We inherit many things from our parents and grandparents — our eye color, maybe, or a cleft chin. Sometimes, that list can also include a higher risk of heart disease. But that doesn't seal our fate.
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Here's how much genetics plays a role in heart disease, and what you can do to lower your risk.
Is Heart Disease Genetic?
Heart disease is the leading cause of death in the U.S., both among people assigned male at birth and those assigned female at birth, responsible for more than 650,000 deaths per year, according to the Centers for Disease Control and Prevention (CDC). (The most common type of heart disease in the U.S. is coronary artery disease, which can lead to a heart attack.)
For decades, experts have known that coronary artery disease can run in the family — and since the mid-2000s, researchers have identified certain gene variations that can increase the risk of the condition.
One oft-cited study in The New England Journal of Medicine from December 2016 found that people who were the most genetically predisposed to coronary artery disease were about 90 percent more likely to have a heart disease incident, like a heart attack, than those who were the least at-risk, genetically speaking.
Newer research, however, published February 2022 in Circulation, found that genetically at-risk people can stave off heart disease for up to 20 years by following a few basic healthy lifestyle habits.
"It's encouraging that, while we know genetics plays an important role in heart disease, it doesn't make heart disease inevitable," says Natalie Hasbani, MPH, the lead author of the study and a research assistant at UTHealth School of Public Health in Dallas. "You have a lot of tools at your disposal to combat high genetic risk, including taking control of your lifestyle."
There's also some overlap between genetic inheritance and lifestyle, says Christine Jellis, MD, PhD, a cardiologist at the Cleveland Clinic. For example, eating a poor diet, smoking or not exercising can also run in the family. "We have the same dietary and exercise habits as our families and pass those habits on to our children," she says.
How Often Should You Get Screened?
There's no single screening test for heart disease, but there are screenings to help you keep an eye on the biggest risk factors for the condition, including high blood pressure, high low-density liproprotein (LDL) cholesterol and obesity, per the CDC.
Some risk factors, like high blood pressure, don't cause any obvious symptoms, which makes screenings even more important. If ticker troubles run in your family, be proactive and set up a screening with your primary care doctor or a cardiologist based on the following guidelines:
- High blood pressure: If you're at high risk for high blood pressure or you're over 40, get it checked once a year. If you're under 40 and not at increased risk, get it checked every three to five years, per the U.S. Department of Health and Human Services (HHS).
- High LDL cholesterol: It's generally recommended to get a cholesterol check every four to six years, but if high cholesterol or heart disease runs in your family, you should get tested more often, per the HHS. Ask your doctor how often makes sense for you.
- Obesity: Your doctor should use your weight at your annual checkup to calculate your body mass index, which will determine if you have overweight or obesity, per the American Heart Association (AHA). If your BMI is 25 or higher, they may also measure your waist circumference. A waist size greater than 35 inches for people AFAB or 40 inches for people AMAB is linked to a higher risk of heart disease, per the AHA.
In general, your doctor should tailor a plan to you and take "an evidence-based approach to looking at your cardiovascular risk factors," Dr. Jellis explains. This may mean checking your blood pressure, blood sugar and cholesterol levels, as well as other screenings, like an EKG or ultrasound, if necessary.
"It's always good to have a baseline checkup and then establish care with a trusted provider," she says. "That way, in the future, people always have someone that they can reach out to if their circumstances change."
6 Tips to Help Lower Your Risk of Heart Disease
1. Set a Bedtime Alarm for 10:00 p.m.
And then stick to it. Far from being harmless, getting too little shut-eye can be harmful to your heart. In a September 2019 study in the Journal of the American College of Cardiology, people who logged fewer than 6 hours of sleep each night had a 20 percent greater chance of having a heart attack than people who got 6 to 9 hours of sleep a night.
One possible reason: When we sleep poorly, we may have less energy to exercise and be more likely to reach for unhealthy foods the next day. Plus, our blood pressure goes down when we sleep, according to the CDC, and staying awake for longer periods of time means our blood pressure stays higher for longer.
The good news: The researchers behind the 2019 study found that getting enough sleep could help ward off a heart attack, even among people who were genetically pre-disposed to heart disease.
Try to go to bed between 10:00 pm and 11:00 pm. A December 2021 study in the European Heart Journal - Digital Health found that people who fell asleep between these times had the lowest risk of heart disease. (Staying up until after midnight was associated with the highest risk.)
2. Eat More Salmon and Olive Oil
By now, you likely know that not all fats are bad for you. Monounsaturated and polyunsaturated fats — which are found in olive oil and salmon, respectively — are particularly heart-healthy, Dr. Jellis says. Plus, by eating more of these fats, you'll naturally replace some of the less-healthy saturated fat (found in meat and dairy) that should be consumed in moderation, she says.
Monounsaturated and polyunsaturated fats are found in abundance in the Mediterranean diet, which, according to a sweeping March 2019 review in Circulation Research, is linked to better heart health and lower rates of heart disease. Other staple foods of the diet include fish, vegetables, fruits, beans, nuts and seeds.
Fish may also be particularly good for people who already have heart disease. A March 2021 study in JAMA Internal Medicine found that eating about two servings of fish per week can lower the risk of having a heart attack, stroke and heart failure among people with pre-existing heart disease.
Aim to eat fish about twice a week, per the AHA, and make sure to choose fatty fish like salmon, tuna and mackerel.
