By Lindsay Meyers, MS, LCGC, Genetic Counselor and Cardiovascular Service Lead
The holidays are a time for coming together with family and friends. It’s a time for enjoying a meal with the people you love and sharing stories from the year. You might talk about politics or relationships or school. Will you talk about health?
Whether health and heart disease are on the docket or not, most people can think of at least one person in their family who has had some sort of heart disease. They wonder if this increases their personal risk of heart disease. The short answer? Yes and no.
Understanding the Causes of Genetic Heart Disease
Since heart disease refers to a large group of conditions, from coronary disease (problems with cholesterol blockage in the heart’s arteries) to problems with the heart’s valves or the way the heart beats (arrhythmias), there is not one easy answer. Some forms of heart disease are caused by one single gene alteration passed down in a family, but the vast majority of the time an individual’s heart problem is the result of many factors, including genetic and environmental (like the food we eat or how active we are).
When someone is discussing to heart disease, they are often referring to coronary disease and associated heart attacks--caused by genetic and environmental factors. Now that we are right smack in the middle of the December holiday season, it seems like cookies, cake, and gingerbread men are everywhere we look and new year's resolutions to lose weight are the topic du jour. Because of that, there is no better time to discuss the interplay of exercise and eating, as well as genetic factors, and how these influence our risk of coronary artery disease (CAD).
Is Coronary Heart Disease Genetic?
While genetics is one of the risk factors is, that alone is usually not enough to cause coronary heart disease. If someone has a family history of coronary disease, heart attacks, strokes and elevated cholesterol levels, we know this can increase that person’s risk of coronary heart disease. This is because there can be alterations in our genetic makeup (DNA) that may make one person more likely to develop coronary heart disease, while another person may have genetic alterations that protect them from developing CAD. If you have a family member with CAD, this increases your risk for having inherited those genetic risk factors.
What Are the Risk Factors of Heart Disease?
The most common ones are listed below; some, like your genetics, are not within our control, but many are.
|Factors we do have control over||Factors we have no control over|
|Smoking||Age (the older we get the higher our risk is)|
|High blood pressure (hypertension)||Gender (males have a higher risk than females)|
|Diabetes||A family history of CAD|
|Lifestyle (diet, exercise, weight)||Race|
The factors listed above are by no means an all-encompassing but they do have the greatest impact on an individual's risk of heart disease. Other factors include excessive alcohol consumption and illicit drug use among others. So while heart disease may be the number one cause of death in the United States, thankfully there are many factors are within your control that can help reduce your risk, including the food we eat and how active we are. So make sure those January goals are heart healthy!
What Can You Do to Reduce Your Risk of Heart Disease?
- Stop smoking. If you are a smoker, talk to your doctor about a plan to help you stop smoking. Smoking is a significant contributor to the development of CAD.
- Have your lipid levels (cholesterol and triglycerides) checked at least every five years as an adult. Children are recommended to have their lipids checked once between the ages of 9-12 and again between 17-21 years. Your doctor may recommend more frequent screens if you have a strong family history of CAD. If you are found to have elevated lipid levels, talk with your doctor about possible diet modifications to help lower your levels, or starting lipid-lowering medications if needed.
- Have your blood pressure checked at least every 2 years if you have had normal blood pressure levels in the past. If you are found have high blood pressure, talk to your doctor about diet and/or medications to help lower your blood pressure.
- Starting at age 45, have your blood sugar checked at least every 3 years.
- Reduce your salt and saturated fat intake, and try and exercise for at least 30 minutes regularly.
The great thing about taking action to help reduce your risk for coronary heart disease is that is can also help you reduce your risk for diabetes and lower stress levels, as exercise is a known stress reducer. It can also help reduce your risk for forms of heart disease other than CAD.
What Types of Heart Disease are Genetic?
Even with environmental factors well controlled, some individuals will still have an increased risk for certain types of heart disease. This is because some forms of heart disease are due to an underlying single genetic cause. While these are the minority of causes of heart disease, it is crucial to identify who is at risk since this can help detect the disease earlier which leads to better outcomes and reduces the risk of a sudden cardiac arrest.
Signs You’re at Risk for Genetic Heart Disease
- Personal or family history of elevated “bad” cholesterol (LDL levels over 190 in adults, over 160 in children)
- Personal or family history of early onset heart attacks or coronary disease (those with stents or bypass surgery).
- For men, this would be younger than 55 years.
- For women, early onset is younger than 65 years.
- Early onset coronary disease is even more suggestive of an inherited condition if the affected person did not have any of the known risk factors listed above.
- A family history of sudden cardiac death or any sudden, unexplained death including single motor vehicle accident or drowning in an otherwise good swimmer.
- Personal and/or family history of fainting (syncope), especially during exercise, excitement or after being startled and without any proceeding symptoms like dizziness or tunnel vision.
- Unexplained seizures
- Personal and/or family history of cardiac interventions at a young age (<50 years), including heart transplants/heart failure, ICDs, pacemakers, aortic replacements
- A personal or family history of any of the following
- Cardiomyopathy (heart muscle disease) younger than 50 years
- Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, or short QT syndrome
- Aortic dilation/aneurysm or dissection and related conditions, like Marfan syndrome or Loeys-Dietz syndrome
Genetic testing can be done for inherited (genetic) forms of heart disease. Although there is no cure for heart disease, genetic testing can help identify who is at risk to allow proper screening and/or early treatment/management. Identifying inherited forms of heart disease early can help prevent sudden cardiac death associated with inherited heart disease.
How Genome Medical Can Help You Understand Your Risk for Genetic Heart Disease
Genome Medical has genetic counselors with expertise in inherited heart disease who can:
- Talk to you about your risk of heart disease,
- Help interpret previous genetic testing, or
- Have a conversation about the risks and benefits of genetic testing for heart disease, if warranted.
If you’d like to speak to a genetic counselor, click here. If you have questions about the services Genome Medical provides click here.
Goff, David C., et al. "2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 63.25 Part B (2014): 2935-2959.
Eckel, Robert H., et al. "2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 63.25 Part B (2014): 2960-2984.
FOR, EXPERT PANEL ON INTEGRATED GUIDELINES, and RISK REDUCTION IN CHILDREN. "Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report." Pediatrics 128.Suppl 5 (2011): S213.