• Your Heart Health: What Family History Tells You

    Image for family history article It is good that you are actively thinking about what steps you can take to prevent history from repeating itself. Although cardiovascular disease (CVD)—the number one killer and a leading cause of premature, permanent disability in the US—may be more common in families with a positive family history of CVD, the outlook is far from hopeless.
    Scientists have established that several risk factors—both modifiable (such as diet, physical activity level, and tobacco use) and nonmodifiable (like age and genetics)—play a role in the development of CVD. Moreover, scientists are not even sure if the increased risk of developing CVD in someone with a family history of the disease is solely a result of a shared genetic predisposition or if it simply represents a greater exposure to the same harmful environmental influences.

    Genetics and Cardiovascular Risk

    The Human Genome Project (the scientific undertaking to identify all the genes in human DNA) was completed in 2003. It was done to assess specific genes to determine individual disease risk. Examples of genetic influences on cardiovascular risk that researchers studied included the following:
    • Genes that appear to predispose a person to congenital heart disease (heart disease from birth)
    • Apolipoproteins B and E (proteins that combine with a lipid that affect blood cholesterol concentrations)
    • The angiotensinogen gene variant (an alteration in the hormone angiotensinogen, which is associated with high blood pressure)
    • Homocysteine (an amino acid which contributes to atherosclerosis by irritating vascular endothelial cells lining the blood vessels)
    • C-reactive protein (a protein that is a marker of inflammation and may predict future cardiovascular risk)
    However, while genetic and protein markers may identify enhanced CVD risk (and would allow for targeted prevention) further confirmation is required before widespread clinical use is indicated.
    What is known is that CVD occurs more commonly in families with a positive family history of the condition. This means that your risk of CVD is increased if any of your immediate relatives, such as siblings, parents, or children, have or had heart disease, a heart attack, or stroke, especially before age 50.

    How Knowing Your Family History Can Help

    Research clearly demonstrates that family history of CVD is an independent predictor of disease. One study looking at CVD in families in Utah found that while only 14% of families had a strong positive family history of coronary heart disease (CHD), these same people accounted for 72% of all CHD events (such as heart attack and coronary bypass surgery).
    And, while only 11% of families had a positive family history of stroke, 86% of all early strokes occurred in these families. Since major cardiovascular risks (such as smoking and excessive alcohol consumption) may be less prevalent in Utah than in other states, these results may not apply throughout the country.
    Nonetheless, because family members share not just the same positive family history, but also other modifiable risk factors as well, family history can help doctors capture the underlying complexities of both genetic and environmental (behavioral) influences leading to the appearance of disease.
    Perhaps most important, people at risk for CVD because of their genetic makeup can benefit from modifying their behavior. For instance, quitting smoking is projected to decrease CHD to a greater extent in men with a positive family history of CHD compared to men without a positive family history.
    Family history is thus an important tool used by doctors to evaluate risk of CVD.

    What to Do If You Think You Might Be at Risk

    In the future, as the genetic basis of CVD is unraveled, doctors may be able to diagnose disease based on tests for genetic markers.
    In the meantime, while a family history of CVD does not doom you to the same fate, you are at a higher risk. Therefore, modifying certain risk factors for CVD, may help you reduce your risk of disease. These modifiable risk factors include the following:
    • Quitting smoking
    • Reducing the total fat, trans fat, and saturated fat in your diet
    • Increasing fiber in your diet
    • Controlling your blood pressure
    • Controlling your diabetes
    • Exercising regularly
    • Maintaining an ideal body weight
    • Managing your stress
    • Moderating your alcohol intake
    • Lowering your total cholesterol, triglycerides, HDL, and LDL levels
    Some doctors may also recommend taking aspirin daily or other medications. Talk to your doctor to find out if this is suitable for you.
    Remember, prevention is key. Keep in mind, too, that if you have a family history of CVD, your children are at an increased risk as well. But you can set them on the right path to a healthful lifestyle. Children learn from example. So, if they see you eating right, not smoking, and getting plenty of exercise, they will be more likely to follow your lead.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    Men’s Health Network http://www.menshealthnetwork.org/

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Canadian Association of Family Physicians http://www.cfpc.ca/

    Canadian Public HealthHealth Unit http://www.phac-aspc.gc.ca/pau-uap/fitness/

    References

    Agency for Healthcare Research and Quality. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=9373. Accessed April 11, 2011.

    Day INM, Wilson DI. Genetics and cardiovascular risk. BMJ. 2001;3232:1409-1412.

    DynaMed Editors. Cardiovascular disease prevention overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated October 13, 2010. Accessed April 11, 2011.

    Human genome project information. United States Genome Science Program, Oak Ridge National Laboratory website. Available at: http://www.ornl.gov/sci/techresources/Human%5FGenome/home.shtml. February 03, 2011. Accessed April 11, 2011.

    Hunt SC, Gwinn M, Adams TD. Family history assessment: strategies for prevention of cardiovascular disease. Am J Prev Med. 2003;24:136-142.

    Jomini V, Oppliger-Pasquali S, Wietlisbach V, et al. Contribution of major cardiovascular risk factors to familial premature coronary artery disease: the GENECARD project. J Am Coll Cardiol. 2002;40:676-684.

    Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290:898-904.

    Men and cardiovascular diseases. American Heart Association (AHA) website. Available at: http://www.americanheart.org/downloadable/heart. Accessed August 25, 2003.

    Olden K, Wilson S. Environmental health and genomics: visions and implications. Nature Reviews: Genetics. 2000;1:149-153.

    Pearson, TA, Blair SN, Daniels, SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002;106:388.

    Preventing heart disease and stroke: addressing the nation’s leading killers. Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/dhdsp.htm. Accessed April 28, 2009

    Women and cardiovascular diseases. American Heart Association (AHA) website. Available at: http://www.americanheart.org/downloadable/heart. Accessed August 25, 2003.

    Yoon PW, Scheuner MT, Peterson-Oehlke KL, et al. Can family history be used as a tool for public health and preventive medicine? Genetics in Medicine. 2002;4:304-310.

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