Family history of heart attack - A risk factor that can't be changed
What is a strong family history of heart attacks?
People who have a strong family history of heart attacks have an increased risk of heart attack also. A strong family history is defined as having a first-degree relative (parent or sibling) who developed coronary artery disease (angina or heart attack) before the age of 60 years if the relative was male and before the age of 65 years if the relative was female.
How much does a strong family history of hear attacks increase my risk?
The section, 'Assessing your risk of suffering from vascular disease (heart attack and stroke)' details how risk factors are used to divide individuals into three 'risk groups' with respect to their likelihood of suffering a heart attack in the next 5 years. Generally speaking, for people over the age of 45 to 50 years, having a strong family history elevates them into the next highest risk group. (This, of course, would not apply to a twenty year with no inherited condition causing the family history of heart attacks as all such people are at low risk.)
A few people with a family history of heart attacks will have the inherited conditions familial hypercholesterolaemia or familial combined hyperlipidaemia as the cause of their family's problem. These people are already defined as being at high risk.
What should you do?
A family history of coronary artery disease is an important risk factor and people with such a history should consider adopting all measures possible to reduce their risk, including doing the following.
Reducing your risk
a. Minimise risk factors that you can modify.
This should always include changing lifestyle factors. Whether it also means adding medication to reduce cholesterol, high blood pressure or blood clotting will depend on overall risk level and untreated blood pressure and cholesterol levels.
A complete list of modifiable risk factors is listed in the section 'Assessing your risk of suffering from vascular disease (heart attack and stroke)'
b. Identify any inherited condition that might cause increased risk of heart attacks
It is also important to look for the cause of the relative’s coronary artery disease. If the relative had risk factors that can be prevented, such as smoking, high blood pressure, obesity or lack of exercise, there may be less cause for concern. If diabetes or high cholesterol were problems, then regular testing for these conditions is needed as they are to some extent inherited.
Cholesterol
For the general population, there is no need to test for raised cholesterol until about the age of 45 years. However, a test should be done much earlier, at about 20 years of age or before, if the person has either:
- A strong family history of heart attacks or
- A family history of an inherited condition that causes raised blood cholesterol. The most common ones are Familial Hypercholesterolaemia and Familial Combined Hyperlipidaemia. If either of these conditions are known to be present in the family, blood lipids should be checked in childhood.
Diabetes
Having a relative that has diabetes increases the risk of developing the disease. Certain racial groups are also at increased risk of developing diabetes. (See diabetes section.)
Testing for diabetes is not routinely done in the population until the age of 55 years. However, those with a family history of the disease should be initially tested at about 45 years of age. If this initial test is normal, testing should repeated every three years unless an abnormal result occurs.
Homocysteine
If the relative that developed coronary artery disease did not have any obvious risk factors and the family history is relatively strong, then consideration should be given to being tested for a raised homocysteine level in the blood as this can be associated with increased vascular disease and is usually an inherited condition. Homocysteine is dealt with in the 'Other risk factors section'.
Additional Information
British Hypertension Society Risk Calculator
This is a calculator that you can actively use on your computer. It is best done with your doctor as it requires medical information that you may not have available. It is located at:85,358
www.bhsoc.org/resources/prediction_chart.htm