It is very common to hear phrases like the following in a cardiology consultation:
"I have a family history of heart attacks because my grandfather suffered a heart attack at the age of 82."
"My father had heart problems in his 80s, so I'm at risk too."
Although this concern is completely understandable, it is important to clarify that not all family histories have the same meaning or imply the same level of cardiovascular risk.
What is considered a family history of cardiovascular disease?
To assess whether there is a true family history of cardiovascular risk, two fundamental aspects must be taken into account:
- The degree of kinship with the affected person.
- The age at which cardiovascular disease appeared.
The most relevant family history is that which affects first-degree relatives , that is, parents or siblings.
However, it's not just who suffered from the disease that matters, but also when it occurred.
The importance of age: early cardiovascular disease
A heart attack or stroke that occurs at an advanced age is usually related to the natural aging process and the accumulation of risk factors throughout life.
In contrast, when these events occur early, the likelihood of an inherited genetic predisposition increases.
For this reason, it is considered especially relevant if a first-degree relative has had cardiovascular disease:
- Before 55 years, if he is a man.
- Before 65 years, if she is a woman.
This data helps the cardiologist to identify patients with a potentially increased hereditary cardiovascular risk.
So, does a grandfather who has a heart attack at 80 years old count?
Yes, it is information that is always useful to know and communicate during a medical consultation.
However, on its own it is not usually considered a family history of high cardiovascular risk.
Reaching 80 years of age before suffering a heart attack indicates that the disease appeared at a very advanced stage of life, which has a very different meaning than that of a person who experiences a cardiovascular event at 45 or 50 years of age.
What situations suggest a higher genetic load?
There are certain family histories that can indicate a greater hereditary predisposition:
- Heart attacks in parents or siblings at young ages.
- Several family members affected by cardiovascular disease.
- Cases of sudden death in the family.
- Very high cholesterol levels in several family members.
- Discovery familial hypercholesterolemia or other hereditary cardiovascular diseases.
Genetics plays a role, but it doesn't determine the future.
One of the most important messages is that genetics is not destiny.
Although family history can increase cardiovascular risk, in most people it is possible to reduce it significantly by acting on modifiable factors:
- No smoking.
- Maintain a healthy diet.
- Perform physical activity on a regular basis.
- Control blood pressure.
- Monitor cholesterol levels.
- Keep a healthy weight.
- Properly manage diabetes when it exists.
Adopting these habits can make a big difference, even in people with a genetic predisposition.
The key message
Having a family member who suffered a heart attack at a very advanced age does not necessarily mean that there is a high hereditary cardiovascular risk.
What really points to a genetic predisposition is the early appearance of the disease in close relatives.
Therefore, when you go to the Cardiology clinic, it is not enough to simply state that there is a family history. It is important to explain:
- Which family member presented with the disease?
- What cardiovascular problem did he suffer?
- At what age did it happen?
- Whenever possible, provide reports or a medical summary that allows for a detailed understanding of the diagnosis.
All this information helps the cardiologist to make a more accurate assessment of cardiovascular risk and to offer preventive recommendations tailored to each patient.
By Dr. Roylán Falcón Rodríguez, specialist at UICAR