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"Our brother had a heart attack…now our risk for one is increased"

When their older brother had a heart attack at age 49, two younger brothers were shocked to learn that they were now at a greater risk to have the same thing happen to them, even more than their sisters. What could they do to stay healthy, even with this genetic link?




The Johnsons were a large family. Even after they became adults, married, and had their own families, the five siblings remained close. They gathered for holidays and celebrations, making room for their own children. It was an active and healthy family, so everyone was shocked and saddened when Mr. Johnson died of a sudden heart attack at age 54.



Michael and Andrew were the most connected of the Johnson brothers and sisters. Only a year apart, they had similar dispositions and interests; their families often vacationed together. When Michael received a call that their older brother, Damien, who was only 49, had been rushed to the hospital with a heart attack, he called Andrew and they went together.



Damien was stable in the Cardiac Intensive Care Unit. His cardiologist led the brothers to a conference room to discuss the situation. He explained that Damien had premature cardiovascular disease (CVD), the same condition that had caused their father’s death. “Premature CVD in a parent means the children have a greater risk of developing it, too. In men, it happens before they’re 55. In the United States, the average age for a first heart attack in men is 65. But 4% to 10% of all heart attacks occur before people are 45 years old, and most happen in men.” The cardiologist continued: “Something else you should know is that if any sibling (male or female) has a heart attack or chest pain due to obstructed arteries in the heart, the chances of healthy brothers developing the same problems within the next 10 years increases by 20%. Sisters have a 7% greater risk, too. And the younger the sibling is when they have the event, the higher your risk.”


Matthew and Andrew were astounded. They were only 43 and 42 years old! What could they do to avoid a heart attack, like their father and Damien? The cardiologist told them they couldn’t shake their genetic history, but they could make sure to adopt a strict healthy lifestyle: daily exercise, a Mediterranean diet, maintain appropriate weight, and stop smoking.



He also encouraged them to monitor their health closely, starting by getting a HeartLung™ scan. Although they were young adults, it would be good to get a baseline Coronary Artery Calcium (CAC) score to see if they already had calcified plaque in the blood vessels that bring oxygen and nutrients to the heart. With that information, their health care providers could recommend specific treatment according to the latest guidelines.



Andrew and Michael thanked the cardiologist, who assured them their brother would recover. On their way home, they called their siblings to provide an update. They also told them about getting a HeartLung™ scan. To honor Damien, all four promised each other they would schedule their scan the next day. And Johnsons always keep their word.




REFERENCES

  1. Vaidya D et al. Incidence of Coronary Artery Disease in Siblings of Patients With Premature Coronary Artery Disease: 10 Years of Follow-up. American Journal of Cardiology, 1 Nov 2007. https://doi.org/10.1016/j.amjcard.2007.06.031

  2. Ambroziak M et al. Younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature atherosclerosis. BMC Vascular Disorders, 11 Sep 2020. https://doi.org/10.1186/s12872-020-01677-w

  3. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

  4. Premature Heart Disease, 15 Dec 2019. Harvard Health Publishing. https://www.health.harvard.edu/heart-health/premature-heart-disease

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