About Family History & Healthy Lifestyle
with
Dr. James Bartlett
The heart of the family
Family history has long been used in targeting heart disease prevention strategies to those who need them most. It's considered a major risk factor when a first- or second-generation male relative age 55 and less or female relative age 65 and less died of coronary artery disease.
In such cases, prevention strategies are put in place. Patients are told to exercise more, eat less fat, lose weight and quit smoking. When that doesn't work, they are given prescriptions to lower cholesterol and blood pressure. Some of these strategies are appropriate for most patients, according to the American Medical Association, but especially important for those whose close relatives have coronary artery disease.
James Bartlett, MD
Columbia St. Mary's
When heart disease runs in the family
Even the healthiest among us can fall prey to heart disease if it runs in the family. Consider Dr. Bartlett's patient, the marathon runner, who competes in five to six races around the world every year. He has been running seven miles a day since he was in his 20s. He also has a family history of heart disease.
"He was concerned about the chest discomfort he was experiencing when he ran, so he came in. We checked his cholesterol. It was high. We did a stress test. It was very abnormal. He was basically a vegetarian, but he could not get is cholesterol down," Dr. Bartlett said.
Dr. Bartlett ended up doing a heart catheterization and a five-vessel bypass. He also prescribed medication to lower his cholesterol. The patient has been fine ever since and continues to participate in marathons.
Marathon running is not in the picture for most of us, but general aerobic activity should be, Dr. Bartlett says. "If you fail to exercise at least two to three times a week for at least 20 minutes, it's as high a risk as smoking two packs of cigarettes a day."
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Is the answer in the genes?
Medical research is making headway in identifying genes that cause congenital heart defects, but genes implicated in the more common forms of heart disease, have remained elusive. There are just too many of them, reports the AMA.
"There isn't just one gene that directly causes heart disease, but we know that there are genes that cause high cholesterol and high cholesterol causes heart disease," says James C. Bartlett, D.O., cardiologist with Columbia St. Mary's. There are also genes for obesity, high blood pressure and diabetes - all of which make people more susceptible to heart disease.
The National Heart, Lung and Blood Institute is devoting millions of dollars toward advanced gene research. Drug firms are heavily invested in developing genetic tests for screening. More targeted prevention and treatment is possible with more knowledge about risks and prevention strategies.
What's new in tests and treatment?
Cardiologists, such as Dr. Bartlett, are now able to do more complex screening than standard cholesterol measurements once used solely to assess heart disease risk. "We look at total cholesterol levels, the HDL or "good" and the LDL or "bad" levels. If these are normal, it's often thought that there is no risk. As specialists, we take things a step further by looking at triglyceride levels and something that is not always looked at called lipoprotein a, which has been identified as a definite risk factor."
Advanced screening for indicators includes elevated levels of homocysteine, subparticle LDL size, high specificity C-reactive protein, and urine proteinuria, Dr. Bartlett said. Based on early research done in Wisconsin, higher homocysteine levels in healthy, post-menopausal women were found to cause increased the risk of future cardiovascular disease.
"Ask your doctor for these tests," advises Dr. Bartlett. "If they balk, you balk." He also recommends asking about folic acid and Vitamin B complex, which have been found important in the primary prevention of coronary heart disease among women.
Family history is not the only correlating risk factor, Dr. Bartlett continues. "We know that smoking only two to three cigarettes a day raises your risk by 300 percent. Obesity is a factor. And diabetes is the strongest risk indicator. Eighty percent of all diabetics will die of heart disease."
Even when controlling for risk factors like family history, hypertension and diabetes, unmanaged stress and anger also contribute to heart disease, as evidenced in a recent Johns Hopkins University study that found angry young medical students are more likely to become angry old doctors with heart attacks. "Those Type A people who burn the candle at both ends need to work on getting anger out of their system. Meditation and exercise help," Dr. Bartlett said.
As they keep up with all these advances, cardiologists like Dr. Bartlett invest a lot of time in educating patients and their families. "I talk to the whole family about the importance of such things as heart scans (which show calcium buildup in heart vessels, a precursor to blocked arteries), stopping smoking and getting off the American diet. It's really important for patients, families and physicians to work together on positive long-term outcomes."
