Susan has been feeling her heart skipping beats lately, and she's concerned. She's in her early 50's, which is about the age when her dad had his first heart attack. On top of that, her mother had a stroke in her early 60’s. With her history in mind, Susan has done a good job of doing the right things to stay healthy – she never smoked (like her dad did) and she generally eats well and stays active.
But, she is wondering, is that enough to prevent heart disease or stroke in her future?
What is Your Risk?
A family history of heart disease is the most challenging of the heart disease risk factors to evaluate. Unlike the other major risk factors (age, smoking, diabetes, high cholesterol, and high blood pressure), it’s difficult to measure how much impact family history has on an individual’s risk. We know that a family history of heart disease increases your risk (particularly if the heart attack or stroke occurred early in life, usually defined as a first-degree male relative < 55 years of age or female < 65 years of age), but there may be more to the story than just "bad genes." It may be that the afflicted family member made poor health choices (like Susan's dad being a smoker), or had different environmental exposures than you.
And the question about how much risk is critically important because the amount of risk is the primary factor in determining how aggressive we should be in our prevention efforts. Once we know someone's risk is high, we have very effective ways to lower that risk. The problem is that often with family history, people are at high risk and aren't aware of it.
How to Determine Your Risk
Sometimes, the reason for the family history of heart disease is obvious. For example, if high cholesterol runs in the family, that person will likely benefit from treating their high cholesterol aggressively. Other times, the reason for the family history isn't as easily explained by traditional risk factors. Most of us probably know someone, possibly with a family history, who has had heart disease even though they appeared to be the picture of health.
In these situations, we need more information to determine that individual's risk accurately. And in my practice, we obtain that information by performing an imaging study to assess how much artery disease the patient has, either with a CT calcium score or a carotid ultrasound.
The role of these imaging studies like CT calcium score or carotid ultrasound is to further clarify an individual’s risk for future heart disease. The amount of artery disease a patient has is a powerful predictor of their future risk for heart disease. And when we know someone is at high risk, we can be more aggressive with their prevention.
Heart disease and stroke are strikingly common. Research has shown us that 60% of men and 56% of women in the US will have a heart attack, stroke, or heart failure in their lifetime. That's the bad news. The good news is that as much as 80% of heart disease is preventable. If you have a family history of heart disease, talk to your doctor to see if there are ways you can better understand, and lower, your risk.
BY R. TODD HURST, MD, FACC