3. Go for Walks
Even if that walk is just around the house. Replacing 30 minutes of sedentary behavior a day with even light-intensity exercise — like walking slowly or doing chores like dusting — could lower the risk of dying of heart disease by 24 percent, according to a January 2018 study in Clinical Epidemiology.
"The heart is like any other muscle — it needs to be exercised," says Dr. Jellis.
As your endurance levels pick up, you can also pick up the exercise pace. The AHA recommends getting 150 minutes of moderate-intensity exercise a week, or about 30 minutes a day, five times per week. Moderate- and vigorous-intensity exercise (think: biking, running) improves your heart's ability to pump blood and shuttle oxygen throughout the body, according to the National Heart, Lung, and Blood Institute.
4. Download a Meditation App
What's bad for your mood may also be bad for your heart. "Stress can be associated with developing heart disease," says Dr. Jellis. "In situations of high stress, people can take on unhealthy habits, like smoking or vaping, making poor diet choices and staying sedentary."
Practicing mindfulness — in which you're aware of your feelings and senses, but aren't judging them — is one way to relieve stress, according to an April 2016 paper in Clinical Psychology Review. Apps like Headspace ($13 a month, Headspace.com) and Insight Timer (Free, InsightTimer.com) offer guided mindfulness sessions that can teach you how to practice the technique throughout the day.
For example, some mindfulness techniques might include focusing on your breathing — paying attention as each breath comes in and out of your lungs — or paying more attention to sensations, like the feel of warm water as you wash dishes.
5. Add Another Serving of Fruit to Your Diet
Regular exercise and maintaining a healthy weight can help ward off type 2 diabetes, a condition characterized by high blood sugar levels that can increase the risk of heart disease, according to the AHA.
Something else that may lower the risk of type 2 diabetes? Eating fruit. A study from October 2021 in The Journal of Clinical Endocrinology & Metabolism found that eating about two servings of fruit per day was associated with a 36 percent lower risk of developing type 2 diabetes over the next five years compared to people who ate less than half a serving of fruit per day.
"Many people have heard that sugar is bad, and think that this must also therefore apply to fruits," says Nicola Bondonno, PhD, lead study author and postdoctoral research fellow at the Danish Cancer Society Research Centre, in Copenhagen, Denmark. Buy, she says, "evidence shows that the health risks from sugars…are related to consuming 'added sugars,' not from eating sugars that are naturally present in fruits."
Fruits are chock-full of vitamins, minerals and fiber, according to the American Diabetes Association, and most of them have a low glycemic index (meaning, a lower effect on your blood sugar levels), because they also contain fiber.
While some fruits are higher in fiber or antioxidants than others, try to vary your selections. "Given that different fruits contain different nutrients and phytochemicals, and these nutrients and phytochemicals all work in different ways to keep you healthy, I think that variety is key," Bondonno says.
6. Call a Friend
Chances are, everyone feels a little FOMO now and then (especially in the era of COVID-19). But loneliness can be more dangerous than you may think. An April 2016 review in Heart found that poor social relationships — for example, a lack of social ties with others — were associated with a 29 percent increased risk of a heart disease event (like a heart attack) and a 32 percent increased risk of stroke.
People who are lonely may also be more likely to smoke or be less physically active, say the researchers. To stay social and active, try streaming an online fitness class with a friend or joining a virtual workout class, like Crunch Live or NEOU Fitness.
- Centers for Disease and Prevention: "Heart Disease Facts"
- Centers for Disease Control and Prevention: "About Heart Disease"
- The New England Journal of Medicine: "Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease"
- Circulation: "American Heart Association's Life's Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease"
- Journal of the American College of Cardiology: "Sleep Duration and Myocardial Infarction"
- European Heart Journal - Digital Health: "Accelerometer-derived Sleep Onset Timing and Cardiovascular Disease Incidence: a UK Biobank Cohort Study"
- Centers for Disease Control and Prevention: "How Does Sleep Affect Your Heart Health?"
- Circulation Research: "The Mediterranean Diet and Cardiovascular Health"
- JAMA Internal Medicine: "Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries"
- American Heart Association: "Fish and Omega-3 Fatty Acids"
- Clinical Epidemiology: "Replacing Sedentary Time With Physical Activity: A 15-year Follow-up of Mortality in a National Cohort"
- National Institutes of Health, National Heart, Lung, and Blood Institute: "Physical Activity and Your Heart"
- Clinical Psychology Review: "Effectiveness of Online Mindfulness-based Interventions in Improving Mental Health: A Review and Meta-analysis of Randomised Controlled Trials"
- Mayo Clinic: "Mindfulness Exercises"
- American Heart Association: "Life's Simple 7 Manage Blood Sugar Infographic"
- American Diabetes Association: "Healthy Food Choices Made Easy"
- Mayo Clinic: "Glycemic Index Diet: What's Behind the Claims"
- BMJ: "Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-analysis of Longitudinal Observational Studies"
- CDC: "Heart Disease and Stroke"
- American Heart Association: "Heart-Health Screenings"
- U.S. Department of Health and Human Services: "Get Your Blood Pressure Checked"
- U.S. Department of Health and Human Services: "Get Your Cholesterol Checked"
- The Journal of Clinical Endocrinology & Metabolism: "Associations Between Fruit Intake and Risk of Diabetes in the AusDiab Cohort"