Do you have an uncle who always seems short of breath? Did one of your grandparents or parents die at an early age from "heart problems?" If heart failure is in your family tree, you might wonder if its branches extend to you.
Family history does play a part in your risk for heart failure. Genes your parents passed down to you could make you more prone to diseases that damage or weaken your heart. But genes alone don’t doom you to heart failure. How well you take care of your heart health matters, too.
"You can't help who your parents are or what genes they gave you, good and bad, but you can determine what you do with the genes you have," says Khadijah Breathett, MD, associate professor of medicine at the Indiana University School of Medicine. "It's kind of like a forest fire. You can choose to add more fuel to the burning fire, or you can choose to work on putting it out."
Genes and Your Heart Failure Risk
Genes are responsible for part of your heart failure risk. You and your relatives share many of the same genes, some of which control how well your heart works.
Having one parent with heart failure increases your risk by as much as 70% compared to someone without a family history. A brother or sister with heart failure increases your risk by about 40%.
Some genes directly cause diseases that damage your heart and lead to heart failure, such as:
- Dilated cardiomyopathy — diseases of the heart muscle
- Channelopathies — problems with the heart's rhythm
- Familial hypercholesterolemia — very high cholesterol that runs in families
A few of these genetic risks are more common in people of color. For example, Black people have triple the risk for dilated cardiomyopathy that white people have.
Black and Hispanic people are also more likely to have a change (or mutation) in the TTR gene. About 4 percent of Black people have this mutation, which increases the risk for cardiac amyloidosis, an abnormal buildup of protein in the heart that can lead to heart failure.
"Not everyone who has that gene mutation will go on to develop heart failure, but people who carry that gene mutation have a higher risk of developing heart failure than those who don't," says Alanna Morris, MD, associate professor at Emory University School of Medicine.
Genes also play a part in other heart failure risks that run in families, such as high blood pressure, diabetes, and obesity. That is, you could have a gene that predisposes you to high blood pressure, which in turn ups your odds of heart failure.
The Family Environment
Except for diseases like cardiac amyloidosis that are caused by a single gene, genes only set you up for heart failure. Lifestyle is what puts the disease into motion. That's something families share, too.
"In certain families there's not enough exercise. High blood pressure runs in families, and that may be related to stressful environments or excess intake of salt," Morris says.
The foods you eat together as a family, whether you get enough exercise, and if you live in an area with a lot of pollution can all affect your heart failure risk. Many of these environmental risks are under your control.
Breathett stresses the importance of “Life's Simple 8” — eight things you and other family members can do to protect your heart health if you're at risk of heart failure.
- Get at least 30 minutes of exercise a day.
- Quit smoking.
- Lower your cholesterol level.
- Manage your blood pressure.
- Control your blood sugar.
- Stay at a healthy body mass index (BMI).
- Get enough sleep.
Know Your Family History
"Understanding the heart history and health issues in your family and community is an important step in making changes to your lifestyle to improve your health," says Patricia Chavez, MD, MBBS, assistant professor of medicine at Albert Einstein College of Medicine and a heart failure and transplant cardiology specialist at Montefiore Medical Center.
The only way to know your family history is to ask. It might feel awkward to ask about your relatives' health, but it's an important conversation to have. Once you know your family history, you can use strategies like Life's Simple 8 to reduce your chance of getting heart failure.
You might bring up the topic with relatives when you're all together at a family reunion or other gathering. Here are a few questions to ask:
- Have you ever had heart failure, a heart attack, high cholesterol, high blood pressure, or coronary artery disease?
- Do you know if any of our other close relatives have had these conditions?
- Has anyone in the family had a procedure to treat a heart problem?
Write their answers on a Family Health Tree, which you can get from the American Heart Association's website. Take it with you to your doctor's office.
Not everyone in your family will be equally comfortable sharing their health history with you. With those family members, Morris suggests, bring a health care provider in on the conversation. "That often makes it easier to transmit the importance of why we are doing this."
Bring family members along to a doctor’s appointment. You can even meet with your doctor virtually to involve family members who live in other parts of the country.
Do You Need Genetic Testing?
You may need genetic testing or other heart disease screening if anyone in your family died from heart failure or a heart attack, especially at a young age (in their 40s or 50s). Also tell your doctor if you have a strong family history of high cholesterol, high blood pressure, diabetes, or obesity.
Tests for cardiac amyloidosis are especially important for Black people with a strong family history of that disease, Morris says. Early treatment is key. "If we diagnose it too late, the treatment options that are now available often aren't effective," she says.
Your primary care doctor can refer you to a genetic counselor, who will suggest tests based on your family history. Depending on what those tests show, your doctor might want to check you more often and help you get a better handle on your weight, blood pressure, and blood sugar levels to protect your heart.
Genetic testing doesn't just help you. It also lets your relatives know whether they're at higher risk for heart failure. Once you tell them about their risks, they can take steps to protect their heart and possibly prolong their life in the process.
Photo Credit: monkeybusinessimages / Getty Images
American Heart Association: "My Family Health Tree."
British Heart Foundation: "Family history."
Circulation: "Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association."
Circulation: Heart Failure: "Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients."
Congestive Heart Failure: "Heart Failure Risk: Lessons from the Family."
Current Cardiovascular Risk Reports: "Racial and Ethnic Disparities in Transthyretin Cardiac Amyloidosis."
Khadijah Breathett, MD, associate professor of medicine, Indiana University School of Medicine.
Alanna Morris, MD, associate professor, Emory University School of Medicine.
Patricia Chavez, MD, MBBS, assistant professor of medicine, Albert Einstein College of Medicine; heart failure and transplant cardiology specialist, Montefiore Medical Center.