Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.See all posts »
You are Your Father’s Son
What you should know about genetics and heart health.
Although we would like to blame all our woes—healthwise and otherwise—on our parents, in reality, only 15 percent of coronary artery disease can be directly attributable to our genetics. Before we let our ancestors completely off the hook, it’s important to understand that our genetics interact with other risk factors in complex and often unpredictable ways.
Take hypertension for example. Hypertension is a treatable risk factor, so even though about 30 percent of hypertension can be blamed on good old dad (or mom), it is usually controllable with a combination of medications, diet, and exercise. Once the numbers are in range, hypertension loses its cardiac punch, and is no longer a trigger for heart attacks and strokes. For some people, genetics may dictate which medications will work best, and what types of side effects the drugs may cause. For most, a lower sodium Mediterranean diet, regular exercise, and weight loss (when needed) will have a huge impact on blood pressure, regardless of heredity.
High cholesterol is another problem that may be inherited, but more often than not is directly linked to diet, weight, and exercise (or lack thereof). It is not uncommon for my patients’ cholesterol levels to drop 50 points or more when they start making smarter choices. Our hunter gatherer ancestors had LDL (bad) cholesterols that ran in the 50s, while the typical American’s LDL is around 130. Having said that, some people do have genetically high cholesterol, no matter how hard they try. For those folks, and for people who have heart disease or are at high risk for it, medication is essential.
Let’s say your cholesterol, blood pressure, blood sugar, and weight are just right, you don’t smoke, and you exercise regularly. Could you still be at risk? The truth is, heart disease is a risk we all carry, but if your dad developed heart problems at the age of 55 or younger, or your mom before 65, then your chance of developing heart problems is twice normal. If you smoke and have a family history, your risk is even greater. There are undoubtedly genes that interact with our other risk factors, such that some people can eat an absolutely horrendous diet or carry a hundred or more extra pounds, and yet have pristine coronary arteries. Others may do everything right, yet still suffer a heart attack or stroke. We still don’t fully understand how or why these things happen, but medical scientists are hard at work to try to unravel the mysteries of our genetics.
Coronary disease aside, there are other forms of heart disease that may also be inherited. Most notably, these include the cardiomyopathies, which are conditions that can weaken or enlarge the heart. Some heart valve problems tend to run in families, as do a few unusual but sometimes fatal forms of heart rhythm disturbances. If you suspect that you might have a genetic tendency towards heart disease, see your doctor and get screened. A few simple tests might just save your life.
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