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Family history of heart disease? Here’s what you need to know

It’s a good idea to know if cardiovascular problems run in your family – but lifestyle factors also play a key role. Abi Jackson finds out more.

It’s always alarming when a loved one develops cardiovascular disease or suffers a heart attack. As well as worrying about them, it might make you consider your own health too – especially as these things can run in families.

So, if you do have a family history of heart disease and stroke, how concerned should you be? And what can you do about it?

To get some straight answers we talked to Dr Gerald Carr-White, a consultant cardiologist at Guy’s and St Thomas’ Hospital, as well as London Bridge Hospital, part of HCA Healthcare UK (londonbridgehospital.com), and Philippa Hobson, a senior cardiac nurse for British Heart Foundation (bhf.org.uk).

How important is family history for heart health?
Around 7.5 million people are living with heart and circulatory disease, according to British Heart Foundation, and even though treatments have generally improved,
cardiovascular disease remains a leading cause of death in the UK and Ireland.
Family history can be very relevant – but it’s important to remember this is part of a bigger picture. Generally, “the most common thing that tends to run in families is vascular disease, affecting the coronary arteries”, says Dr Carr-White. Known medically as ‘atherosclerosis’, heavily clogged or narrowed arteries are a cause of potentially life-threatening heart attacks and stroke. It occurs due to a build-up of fatty deposits which, over time, leads to plaque developing within the artery walls.
Family history is one of five or six important risk factors that come into play, says Carr-White: “The others are smoking, whether you have a healthy diet, exercise, blood pressure, diabetes, high cholesterol to consider. All of these are very important.”

Find out what’s actually going on
The first step is to try and have a general awareness of your family history, and if you are concerned, Hobson says it’s a good idea to “ask questions about what happened”. Did doctors specify a cause? How old were they when it first happened?
“If your granddad or dad was in their 60s or 70s then, of course, that’s still a serious thing, but if there is a family history of very premature heart attack, then you might want to take a more serious look at things like high cholesterol in the family,” says Hobson. “Some people may even be born with high cholesterol but just not know about it until something happens.”
For example, familial hypercholest- erolaemia, a genetic condition that affects around one in every 250 people, causes abnormally high cholesterol from a young age.
“It’s also worth pointing out that a lot of the time when people die young or suddenly, while [the cause of death] is often put down to a heart attack, this can sometimes be due to inherited conditions within the muscle or electrics of the heart,” adds Carr-White. “So, if you do have a family history of people dying at a young age, particularly if it’s below 40, it’s worth going for a check-up with a specialist to see if there is anything else running through the family.”

Healthy lifestyle habits go a very long way
Understandably, knowing heart problems run in your family can be worrying. “Family history is what’s called an ‘unmodifiable risk factor’,” says Hobson – but that doesn’t mean future heart problems are inevitable. “We can’t help our family background, but many of the other key risk factors are modifiable. So, it’s really about addressing the other risk factors.”
Lifestyle plays a vital role here. “Lifestyle measures are the most important thing anyone can do, and probably make more of a difference than anything else,” says Carr-White. “So keep an eye on your weight, don’t smoke, exercise regularly, eat a healthy diet – that probably does more good than all the tablets put together.”
This is important for everyone, regardless of family history. For those of us who are more genetically predisposed to developing problems, Carr-White notes that a healthy lifestyle “can make a difference to when those problems present”. In other words, we could help delay them, and sometimes prevent them entirely, by living healthily.
He recommends looking to the Mediterranean diet – typically rich in fresh fruit, vegetables and healthy fats found in nuts and oily fish, and low in saturated fat – which is often dubbed the world’s healthiest diet, thanks to numerous major studies.
Watching your salt intake can help keep blood pressure healthy, and while exercise is important this isn’t just about hitting the gym for an intense workout every now and then. There’s lots of evidence that having a generally active lifestyle – think daily walks and avoiding too much time being sedentary – can be just as beneficial.
Don’t wait for a health scare to start
There’s growing evidence on how our diet and lifestyle in childhood impacts health in later life – and it’s never too early to start encouraging healthy habits. Plus, the build-up of plaque in our arteries develops over years and prevention is always better than cure. “If you look at the aortas and arteries of adolescents, you can see the early stages of problems with the walls of the arteries,” says Carr-White. “So getting those lifestyle habits in from an early age is a good idea.”

Know your numbers
Another way we can be proactive is by finding out our blood pressure and cholesterol levels. “High blood pressure and high cholesterol don’t normally have any symptoms,” says Hobson, “so it’s a good idea to have your numbers checked.”
Detecting these things early means we can take steps to manage them – through lifestyle adjustments and sometimes medication – before they get worse. You don’t have to wait until you’re inviting for a routine health check either. In fact, you can often now get these things checked on your local high street.
“Chemists are very good at this now, you don’t always have to go to your GP,” says Carr-White.

Be symptom savvy
Being aware of potential symptoms is also key, and ensuring you get them checked out quickly, and this doesn’t just include chest pain. “Particularly if you’re becoming more breathless when you do things, if you’re having a very fast heart rate or having blackouts, it’s very important to get those checked out. They could indicate narrowing in the coronary arteries, or a weakness of the heart muscle or an electrical problem,” says Carr-White.
“It’s also worth saying that women often present late with coronary heart disease, and people don’t tend to think about this sort of thing as much with women.”
Indeed, anyone experiencing symptoms, regardless of whether they fit the ‘stereotype’ of a typical heart attack victim, should get things checked.
As Hobson notes, even very slim people can have clogged arteries.
And Carr-White’s final piece of advice? “Everyone should learn CPR,” he says. “You never know when this vital first aid skill could help save a life.”

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