Including how to have a constructive conversation with your loved ones.

By Toni Gerber Hope
January 24, 2020

Knowing the who, what, when, and whys of your relatives’ heart disease histories helps you best protect your own. The heart health of your first-degree relatives—parents, siblings, children—impacts your own risk the most, especially if they developed heart disease prematurely (65 or younger for women, 55 or younger for men), says Jennifer H. Mieres, M.D., professor of cardiology, senior vice president, Center for Equity of Care, Northwell Health.

The health history of second-degree relatives—grandparents, aunts, uncles, cousins—provides less information about your risk, but their info is still worth getting. “Your family heart health history is along a continuum, with closer relatives counting more heavily. But your doctor needs to know all of it to best evaluate your own risk,” says Stacey E. Rosen, M.D., cardiologist and senior vice president, Women’s Health, Katz Institute for Women’s Health at North Shore-LIJ Health System. For example, if Grandpa had a heart attack at 80, that’s probably not a red flag. But if he was 48 and his relatives also had heart disease when young, that could signal a stronger genetic link. Follow this road map to fill in the blanks—what you find out may save a life

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Which Conditions Can Increase My Risk of Heart Disease?

Find out if any of your relatives had the following conditions, as they may be indicators of your individual risk factors.

High Blood Pressure

If a first-degree relative has hypertension, your chances of developing it increase, and you should be checked at least once a year.

High LDL or Low HDL Cholesterol

Your doctor may want to test your cholesterol more often than the guidelines, which say every four to six years starting at age 20.

Diabetes (Type 2)

High blood sugar damages arteries; diabetes doubles your risk of heart disease. Everyone should be tested starting at age 40. If diabetes runs in your family, testing earlier and more often can catch high blood sugar before it becomes a heart risk.

Familial Hypercholesterolemia (FH)

This is a genetic disorder in which your body can’t clear “bad” LDL cholesterol from your bloodstream, which ups the risk of clogged arteries. Children in families with FH should have their cholesterol checked as young as age 2, says the American Academy of Pediatrics. A genetic screening via a blood test can identify risk.

Arrhythmias

Abnormal heart rhythms occur when the electrical impulses that coordinate your heartbeat are out of sync, triggering an erratic heartbeat. If a parent or sibling has an arrhythmia—for example, long QT syndrome, which is characterized by chaotic, rapid heartbeats—relatives need to get checked. Tests to monitor the heart’s electrical activity may include having an electrocardiogram (ECG), wearing a Holter monitor (a portable ECG device) for a day or two, or having a tiny device called an ILR (indwelling loop recorder) implanted in your chest wall.

Aneurysm

If a relative had an aneurysm before age 55, it may be hereditary. Imaging tests such as an ultrasound, CT, or MRI scan can tell if you’re at risk.

Cardiomyopathy

This disease of the heart muscle makes the heart unable to pump blood efficiently, leading to heart failure. If a relative has the condition, ask your doctor about having tests such as an echocardiogram and genetic testing.

Related: These Sneaky Symptoms Could Signal a Thyroid Disorder

How Can I Talk to My Family About Heart Health?

It can be awkward to ask relatives about their medical issues or details about a loved one’s death. If you have children, you might start the conversation by saying something like, “I want to do everything I can to protect my kids,” says Amy Sturm, president of the board of directors of the National Society of Genetic Counselors. You’ll want to ask specifics, such as:

  • Has anyone had a heart attack, stroke, heart rhythm condition, or other heart problem? At what age did the relative develop the condition? (If several relatives have the same issues and/or developed them at young ages, that points to a possible genetic link.)
  • Was the relative who had heart issues overweight? Did they smoke or have high blood pressure, high cholesterol, or diabetes?
  • Was death sudden for relatives who have passed? (That could indicate certain heart conditions like an aneurysm, genetic heart rhythm disorder, or heart attack.)
  • If no one knows what caused a relative’s death, see if you can find out what medical procedures they had and what medicines they took. These might be clues to what was going on and help your doctor fully assess your own heart disease risk.

What If I Don't Know My Family's Medical History?

Tell your doctor that, says Sharonne N. Hayes, M.D., professor of cardiovascular medicine at Mayo Clinic. If your blood pressure and cholesterol show you’re at risk for heart disease, your doctor may do additional screenings, such as a blood test to check for high- sensitivity C-reactive protein (a measure of inflammation) or lipoprotein (a type of LDL), or do a coronary calcification scan (a CT that measures plaque in arteries).

How Can I Lower My Heart Disease Risk?

Even if a disease runs in your family, making healthy lifestyle changes can lower your risk. A recent study found that among people with a strong genetic risk for heart disease, lifestyle was a big contributor to developing it at a young age. Four of the most powerful preventive steps:

1
Don't Smoke

Smoking damages the lining of your arteries, which causes plaque/blockages to form over time. Within a few days after quitting, blood pressure begins to fall. Within a year, your risk for coronary artery disease is cut in half; in 15 years, your risk drops to that of a nonsmoker.

2
Stay at a Healthy Weight

A BMI of 18.5–24.5 is ideal, but losing just 10 pounds can reduce your chances of developing heart disease.

Related: 10 Superfoods for Heart Disease

3
Exercise

You can lower LDL cholesterol with diet, but to raise “good” HDL, you need physical activity. Aim for 30 minutes or more of at least moderate aerobic activity (brisk walking, swimming, bike riding) five days a week along with resistance training twice a week. Need motivation? Studies have shown that partnering with a friend or taking a class can help you keep at it. “Wearables (like pedometers and trackers) have also been shown to help,” says Mieres, who co-authored Heart Smart for Women: Six S.T.E.P.S. in Six Weeks to Heart-Healthy Living with Rosen.

4
Work with Your Doctor

Keep your doctor in the loop about your lifestyle. If tweaking your habits doesn’t improve your cholesterol, blood pressure, and/or blood sugar levels, medications can make a huge difference. One study found that lowering blood pressure to recommended levels and reducing LDL cholesterol by 30 percent could lower your heart disease risk as much as a third.

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