Among the well-known risk factors for the development of coronary heart disease, there are many that we can change and some that appear beyond our control. Through diet, exercise and good habits, you can influence your blood pressure, cholesterol, blood sugar and weight; these, in turn, play large roles in determining your risk of developing cardiovascular disease.

But what about your genes? You can choose to follow a heart-healthy Mediterranean diet, exercise daily and abstain from smoking. But you can’t choose your parents. If you have a strong family history of heart disease, is your fate sealed? Or, put another way, is a future heart attack inevitable?

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Know Your Family History:
Scientists have long-recognized that family history is an important, non-modifiable risk factor for heart disease. In fact, it is a component of many scoring systems that try to predict a person’s risk of developing cardiovascular disease. But the truth is, most of us have some family history of heart disease. Heart disease is so common that it touches nearly every family.When you consider your own family history, you need to dig a little to get the full picture. The age at which a relative developed heart disease is critically important. If a first-degree relative (parent or sibling) developed coronary heart disease before age fifty-five, this represents a special warning of increased risk for you. Knowing that your father had a heart attack is important, but the implications for you are much greater if he had it when he was fifty-two years old (versus eighty years old).

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A Heart Disease Gene?
The precise link between family history and development of coronary heart disease is a subject of intense scientific investigation. It’s complicated. There is no single heart disease gene. More than 100 genes appear to contribute to the development of heart disease. Don’t believe advertisements on the Internet that promise to scan your genes and determine your heart disease risk if you agree to swipe your Visa card.

Familial Hypercholesterolemia: An Important Exception
While there is no gene that guarantees a future heart attack, we have identified one genetically-controlled condition that contributes substantially to the risk of developing artery-blocking plaques. This condition is called familial hypercholesterolemia.People with familial hypercholesterolemia carry a defective gene that causes LDL cholesterol (the bad cholesterol) to build up in the blood. One in every 500 people has a single copy of the defective gene; this often leads to the development of coronary heart disease by the age of forty. One in a million people has two copies of the defective gene, and this can cause heart attacks in children and teenagers.

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How do you know if you carry this gene? You don’t need a genetic test—you just need a simple lipid profile (cholesterol test). Every adult should have a cholesterol test by age 20. If the LDL cholesterol is greater than 220, you probably have a single copy of the bad gene. But we have good news—with statins, additional cholesterol-lowering medicines, diet and exercise we can generally control cholesterol levels and dramatically reduce the risk of a heart attack.

The Best Approach:
Your genes neither guarantee that you will develop coronary heart disease nor confer absolute protection that you won’t ever suffer a heart attack. In nearly all cases, lifestyle choices trump your genes. Follow a heart-healthy lifestyle, marked by a Mediterranean diet, daily exercise, weight control and no smoking to ensure the greatest protection from heart disease.With this strategy, you can beat your genes.

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