Heart Health and Your Family History

Genetics play a big role in the health of your heart. What can you do to protect it -- today?

By Gina Shaw
WebMD Feature

Reviewed By Brunilda Nazario, MD

Most people know that cardiovascular disease can run in families -- that if you have a family history of heart disease, you may be at greater risk for heart attack, stroke, and other heart problems. But how much does family history affect your heart health? What parts of the family tree are most important? And what can you do about it?

Simply put, the closer the relative, the greater your heart disease risk. If you have a "first-degree relative" -- that's a mother, father, sister, or brother (or even a son or daughter) who had heart disease at an early age, that increases your risk of developing heart disease.

"The more family members you have, the higher the potential risk," says Roger Blumenthal, MD, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. "More than one first-degree relative with early heart disease doubles your risk, even if you control for other factors."

So what's considered "an early age?" Generally, says Blumenthal, heart attacks, strokes, and documented cardiovascular disease in a man under 55, or a woman under 65, raise a red flag. The more family members you have, the higher the potential risks of heart disease.

"If we see multiple first-degree relatives with premature cardiac events, even if the patient is young and looks otherwise healthy, this is when we'd consider really aggressive measures to manage cardiovascular risk factors," says Stanley Hazen, MD, section head for preventive cardiology and cardiac rehabilitation at the Cleveland Clinic. For example, instead of shooting for an LDL (bad cholesterol) level of less than 130, your doctor might want you to aim for 100 or lower.

People with a particularly strong family history of heart disease might be put on aspirin at an earlier age than normal, or blood pressure medication for even borderline blood pressure, says Blumenthal. "That's the medication approach, but such a risk should also motivate you to improve your dietary and exercise habits."

What if your father died of a heart attack in his 80s? That, says Hazen, shouldn't be considered a risk factor for you. "The fact is that half of us will experience cardiovascular disease in our lifetime, so you have to consider where, statistically, the family history looks like it is a significant factor. Parents having heart disease in their 80s doesn't really qualify."

What's less clear is how more-distant relatives, such as aunts, uncles, and grandparents, affect your heart disease risk.

"The data isn't as strong, but some suggest it still plays a role," says Blumenthal. One study showed that second-degree relatives with cardiovascular disease are also associated with an increased risk of having a higher coronary calcium score." A high coronary calcium score suggests coronary artery disease and can be an early warning sign of heart disease.

Yet Hazen says that he tends not to consider such relatives as part of a patient's risk profile. "It's a further shade of gray away."

If there's serious history of heart disease lurking nearby in your family tree, can a healthy lifestyle negate your risk? It probably can't erase the risk entirely, but it can slash it substantially.

"You can't eliminate the influence of these genetic factors, but by adopting a very healthy lifestyle -- eating well, pursuing an exercise program, and aggressively working on lowering your cholesterol and triglycerides -- you can substantially reduce your risk," says Hazen. "Both heart disease itself, and the contributing risk factors like blood pressure and cholesterol, are controlled by both genetic and environmental factors."

If you do have a strong family history of heart disease, don't figure that you can wait until you're older to take care of your own risk factors. "If you are a college student with substantially increased risk because of elevated cholesterol, the time to start aggressive lifestyle changes and therapy is now," says Hazen. "The longer you do it, the more benefit accrues over time. The younger you are, the more you stand to benefit from therapy."

SOURCES: Roger Blumenthal, MD, director, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md. Stanley Hazen, MD, section head, preventive cardiology and cardiac rehabilitation, Cleveland Clinic, Ohio.

© 2008 WebMD Inc. All rights reserved.