by Carolyn Thomas ♥ @HeartSisters
A young 30-something in one of my Heart-Smart Women presentation audiences asked an intriguing question while we were discussing cardiac risk factors. She was especially worried about her own personal risk for developing heart disease one day because of her family history. Her mother had died several years earlier from a heart attack while only in her 40s. But then this young woman added a few additional facts about her Mum. For example, her mother had also:
- weighed over 300 pounds
- rarely if ever engaged in physical exercise
- lived with poorly controlled Type 2 diabetes
- been a heavy smoker for over two decades
This young woman, however, shared none of those risk factors. So what do you think? Should she be concerned about this family history of heart disease after all? The World Heart Federation helps to answer this question by reminding us:
“You can protect yourself by taking care of your heart, as the development of cardiovascular disease involves many different risk factors, not just your family history.
“We know that people often behave and act as their parents and siblings do. As a result, the genes and habits that cause us to be sedentary, to smoke, to be overweight/obese, or to follow poor diets often tend to cluster in families.”
But it’s important to remember that not everybody who has a strong family history will develop cardiovascular disease, and not everybody with cardiovascular disease has a family history at all. Mayo Clinic cardiologists add:
“A family history of heart disease – including heart attack, valve or heart rhythm conditions – can increase your own risk, especially if a parent or sibling developed it at an early age (before age 55 for a male relative such as your brother or father, and before age 65 for a female relative such as your mother or sister).”
And if both parents have suffered from heart disease before the age of 55, your risk of developing heart disease can rise significantly compared to the general population.
But as I like to remind my audiences, even a strong family history is NOT necessarily a death sentence.
A stroke is also a type of cardiovascular disease (affecting blood flow to the brain instead of to the heart). Canada’s Heart and Stroke Foundation warns that you may be at higher stroke risk if a close family member (parent, sibling or child) had a stroke before age 65 – and particularly if you are a woman and your mother has suffered a stroke.
Some heart rhythm disorders can also run in families. Alicia Burns, who blogs at Brugada Girl, experienced distressing cardiac symptoms for 14 years that were misdiagnosed or dismissed entirely before being correctly diagnosed with Brugada Syndrome. Her father had died suddenly of cardiac arrest at age 55 (now believed to have been caused by Brugada) and the whole family knew that her paternal grandmother had always lived with fainting spells, yet it was only after Alicia’s diagnosis at age 34 that her father and grandmother’s experiences began to make sense.
You should be screened by a cardiologist (or an electrophysiologist who specializes in heart rhythm issues) if any first degree relative has experienced:
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
- Hypertrophic cardiomyopathy (HCM) Although it is not very common, HCM can lead to the development of abnormal heart rhythms which can then lead to sudden death in some people.
- Long QT syndrome
- Wolff-Parkinson-White (WPW) Syndrome
- Brugada syndrome (BrS) BrS is a heart rhythm disorder that causes abnormal beats in the bottom chambers of the heart (ventricles). If left undiagnosed, BrS can cause fainting, irregular heartbeats, and/or sudden death.
- Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) CPVT is an abnormal heart rhythm characterized by fainting or cardiac arrest while engaging in physical activity or intense emotional stress. It commonly occurs in younger people.
- Short QT intervals (SQT) SQT is characterized by an abnormal heart rhythm where the heart muscle takes a shorter time to recharge between beats. It can cause a variety of complications from fainting and dizziness to sudden cardiac arrest.
And if you have a family history of any of these conditions, make sure every adult in your family learns how to do CPR.
Some heart valve disorders can also be inherited. A study in Denmark reported that the risk of aortic stenosis (one of the most common heart valve diseases in the elderly) doubles when a first degree relative also had the disease. This study also found that aortic stenosis risk increased by eight-fold in patients who have both heart disease and a family history. (2)
Heart Sisters 
Nice article. By increasing awareness, we can prevent heart disease. We are all aware that high blood pressure, obesity, unhealthy diet, smoking and drinking are the most common reasons cited for heart diseases but in this article, as you mentioned, most of us are not aware that family history of heart disease can be one of the risk factors of heart disease.
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My mother died of lethal cardiac arrhythmia and cardiomyopathy when she was 38, I was 8, and I am the third child. I don’t think anyone else in my family has had any problem like this but I am aware that it is hereditary and I get checked every year. But is it something that can show up? If it was lethal does that mean it doesn’t have like a cure?
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Hi Emily – I’m not a physician so cannot comment specifically on your family history. I can tell you generally, however, that depending on what kind of arrhythmia and what kinds of tests you’re getting each year, the hereditary arrhythmia that caused your mother’s untimely death at such a young age would likely show up on an EKG. It’s important to keep in mind that not all children of a person with a genetic heart arrhythmia necessarily inherits that condition, but all of your siblings should be tested as well.
