Cardiovascular disease is the No.1 killer in the United States, so most of us have a family history of, and some genetic risk for, heart disease. In my family, for example, we have a history of high cholesterol and coronary artery disease.
A number of years ago, while I was working as a medical resident, our team finished our rounds in the cardiac intensive care unit and had a meeting in the cafeteria.
Our head physician, whom I’ll call Dr. Thompson, was a seasoned veteran of cardiology who had spent his life helping prevent and treat coronary artery disease and heart attacks.
We all sat down around a large circular table with our trays in front of us.
Dr. Thompson‘s tray was filled with multiple sausages, eggs, bacon, and a doughnut. After treating heart problems for four hours before breakfast, the rest of us had chosen some combination of heart-healthy foods: oatmeal, banana, cantaloupe, and yogurt.
Sensing a moment to educate the younger doctors around him, Dr. Thompson said, “People in my family die one of two ways. They either get cancer or heart disease. I’ve chosen how I’m going to die.”
Most of us can imagine that there are better ways of dying than having cancer. And most of us would prefer to die from a disease that doesn’t involve languishing with severe pain or debilitating symptoms. So I can understand Dr. Thompson’s reasoning: He would rather have died from heart disease than cancer.
The question before all of us who have a family history of coronary artery disease -- a family member who’s had a heart attack, coronary artery bypass surgery, a heart artery stent, or heart failure -- is this: What can we do? Are we able to overcome, to a certain extent, our genetic risk of heart disease?
Depending on your answer, you may prefer to go for the giant breakfast of eggs, sausages, bacon, and doughnuts versus the small portion of fruit and oatmeal.
Genetic Risk of Heart Disease vs. Lifestyle Risks
The answer to these questions came in a study presented in November 2016 at the American Heart Association Scientific Sessions in New Orleans, and simultaneously published in The New England Journal of Medicine.
This study included more than 55,000 people, and because of its large size, gave us unique insights into groups of people often underrepresented in medical research: women and racial and ethnic minorities. It included data from four prior studies (Atherosclerosis Risk in Communities, Women’s Genome Health Study, Malmo Diet and Cancer Study, and BioImage Study).
Researchers looked for 50 genetic mutations associated with
higher risk of coronary artery disease in the people who participated in the study. Based on whether they had these mutations, people were grouped as having low, intermediate, or high risk of developing coronary artery disease.
Next, the researchers looked at things each person can choose do with their lives to potentially lower their inherited risk for heart disease.
People were grouped in unfavorable, intermediate, and favorable categories based on four healthy lifestyle choices:
- Not smoking
- Maintaining a healthier body mass index (BMI) of less than 30
- Exercising at least once per week
- Eating a healthy diet that contains more fruits and vegetables, less processed meat, and fewer foods high in sodium
The results showed these levels of increased risk for heart disease:
- 27 to 35 percent for people in the intermediate-risk genetic group
- 75 to 98 percent for those in the high-risk genetic group
- 9 to 32 percent for those in the intermediate lifestyle category
- 71 to 127 percent for those in the unfavorable lifestyle category
It turns out Dr. Thompson was right. His disease destiny was being driven, in part, by his genetics. But unfavorable lifestyle choices raise risks, too, and this study showed that each of the poor lifestyle choices by themselves raised heart disease risk.
How to Lower Your Genetic Risk of Heart Disease
People in the study who adhered to a favorable lifestyle lowered their risk of heart disease even more, despite their genetics. Those at:
- low genetic risk cut their risk by 45 percent
- intermediate risk, by 47 percent
- highest risk who had a healthy lifestyle, by 46 percent
But you aren't destined to the fate of your parents and grandparents. The choices you make can influence your heart disease risk and possibly slow the progression of heart disease if you do have it.
Favorable lifestyle choices aren’t easy, but they’re worth trying and not that hard to pursue: Stop smoking, keep your weight down, eat a healthy diet, and stay active.
Imagine the possibilities if you make even more changes, such as a focusing your diet on whole foods, fruits, vegetables, and nuts, getting daily exercise, and working toward a BMI of around 25.
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