Ask Dr. Arthur Agatston
Does Family History Put Me at Higher Risk of Heart Attack?
Q: My grandfather, one aunt, and two uncles on my mother's side all died of heart attacks. Am I at higher risk of having a heart attack because of my family history?
ó Iliana, North Carolina
A: Yes. Family history is an often underestimated and underreported risk factor for heart disease and heart attack, so Iím glad you asked this question. That said, I have numerous patients with bad family health histories who still have good hearts, and I have patients with good family histories who come to me with badly diseased hearts. The fact that they made an appointment to find out where they stood is a good thing.
The more distant a relative is and the older that person is when he or she had a heart attack, the less concerned you need to be. The more closely related you are to family members who have had heart attacks and the younger they were when the event occurred, the greater your risk is. First-degree relatives ó parents and siblings ó who die of a heart attack at a young age are of greater concern than grandparents, aunts, and uncles.
Furthermore, if one of your siblings has heart disease or has had a heart attack, that puts you at an even higher risk than if one of your parents has heart-related issues, because the sibling, besides having similar genes, has usually grown up in an environment similar to yours. Experts suggest that if you have a brother or sister with cardiovascular disease, your own risk is increased by as much as 100 percent.
Remember that the younger a close relative was when the heart attack occurred, the greater the concern is. I treated a woman recently with very high cholesterol, and her sister had a heart attack at age 38, while another of my patients has a father who had a heart attack at 52. I take this information very seriously.
If a family history indicates potential problems and youíre only in your twenties, I would do a blood test for basic lipids (blood fats) and perhaps advanced blood tests to check the size of your cholesterol particles and levels of C-reactive protein. If youíre older, I would also do imaging of your carotid arteries (the arteries that run just under the skin on each side of your neck and supply blood to your brain). If the carotid arteries show premature thickening of their lining (called the intimal-medial thickness), I would do a noninvasive CT [computed tomography] scan of your coronary arteries to get a calcium score, a measure of the total amount of plaque in your coronary arteries. In general, I do imaging for at-risk men beginning in their forties and at-risk women in their fifties, but will do so earlier in circumstances of particularly high-risk families.
As I noted above, having a family history of heart disease is not a guarantee of a heart attack. And even if you're diagnosed with heart disease, improving your diet, getting regular exercise, and taking medications as necessary can go a long way toward reducing plaque buildup and improving your risk profile. The earlier that high-risk individuals are evaluated, the easier it is to prevent a heart attack.
Learn more in the Everyday Health Heart Health Center.
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Last Updated: 01/27/2010
Heart disease expert Arthur Agatston, MD, is a preventive cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. Besides being a researcher and lecturer, Dr. Agatston is well known as the author of the bestselling South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach.