If you have a family history of heart disease, you probably know that your risk of heart disease is higher. But how much higher? The answer is important as we have remarkably effective ways to lower your risk once we know how high it is. Your genes don’t have to be your fate.
Jessica’s story
Jessica has been feeling her heart racing lately and is concerned. She is in her early 50s, around the age of her father’s first heart attack. In addition, her mother had a stroke in her early 60s. Looking at her story, Jessica did a great job of staying healthy – she never smoked (like her father) and she generally eats well and stays active.
But, she wonders, is that enough to prevent heart disease or stroke in the future?
What is your risk
A family history of heart disease is the most difficult risk factor to assess for heart disease. Unlike the other main risk factors (age, smoking, diabetes, high cholesterol, and high blood pressure), it is difficult to measure the impact of family history on a person’s risk. We know that a family history of heart disease increases your risk (especially if the heart attack or stroke occurred early in life, usually defined as a first-degree male relative <53 years or a female relative <63 years) can be more than history just “bad genes”. The affected family member may have made poor health decisions (such as Jessica’s father is a smoker) or may have had other environmental factors than you.
And the question of how high the risk is is critical as the level of risk is the main factor in how aggressive we should be in our prevention efforts. Once we know that a person’s risk is high, we have very effective ways of reducing that risk. The problem is that people with family history are often at high risk and are not aware of it.
How to determine your risk
Sometimes the reason for the family history of heart disease is obvious. For example, if there is a high cholesterol level in the family, that person is likely to benefit from aggressively treating their high cholesterol level. In other cases, the reason for family history cannot be easily explained by conventional risk factors. Most of us probably know someone, possibly with a family history, who has heart disease, although it appears that this is a picture of health.
In these situations, we need more information to accurately determine that person’s risk. And in my practice, we get this information by doing an imaging study to assess which artery disease the patient is suffering from, either with a CT calcium score or with a carotid ultrasound.
The role of these imaging tests, such as CT calcium score or carotid ultrasound, is to further clarify a person’s risk of future heart disease. The extent of a patient’s artery disease is a meaningful indicator of their future risk of heart disease. And when we know that someone is at high risk, we can be more aggressive about prevention.
Heart diseases and strokes are strikingly common. Research has shown that 60% of men and 56% of women in the United States will have a heart attack, stroke, or heart failure in their lifetime. That is the bad news. The good news is that up to 80% of heart disease is preventable. If your family has had heart disease, talk to your doctor to find out how you can better understand and reduce your risk.
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