Genetic Risk, Testing for Heart Disease

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Genetic Risk, Testing for Heart Disease

Question:

My 60-year-old brother recently died of a massive heart attack. He seemed healthy. He was not overweight, he exercised daily and ate well, he took his cholesterol medication and he saw his doctor regularly. Others in my family have died of sudden heart attacks. Is there any genetic test that I (and my siblings) should undergo to see if we are at risk for sudden heart attack?

Answer:

Although there are some genetic tests for coronary artery disease, I would not recommend genetic testing at this time.

Here is the way I suggest you approach your possible increased risk. First, I would want to be sure that your brother and other family members died because of a blocked coronary artery. Sometimes sudden death is called a massive heart attack when actually the death was caused by an electrical abnormality that causes a fatal rhythm disturbance.

You can have this evaluated by getting a routine EKG.

Second, assuming that coronary artery disease does run in your family, genetic testing would not alter my advice regarding what you should do to minimize your risk of a heart attack:

• Don't smoke.

• Eat a diet loaded with whole grains, vegetables and fruits.

• Exercise at a moderate intensity for one hour daily, after checking with your doctor first to make sure this is safe for you.

• Keep your LDL cholesterol below 100 and perhaps as low as 70. You may need medication, usually a statin drug.

• Know your HDL cholesterol. If it is low, you may want to take a statin or niacin even if your LDL is below 100.

• Control your blood pressure so that the systolic is below 140. Below 120 is even better.

• Maintain a healthy body weight.

I personally recommend taking a daily baby aspirin for men and women with a strong family history of coronary artery disease and heart attacks.

Women with heart disease often have symptoms other than chest pain. If you develop shortness of breath, dizziness, excessive sweating with minimal exertion or new fatigue, you need to seek prompt medical advice.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Last updated:	July 20, 2009