If you have a family history of heart disease, you should meet with your doctor proactively and discuss its potential implications for your heart health.
“If a first-degree relative like a parent or sibling had a sudden cardiac arrest before age 50, it doubles your risk of having an event yourself,” says Janet Wei, MD, an associate professor of cardiology and biomedical sciences at Cedars Sinai in Los Angeles.
Even if your family heart history seems relatively normal, you deserve to know your personal risk if you have relatives with heart disease. These questions can help guide your conversation.
1. How Does My Family History Affect My Lifetime Risk?
It’s critical that you ask this question to better understand your personal risk for the various types of heart disease that can run in families.
On the other hand, an early heart attack in a parent or sibling can double your risk of having one, says Dr. Wei.
Asking this question helps you understand the specific heart health risks you face, as well as how to manage them over your lifetime.
2. Should I Get My Children Screened?
“We really should be screening children as young as 2 [years old] if a parent has high cholesterol,” says Wei. “There’s a condition called familial hypercholesterolemia in which bad cholesterol can be extremely high, and those people have higher risks for heart attack and stroke.”
Understanding your child’s risk for heart disease can help you encourage a healthy lifestyle or even start medications at younger ages to reduce the possibility of them developing heart disease later.
3. Would I Benefit From a Calcium Scoring Test?
A calcium scoring (CAC) test is a painless, low-radiation CT scan that detects calcified plaque buildup in the heart’s blood vessels. It can increase the precision of your understanding of your heart health and risks today. Ask this question if you have a family history of heart attack or elevated cholesterol.
“We recommend this test to people over age 35 if they have a strong family history of heart disease,” says Dr. Burka. “We wouldn’t expect to see calcified plaques in a 40-year-old, so if we find them, we can create a treatment plan that may include statin medications or even aspirin therapy.”
4. Should I Get a Lipoprotein-A Test?
Most people don’t ask this question, because most people have never heard of the relatively new lipoprotein-A (LpA) test, but it’s worth asking your doctor about it.
“If a male parent or sibling had a cardiac event before age 55, or a female relative had one before age 65, then we can consider measuring lipoprotein-A,” says Wei. “Lipoproteins are sticky cholesterol particles that we call a risk-enhancing factor for plaque buildup. It should be measured in everyone at least once in their lifetime, and it may be even more important to measure in those with a family history of heart disease.”
5. Should I Take Aspirin Every Day?
Low-dose aspirin was once a standard recommendation, and if a close relative had a heart attack or you know your family history includes heart disease, you may be tempted to start a daily aspirin regimen. However, don’t do so without asking your doctor first, because the consensus on aspirin treatment has shifted.
“Taking a daily aspirin isn’t necessary,” says Burka. “Aspirin therapy can be appropriate for certain people with certain types or levels of heart disease, but no one should self-medicate with aspirin. Instead, talk to your doctor about the types of treatment that make sense for you and your personal heart health and family-associated risks.”
6. Does My Kidney Disease Affect My Cardiovascular Risk?
“According to the new American Heart Association guidelines, CKD is considered a risk enhancer for developing coronary artery disease,” says Burka. “If a person has stage 3 CKD or higher, that can be a reason to intensify your statin [therapy] to keep your LDL [“bad” cholesterol] below 70.”
Burka says that other inflammatory diseases like lupus and rheumatoid arthritis warrant a heart health conversation with your doctor because they can enhance your risk of coronary disease.
7. I Eat Healthy and Exercise Regularly. Do I Still Need to Be Concerned About My Heart Health?
Heart-healthy lifestyle aside, you should still ask your doctor what heart health screenings make sense for you.
“Even if you’re fit and eat healthy, it’s important to know your heart health numbers — cholesterol, blood pressure, and so on,” says Wei. “You can have a normal body mass index and normal blood pressure, and appear asymptomatic, but if your cholesterol is elevated, then we should consider medications for it, especially in light of any family cardiac history. If there’s a genetic cause for something like high cholesterol, only medication can bring it down.”
8. Should I Get Genetic Testing for Heart Attack Risk?
With the proliferation of private DNA health testing kits, you may be wondering whether your doctor can order something similar to help you assess your risk. It’s an appropriate question to ask.
“There’s no genetic testing for coronary artery disease, per se, but there’s genetic screening we can do for familial hypercholesterolemia specifically,” says Burka, “In fact, even if you don’t know your family heart history, if your regular cholesterol test shows your LDL cholesterol is over 190, that’s a strong [indication] that it may be genetic, which makes genetic testing worth pursuing.”
9. Should I Use a Heart Health Tracker?
Ask your doctor this question so you can focus on the type of health tracker that best suits your goals, instead of feeling overwhelmed by the many apps and devices available.
For example, if you’ve been diagnosed with hypertension, it may be a good idea to invest in an at-home blood pressure monitor, says Wei. “They can connect to blood pressure apps that you can easily pull up when you’re in the doctor’s office,” she says.
Burka also likes watch trackers for fitness. “Among the tech we recommend to patients are step trackers to encourage people to stay active,” she says.
The Takeaway
- Understanding your family’s cardiac history is vital because having a first-degree relative with an early cardiac event can double your risk, requiring a proactive discussion with your doctor about your lifetime risk.
- Ask about specific diagnostic tools like CAC tests to detect plaque buildup, LpA blood tests, and even screenings for children if high cholesterol runs in the family.
- It’s important to discuss how non-heart-related conditions such as chronic kidney disease or inflammatory diseases like lupus can act as risk enhancers that may require more intensive treatments.
- Even for those with a heart-healthy lifestyle, it’s worth asking your doctor about your risks and new habits that can help improve them.
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