The word “lethal” is a scary one: it typically means that when left untreated, it can cause sudden cardiac death. If your EGK does show the same heart rhythm pattern that your mother had, for example, your physician would likely recommend appropriate preventive treatment (e.g. having a cardiac device like a defibrillator implanted). If not, he/she wouldn’t.
You might be interested in visiting Brugada Girl’s website (she inherited a serious cardiac arrhythmia called Brugada Syndrome from her Dad, and has lived with this most of her life).
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I’m also a survivor of the widow maker heart attack which didn’t even show up on the EKG. I’m 48, healthy, no history, no family history, I work-out 1 hr every single day, don’t smoke, rarely drink, no cholesterol. I was sent back home after my first visit to the ER. I think I’m pretty lucky to be alive. I thank you for this article…I just didn’t understand why, even more so as a Registered nurse…
Thank you.
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My dad suffered a stroke aged 33, diagnosed with heart disease at 34. He suffered several strokes, mild heart attack and was told he would only live 5 yrs.. he died aged 62 from cancer. As his daughter, I worry I will also suffer strokes as he was so young. Should my doctor do tests?
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Hello Shirley – I’m not a physician so can’t answer your specific question, but talk to your doctor about your family history. It’s important that you and your doctor identify all potential risk factors for stroke and then work on treatment plans/lifestyle improvements to reduce those risks as much as possible. Your father’s cardiac prognosis (five years!) is a very good example of how challenging it is for doctors to accurately predict the future – even with significant cardiovascular disease.
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Thanks Carolyn! This inspired me to find out exactly how old my Grandfather was when he died of a “heart attack”. I’m not sure anyone know what type of heart condition he had, but this was a man who did not smoke, ate healthy and was a farmer with lots of physical activity.
Also, my mother was recently diagnosed with Atrial Fibrillation.
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You know what else would be interesting, Elizabeth? Find out what your Grandfather’s parents or siblings died of (and at what age – remember that heart disease at an older age (over age 65 for women, over age 55 for men) is NOT considered a family history risk factor for one’s children or sibs).
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Mom just answered my e-mail. My Grandfather had his first heart attack in his early 40’s and the one that killed him at 55 years old. I know Grandpa’s brother died of heart problems and the other brother in Europe during the war. Don’t know of any relatives further than that. Know nothing of my father’s side of the family and Dad doesn’t know either.
High blood pressure on Mom’s side of the family, too…sodium sensitive.
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Family history is so interesting, isn’t it?
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My dad died of a sudden cardiac arrest at the age of 42 when I was nine years old. He died while he was talking on the phone and the doctor said he was probably gone before he even hit the floor. His father and his grandfather died the same way under the age of 55. My dad’s mother, my grandmother, also died of a massive coronary. So both grandparents had heart disease. My dad was from a family of 10 children, so I have 27 first cousins! 75% of my cousins have some sort of heart disorder, from high blood pressure to sudden cardiac arrest. One of my cousins’ sons died in his sleep at the age of 32. Out of my 27 first cousins, three have died of sudden cardiac arrest and two of us have survived it. We are the first two to survive cardiac arrest in our family.
Some of them probably didn’t live the most healthy lifestyle, but many of them did. At least in my family, it didn’t seem to matter that much.
I agree that other risk factors can definitely affect a person’s outcome. But I can’t help but think that what is going on in my family is genetic.
I finally have my appointment with an electrophysiologist on April 13. She is a great doctor with an excellent reputation and her specialty is in genetics. I am hoping that with her help, we might be able to identify something that’s going on with me that could be tested for. If there’s any way I could save my family members from having to endure another generation of lost mothers, fathers, aunts, uncles and children, I would be thrilled! ❤️
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Wow, quite the family legacy, Bonnie. So glad you have an appointment confirmed with an EP given that you too have experienced a cardiac arrest AND a parent (a first degree relative) who died at such a young age of the same diagnosis. Best to be as proactive as possible in cases like yours. Best of luck next month!
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Thank you, Carolyn! ❤️
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The very limited scope of family history that is considered relevant has been frustrating for me.
My brother with a double bypass at 47 (who doesn’t exercise) counted, as did the brother with a 98% blocked anterior descending artery at 52, when docs pushed statins on me. I exercise regularly, and my electrocardiogram was alarming, but arteries looked pretty darned good.
For over 6 years, I suggested Apical Hypertrophic Cardiomyopathy instead to docs who smiled tolerantly and assured me “that would be very rare.”
Nobody was interested in my maternal grandfather who “had a bad heart” for years and then died very suddenly. Or my mother’s brother, who died unexpectedly (though after pneumonia, at a vigorous 84, also without autopsy) or even HIS son, who was 49 when he collapsed with atrial fibrillation at the marathon finish line, but recovered.
