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Jonathan Sackner Bernstein, MD:

The issue of how to interpret a family history that I personally believe has not been dealt with in an optimal fashion. I say that for the following reason. If you look at the guidelines, they'll say things such as, if your father had a attack before the age of 55 that means you now have a risk factor of a positive family history. As I've pointed out on several venues, what if your father's heart attack started at 55, during his birthday party, the night before he turned 56 but by the time he got to the hospital, he were 56, that's when the heart attack were diagnosed at 56, but does that mean that you don't have a positive family history? Of course not. 55 is a time point that has been chosen for statistical reason, not based on common sense, not based on its usefulness for a patient or a doctor. I prefer the approach of saying that you need to look at this as a continual risk so that the younger your first degree relative, father, mother, brother, sister had a heart attack, the higher your risk is and my own practice, which is not based on any scientific data, is that I tend to get very aggressive with treatment about ten years earlier than a person's first degree relative actually had their first cardiovascular event. But if you have a positive family history to any degree, you have to be that much more cautious and that much more proactive with your doctor about making sure your risk is optimized.