged to abstain. They should also adopt habits that help protect them from being overweight. Young people should know their family history and should be counseled about high blood pressure, diabetes and high cholesterol.

Those from high-risk families may need early screening and medical treatment. Of these things, providing a healthy diet and establishing a regular exercise routine are two of the most powerful preventive tools a woman can give her daughter.