Sibling Heart Disease A Risk Factor For Brother Or Sister

Persons with a brother or sister who had a heart attack at an early age are at increased risk for heart disease, according to a study published in the medical journal Circulation.

It has long been accepted that a family history of heart disease is a sign of potential problems, says Dr. Roger S. Blumenthal, director of the Johns Hopkins University Ciccarone Preventive Cardiology Center.

Defining the Risk

But the new study Dr. Blumenthal conducted helps experts define that risk.

The researchers used an advanced diagnostic technique called electron beam tomography (also called EBT or ultrafast CT) to look for calcium deposits in more than 8,500 people with no apparent symptoms of heart disease. These deposits can eventually grow to block an artery.

As expected, the test found that anyone whose father or mother had had a heart attack was almost twice as likely to have such deposits as someone whose parents had not had such an event.

But it also found that anyone with a brother or sister who experienced an early heart attack was three times as likely to have such deposits.

"Our data strongly support the idea that the use of family history in assessing risk is important," Dr. Blumenthal says.

The researchers chose to look for calcium deposits because they provide an early warning sign of heart disease, Dr. Blumenthal notes.

Dr. Blumenthal believes the evidence is strong enough for family history to be added to the four major risk factors for heart disease that were identified by the landmark Framingham Heart Study.

Those risk factors are elevated levels of cholesterol and blood pressure, as well as age and cigarette smoking.

It was the Framingham study that identified a doubled cardiac risk for someone with a parent who had had a major heart problem, Dr. Blumenthal points out.

"Now they are analyzing data on whether having a brother or sister with a cardiac event indicates an increased risk," Dr. Blumenthal says. "My suspicion, based on our data, is that having such a brother or sister will have greater prognostic power."

Stay Vigilant, Experts Say

He suggests that anyone with a sibling with heart problems have a diagnostic test beyond the standard measures of risk. One test that Dr. Blumenthal recommends is for blood levels of C-reactive protein, a marker of inflammation that has been linked in many studies to increased heart disease risk.

The American Heart Association (AHA) does not recommend the electron beam tomography test used in the Hopkins study because "there is, as yet, no data demonstrating that actual outcomes are improved in patients who have the test and have an intervention based on the finding," according to an AHA statement.

Whatever extra tests might be done, Dr. Robert O. Bonow, a professor of medicine at Northwestern University and a spokesman for the AHA, says, "It is reasonable to recommend that all treatable risk factors should be identified and treated very aggressively" when a young brother or sister has a heart attack.

"What might be a satisfactory level of LDL [bad] cholesterol for an average person might be high for such a person," Dr. Bonow comments. "The same goes for blood pressure. And those people above all should not be smoking. You can't control your genes, but you can control your smoking habits."

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Heart Association

Centers for Disease Control and Prevention (CDC)

Everyday Choices, AHA, ADA, and ACS

Go Red for Women Campaign, AHA

HealthierUS.Gov

National Heart, Lung, and Blood Institute (NHLBI)

National Institutes of Health (NIH)

National Library of Medicine

US Health and Human Services

November 2004

Sibling Heart Disease A Risk Factor For Brother Or Sister

Defining the Risk

Stay Vigilant, Experts Say

Treadmill Testing May Predict Heart Disease in Healthy Men

Online Resources

Treadmill Testing May Predict Heart Disease in Healthy Men

A brisk trot on the treadmill can clarify the cardiovascular risk for men who do not have heart disease but who do have risk factors pointing toward future problems, says a new study in the medical journal Circulation.

Men with such risk factors who did poorly on the test were twice as likely to have a heart attack or other major cardiac problem over the next decade compared to those who did well, says a Framingham Heart Study report.

Exercise stress testing, in which someone goes faster and faster on a treadmill while heart performance is measured, is generally not recommended for routine screening of people with no history of symptoms of heart disease.

The new study is the first to evaluate the test among people who have no heart symptoms but do have such risk factors as diabetes, high blood pressure, high cholesterol, and smoking.

The study, which included 1,431 such men and 1,621 women, found a doubled risk for men whose heart rate did not reach the expected target rate or who had a heartbeat abnormality called ST-segment depression, compared to men who did not have those problems.

"Our results suggest that exercise testing may be of benefit in asymptomatic men with intermediate to high risk," says study author Dr. Gary J. Balady, a professor of medicine at Boston University School of Medicine.

Even though women develop heart disease at the same rate as men, the study authors say that women did not experience the same number of heart events as men in this study, possibly because women studied were in their 40s and 50s, and heart disease is more of a problem for women at older ages.

According to the American Heart Association, in 2001, over 43 million American women were older than 50. The risk of cardiovascular disease (CVD) increases with age, and that is why it is important to raise awareness of this major public health issue for older women.

The AHA states that coronary heart disease claims the lives of 248,184 females annually compared with 41,394 lives from breast cancer and 65,632 from lung cancer.

Treadmill testing usually is not done for someone with no symptoms of heart disease, says Dr. Gerald Fletcher, a preventive cardiologist at the Mayo Clinic and a spokesman for the American Heart Association.

For persons without symptoms who require assessment, such as a middle-aged, inactive man who is about to start an exercise program, "it might be wise to do a stress test of some sort," Dr. Fletcher notes.

But it is preferable to do a more intensive test, such as treadmill exercise accompanied by an echocardiogram, which give an image of heart performance, he says.

A study reported recently in the Journal of the American Medical Association says that usefulness of results from exercise stress tests to predict heart disease were unclear.

Always consult your physician for more information.