Eventually the right cardiologist saw my echocardiogram and recognized my classic case of Apical Hypertrophic Cardiomyopathy. To the genetic cardiology people, my grandfather, uncle and cousin still don’t count, while I think they may point to a family cardiac condition beyond blockages,
However, thanks to my own diagnosis, last year my sister’s AHCM diagnosis went right on the fast track.
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Hello Kathleen – how gratifying (and maddening!) it must have been to (finally!) after six long years get doctors to agree with your own AHCM diagnosis.
And yes, you are listing good examples of what does count when it comes to evidence-based familial links (your brothers because they are your “first degree” relatives, but NOT your grandfather, uncle or cousin, who aren’t). Apparently, even first degree relatives count statistically only if their heart condition/stroke happened at a relatively young age; in my case, my own mother had a minor heart condition diagnosed in her 80s – doctors were not remotely interested in that link because hers happened in old age.
So: first degree family members only, and only if affected at a relatively YOUNG age! Otherwise, such diagnoses are interesting coincidences but not necessarily significant.
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Another wonderfully informative post, my Carolyn. Tell your siblings and children they shouldn’t be “cranky” with you – the neuro-chemistry of emotion is a BIG factor in health!
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I shall remind them of this important reality straightaway, Judy-Judith!
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Thank you for the very helpful information, Carolyn. I’m curious about a risk factor not discussed here, however.
We always talk about family history, smoking and lifestyle issues and so forth. Rarely do I hear about the issue of inflammatory disease as a risk factor in and of itself. Yet, having been diagnosed with significant blockage of the left anterior descending artery (yep, the widow maker), I learned that the lupus with which I was diagnosed thirty some years ago, likely played a role in the development of CHD. Now, my doctors are keeping me on meds to control inflammation regardless of whether or not my disease is “flaring.”
I don’t smoke, I’m petite (although my cholesterol when not on statins is 300!), I eat a healthy diet and I try to exercise three to four times/week. It is difficult with lupus to maintain a healthy exercise regimen, and that concerns me as well.
I’m just wondering, though, whether chronic inflammation and an elevated C-reactive protein are issues that are often discussed in the coronary health community?
Best Regards,
Penny Wolf
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Such an important question, Penny – to which the answer appears to be YES! Here’s a good explanation from Harvard researchers about that link you mention between inflammation or inflammatory conditions (like lupus, rheumatoid arthritis) and heart disease: “The inflammatory response includes white blood cells and the signals they send throughout the blood stream and can cause cardiovascular disease.” Read all the way down in that first post from Harvard to the table listing Causes of Inflammation and Modifiable Actions.
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Thanks so much, Carolyn. It doesn’t make the disease go away, but it helps to better understand why it’s happening, doesn’t it? I’m going to try to find that Harvard article.
Thanks again!
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Good points on this topic, Carolyn!
The new AHA/ACC risk calculator does not take family history into account in any way. Thus, I recommend in patients with a strong family history of CHD, imaging to look for early evidence of plaque build up in the arteries.
Sorting out what your parents or siblings died of is crucial. Many times my patients are told that mom or dad died of a “massive heart attack” when they dropped dead suddenly or were found dead at home. Although, coronary heart disease (CHD)/heart attack is the most common reason, there are other cardiac causes of sudden death as you listed above. An autopsy is often the only way to know what cardiac condition caused the sudden death.
If it is something other than CHD, then a totally different approach to prevention is likely warranted.
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Thanks for taking the time to comment here, Dr. Anthony. Failing to include family history is yet another concern about that ACC/AHA risk calculator.
It’s so important to know about cause of death in one’s family, particularly for serious arrhythmia diagnoses that can lead to sudden cardiac arrest. For example, my interview with Brugada Syndrome patient Alicia Burns echoes your own patients’ experience of only a vague awareness of personal risks (Grandma used to faint a lot, Dad just dropped dead!) Recommending calcium scans for otherwise healthy people appears more controversial (particularly in its early heyday when those tractor-trailer/clinics parked in Walmart parking lots offering $99 heart scans were linked with unnecessary trips to for-profit cath labs) and given that CAC scores tend to progress even on statin therapy.
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Yes, the exact cause of sudden death is hugely important to know. For example, if your mother dropped dead from V Tach related to her undiagnosed hypertrophic cardiomypathy, then echocardiographic screening is the way to go. On the other hand if it was an MI causing V tach then screening of and treatment for atherosclerotic risk factors (and I would definitely add screening for subclinical atherosclerosis) is the way to go.
The link you provided on coronary calcium gives a good balanced discussion. Definitely, think twice about any test your cardiologist orders that he profits from.
However, the lack of regression of calcium in the coronary arteries I do not view as a limitation of the technique for screening. Once coronary atherosclerosis develops in the arteries and calcium deposits in the plaque, only the most aggressive statin therapy and overall risk factor reduction will lower the calcium levels. This doesn’t influence the ability of CAC to predict risk.
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