Doc's note: Heart disease is the leading cause of death among men and women in the U.S. Nearly 700,000 Americans die each year from heart disease. But too many folks think that if they have a family history of heart disease there's not much they can do to reduce their own risk. Today, we're rounding out our week of debunking health myths with the real reason you're at risk of heart disease...
Go to a doctor and one of the first questions they'll ask is if you have a family history of heart disease or related issues like high cholesterol.
We're often told there's a strong hereditary link between your current heart health and the health of your parents.
For years, I've heard people say things like, "I'm not surprised I have high cholesterol – it runs in my family."
The truth is that yes, you can blame Mom and Dad... but only to a certain extent. And shifting the blame to your genes also misses the point of heart disease risk...
A 2017 study from Massachusetts General Hospital looked at more than 9,000 folks with high cholesterol. The researchers did genetic testing on them to determine a "genetic risk score." They looked at 57 genes known to have changes (or mutations) that increase cardiovascular risk.
If one of your genes is mutated, you might increase your risk by about 10%. If you have several, that risk jumps to as much as 60%.
They found that a surprising one in five folks scored in the highest-risk group. Even more surprising – the test did a much more accurate job identifying risk than a simple family history.
According to the researchers, that's likely due to the initial problem... Will you have a heart attack like your dad because you have similar lifestyles or is it from the genes you inherited?
Family history still plays an important role in determining your risk, so always inform your doctor. That's especially true if anyone in your immediate family has had a heart attack or a diagnosis of heart disease before the age of 65.
However, just because you have a higher "genetic risk score" doesn't mean you also have high cholesterol. Remember, only about half of folks who suffer a heart attack have cholesterol levels above the so-called "normal" value.
It's more likely you're more predisposed to the real cause of heart disease: inflammation.
For years, doctors believed those plaque buildups were the root cause of heart disease. If you had too much cholesterol, it would "stick" to your arterial walls and cause these buildups. If you lower the cholesterol, the theory went, you'd lower the number of plaques and risk of heart disease.
But those plaques actually form in response to inflammation. Chronic inflammation can cause fissures in our blood vessels. When that happens, our immune system uses the so-called "bad" cholesterol LDL to patch the tears. That's why we get plaques. And those plaques can grow over time. They can block the vessel or break off entirely, leading to a stroke or heart attack.
So really, we need to focus on inflammation, not cholesterol.
One 2017 study from the New England Journal of Medicine did focus on inflammation. The researchers ran a randomized double-blind study on more than 10,000 patients who had experienced a heart attack. (Remember, a randomized study is the gold standard for research.)
Half received a placebo and half received an anti-inflammatory drug. The drug did not lower anyone's cholesterol levels. However, those who received the anti-inflammatory drug saw significantly lower rates of any recurring heart problems, including heart attacks.
When calculating your heart disease risk score, the factors included are all things that increase your inflammation. Take a look at the list:
- Being overweight, especially carrying excess weight around the midsection
- Age (65 and older)
- High blood pressure
- Family history of heart disease
Excess weight actually triggers inflammatory chemicals in our bodies. Similarly, several studies show that high blood pressure accompanies higher inflammation scores. Researchers aren't sure if high pressure increases inflammation or the other way around, but they do occur together for many folks.
Similarly, as we age, our bodies tend to have more low-grade, chronic inflammation. The reason is that many processes associated with aging share chemical pathways that trigger inflammation (and vice versa).
It's what I've said for years... many so-called "aging" diseases are driven by inflammation. That includes Alzheimer's, rheumatoid arthritis, and cancer.
And given what we now know about the genetic component of heart disease risk, it wouldn't surprise me if the key was inflammation. I bet in a few years we'll see studies showing this. In fact, I wonder if having the wrong forms of these genes raises heart disease risk because they interfere with the inflammation process.
Remember, though: A genetic predisposition doesn't let you off the hook. It means you need to work harder on making the appropriate lifestyle changes to lower your heart disease risk.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
December 30, 2022
Editor's note: Our offices are closed Monday, January 2, for New Year's Day. You'll receive your next issue of the Health & Wealth Bulletin on Tuesday, January 3, 2022. Have a safe and happy New Year!