Heart disease risk may be all in the family

Content provided by the Faculty of the Harvard Medical School

Heart disease risk may be all in the family

It's not just your genes; habits and attitudes also run in the family.

Heart disease is not exactly the same in the two sexes. Women develop the condition later in life; their symptoms are often different from men's or more subtle; and they are affected more by certain risk factors, such as high levels of triglycerides (a fat in the blood). But women and men also share many risk factors for heart disease, and one of the most important is family history.

It's no secret that heart disease can run in families, showing up in grandparents and parents, children and grandchildren. Heredity is certainly a factor, but families pass on more than DNA. Family members live together, eat together, and can influence one another's attitudes toward smoking, exercise, weight, diet, portion sizes, and other factors that have an impact on heart health and disease.

The influence of family lifestyles is one reason why—even in this era of high-tech genetic mapping and testing—a simple medical family tree is still an important tool. It can provide insight into your own risk for heart disease and suggest the legacy you're leaving your children and grandchildren. Understanding that heart disease is a family matter also means understanding that families that change together are more likely to live longer, and be healthier, together.

Growing the family tree

You don't need special skills or tools to create a medical family tree—just paper and pencil and some memories and conversations can get you started. You can keep a list of the medical information, but arranging the items as a classic family tree or genealogical chart can reveal connections you might otherwise miss. Several health agencies and organizations have links on their Web sites to downloadable family-tree forms and instructions; books and computer programs are also available (see "Selected resources" below).

Start with your own health. List high blood pressure, high cholesterol, strokes, diabetes, blood clots, peripheral artery disease, heart attacks, heart failure, heart surgery, and other problems with your heart or blood vessels. Note when these problems first occurred or when you first became aware of them, because it makes a difference whether they appeared before age 50 or after age 70.

Branch out. The medical histories of your first-degree relatives come next. Start with the people who share half your genes—your parents, brothers and sisters, and children. For each family member, list date of birth, general health, medical conditions, and—if appropriate—age at death and cause of death. If you were adopted, the National Adoption Clearinghouse has information that may be helpful in securing medical histories of your birth parents (see "Selected resources"). Broadening your search to include grandparents, aunts, uncles, nieces and nephews, half-brothers and half-sisters, and cousins can reveal interesting patterns.

Get medical information about relatives. You'll probably need to do some sleuthing, especially if your parents have died or you've lost touch with other relatives. One strategy is to ask questions at family reunions, although you'll need to ask delicately, because such questions can raise guilt and anxiety for some family members. Perhaps there's a "matriarch"—an older woman who knows a great deal about the extended family and is more than happy to share her knowledge. Old family letters or diaries may also contain clues. Death certificates can be helpful, because they list age at death, cause of death, and sometimes other medical conditions. A death certificate can be found at the vital records department in the state where your relative died (for help in locating vital records departments, visit www.cdc.gov/nchs/howto/w2w/w2welcom.htm).

What to do with your family history

A family tree is a map, not a crystal ball. A strong family history of heart disease doesn't mean that you're fated for the same, any more than its absence means you're home free. The results are most telling when several family members are affected, they're closely related, and they developed heart disease early in life.

If you don't have heart disease but it shows up often in your family, talk to your primary care provider, who may refer you to a specialist. Depending on your family history, the specialist may go beyond the standard tests and suggest extra ones, such as measurement of C-reactive protein or homocysteine or an exercise stress test. You should also pay more attention to the familiar risk factors, such as cholesterol, blood pressure, tobacco smoke, and diet.

Keep in mind that the information you gather is important to your children, too, so make sure the family tree is both accessible and secure. You may want to keep a copy with other important family papers.

Family changes

Charting a medical family tree can do more than merely alert family members to future problems. It can also be a catalyst for change. You can't change your genes, but you can modify many other factors that affect your risk for heart disease or other conditions. This in turn can influence the health choices other family members make.

For example, say you're in your 50s and have a strong family history of heart disease. You learn that your cholesterol and blood pressure are elevated. All the lifestyle changes you make that help control these risk factors—switching to a healthier diet, getting more exercise, avoiding tobacco smoke, and maintaining a healthy weight—may encourage family members to stay on top of their cholesterol and blood pressure, too.

If someone in your family is trying to lose weight, exercise more, or boost her intake of fruits, vegetables, and whole grains, you can help her, and yourself, by doing the same. If you're making changes yourself, ask your spouse to join you, or recruit a sister, brother, cousin, or other relative; if she or he isn't nearby, check in by e-mail or phone. Working together can reinforce each other's good habits and successes and result in better long-term outcomes.

Last updated:	September 05, 2008