Posted Jan 26, 2011
We’re forever reminded that our heart health is in our control. Just take a walk down the cereal aisle or have a chat with your doctor about your smoking habit.
It’s true that much of what we choose to do or opt not to do (exercising, for example) has a direct and scientifically proven impact on cardiovascular health.
But there’s also a whole lot that’s out of our control. There are vegetarian marathon runners who have to take pills every day to lower their blood pressure and cholesterol.
Some studies have shown that as many as half of cases involving coronary artery disease are not explained by lifestyle-associated risk factors, said Amy Sturm, a cardiovascular genetic counselor at Ohio State University Medical Center.
People with family members who at a young age had heart attacks or unstable angina — a condition in which the heart does not get enough blood — are considered at increased risk and should be more closely monitored by their doctors, said Dr. Aref Amro, an interventional cardiologist at Doctors Hospital.
“Family history is a very important risk factor for heart disease,” he said.
Any type of serious cardiovascular event in a person’s 40s and 50s (or earlier) is considered a sign that the problem is something they might have passed along to their children, Amro said.
Anyone with immediate family members who have had coronary artery disease should be aware of symptoms, including chest pain and shortness of breath, Amro said. Risk factors, such as high cholesterol, should be lowered with lifestyle changes and medication if necessary, he said.
“They need really to take extra precautions in order to make sure they don’t end up with similar circumstances like their family members,” he said.
Amro recalled a patient who suffered a heart attack in his early 50s. He was a postal carrier who walked as many as 15 miles a day, didn’t smoke and had normal blood pressure.
“He could not come to grips with how such a healthy individual gets a heart attack. I think the only (answer) for him is a family history,” Amro said. “It was really a struggle to convince that man how he ended up with a heart attack despite having such a healthy lifestyle.”
For coronary artery disease, scientists haven’t identified a single genetic mutation to test for, nothing along the lines of common mutations for breast cancer, Sturm said.
“The family history is your best genetic test,” Strum said. “We feel like we’re maybe five or 10 years behind the progress in cancer genetics.”
But much work is being done in the area, and Ohio State has started a special high-risk family heart clinic to help identify biological markers and genetic links.
People who are seen in the clinic also undergo advanced screenings including detailed lipid profiling and imaging to identify problems in the heart and blood vessels.
The hope is that work done here and elsewhere will lead to better treatments, Sturm said.
In addition to playing a role in coronary artery disease, genetics contribute greatly to the risk of other cardiovascular problems, including aneurysms and cardiomyopathy, both of which can lead to sudden death.
Identifying patterns in families and the gene responsible for the disease can save lives and calm fears for those who discover they don’t carry the predisposition, Sturm said.
Janet Graves, a teacher in Springfield, eventually found her way to the OSU clinic after a 9-year-old cousin suffered a heart attack at school.
The child’s heart attack led to the identification of a particularly catastrophic genetic predisposition to hypertrophic cardiomyopathy.
“Your likelihood of immediately dying is huge,” Graves said.
Cardiomyopathy, a disease of the heart muscle, primarily weakens the left ventricle, which is the main pumping chamber of the heart. People who suffer from it may develop heart failure.
The problem was something the family had long suspected — several of Graves’ family members, including a 17-year-old and 19-year-old, had died suddenly.
Graves, 45, has never had heart trouble, but because she carries the mutation, she now takes medication and had a defibrillator implanted last year.
“I feel very fortunate,” she said. “It’s manageable and treatable, and I would much rather know than not know.”
mcrane@dispatch.com
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