UNC Health Talk

How Family History Affects Your Risk of Heart Disease

It’s a question every doctor’s office asks on a new patient form: Do you have a family history of heart disease?

If you answer “yes,” you’re not alone. Most families experience heart disease at some point.

First, rest assured—just because your family has a history of heart disease, it does not necessarily mean that you will have heart disease. But you could be at higher risk depending on the type of heart disease, the number of people in your family who had it and their age when the heart disease occurred.

We talked to UNC Health cardiologist Christopher Kelly, MD, to learn more. Here are three things to know about heart disease and family history.

1. Not all heart diseases are the same.

“Heart disease” is a catchall phrase for a variety of conditions that affect your heart. The specific type of heart disease your family member had may determine your risk level.

“When somebody says they have a family history of heart disease, it’s very important to clarify what that heart disease is exactly,” Dr. Kelly says. “It’s also important to clarify that the disease occurred in a genetically related relative and in some cases to explore a more extended family tree.”

Family history is more of a risk factor in some types of heart disease than others. For example, hypertrophic cardiomyopathy is an inherited heart condition that causes a thickening of your heart muscle and increases the risk of dangerous heart rhythms. If a first-degree family member has this condition—meaning a parent or sibling—your doctor needs to know because you have a 50 percent chance of having the genetic mutation for the disease. Early detection can help guide treatment and prevent complications.

“If I find out their heart disease has a strong inheritance pattern—meaning relatives of affected people are at high risk of having the same disease—I screen the patient carefully and often perform genetic testing as well,” Dr. Kelly says.

However, most of the time when somebody says they have a family history of heart disease, they’re talking about more common conditions with weaker genetic associations.

“They’re usually talking about somebody who had a heart attack at some point in their life,” Dr. Kelly says. “That might mean increased risk for the patient, but because heart attacks are so common, the age at which their relative had their first heart attack becomes more crucial.”

2. The age your loved one had heart disease is another strong indicator of your risk.

Most people will have a family history of heart disease because heart disease is the No. 1 killer of people.

“Just by virtue of that fact, most people will have some family members affected by heart disease, just like having a family member with cancer is an unfortunate but very normal thing,” Dr. Kelly says. “So the question is which family member was it and at what age did it begin?”

In terms of which family member, doctors look at your parents, siblings, grandparents and your parents’ siblings.

Then they consider the age of the person in your family and the type of heart disease. A heart attack is considered “premature” if it’s before the age of 55 in a man or before the age of 65 in a woman, Dr. Kelly says. For example, if your father had a heart attack at age 52, that is abnormal, but if he had it in his late 50s or 60s it does not necessarily raise alarms about significant genetic risk. The same goes for heart failure, another common condition among older adults that can raise concerns about genetic issues if it occurs at younger ages.

“We also look at how many family members were affected and how close they are to you,” Dr. Kelly says. “It’s not normal for all of your male relatives such as your father, brother and grandfathers to have a heart attack at age 56 even though it’s over the age of 55. The fact that it affected many different family members right over that threshold indicates that there’s something going on.”

If it turns out that a family member had heart disease earlier than what is considered normal or you have multiple family members affected at a relatively young age, your doctor may closely monitor your risk factors. This includes your cholesterol, because high levels of cholesterol can clog your arteries and raise your risk of coronary artery disease and heart attack. It also includes your blood pressure, because high blood pressure is a major risk factor for heart disease.

If your cholesterol and blood pressure are under control but you have a family history of heart disease, your doctor may order a test to determine your calcium score; calcium is a marker of plaque in the coronary arteries of the heart.

“If your calcium score is zero, then that’s a sign that whatever genetic issue is going on in the family probably didn’t affect you,” Dr. Kelly says. “You don’t have any plaque that we can detect on your heart, and we can treat you more like someone who didn’t have a strong family history.”

If you have a high calcium score, meaning you have an abnormally high amount of plaque in your heart for someone your age, that’s a sign you may have whatever genetic problem exists in your family.

“If you’re genetically prone to making plaque, we can be even more aggressive than we would usually be about controlling your other risk factors,” Dr. Kelly says. “So even though your cholesterol would be OK for an average person, you’re not an average person because you already have plaque in your heart, so to slow the progression of that and reduce your risk, we have to be really aggressive about getting your cholesterol lowered as early as possible.”

3. You can lower your risk for heart disease even if you have a family history of it.

In addition to monitoring your cholesterol and blood pressure, there are steps you can take to lower your risk of heart disease even if you are considered at high risk of getting it:

  • Get your annual flu shot. Influenza (the seasonal flu) has been linked to increased heart attacks and strokes, Dr. Kelly says. “Get your flu vaccination to reduce your risk of having influenza and also to reduce your risk of having a severe infection if you do get the flu,” Dr. Kelly says.
  • Understand the signs of a heart attack.

“Become educated about what symptoms could indicate a heart problem and make sure you get appropriate medical attention if you experience them,” Dr. Kelly says.

If you experience symptoms of a heart attack, don’t ignore them. Play it safe and call 911. The sooner you get treatment, the greater your chances of recovery.

Need a cardiologist? Find one near you.

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