Q: I am filling out a form that asks for my family medical history. My father died of what we think was a heart attack at age 84. But no one else in my family had heart disease that I know of. Does that mean I check "yes" on that question?
A: That's the problem with forms which use a checklist for filling out medical histories. "Yes" or "no" answers often don't provide useful information. It's the details that make a huge difference in your personal health risks.
Because heart disease is so common, many people check "yes" to the question about whether their father or mother had heart disease. Your father had a heart attack at age 84. That's very different than if his heart attack happened when he was only 47 or you have a brother that needed heart bypass surgery at age 53.
Today, doctors need to know the ages of heart disease onset of immediate family members and also what type of heart problem they experienced. Coronary artery disease that leads to heart attacks is defined as premature if symptoms started before age 55 in a man or before age 65 in a woman.
But there are other types of heart problems that can lead to early death, such as inherited heart muscle diseases and irregular heart rhythms. If these run in your family, they can put you at risk for heart failure and sudden death.
By and large, people who have premature heart attacks are also more likely to have the classic risk factors for coronary heart disease. Some of these, such as high cholesterol or diabetes, may be linked to genetic factors that are passed down from their parents. But unhealthy habits, such as smoking, an unhealthy diet or physical inactivity, also tend to run in families and may contribute to the higher risk.
About 12 percent of people ages 20 and older have a parent or sibling who had a heart attack or angina (chest pain caused by narrowed coronary arteries) before the age of 50. Over all, these people are roughly twice as likely to have a heart attack as people without that family history.
What about genetic testing? Many different gene variants are associated with coronary artery disease and heart attacks. But for the most part, they interact in complicated ways. Today, there's no clear evidence such tests should change how your approach your own personal prevention of heart attack and stroke.
So, the best way to address that form is to not check either "yes" or "no." Instead, write down the details as you provided in your question. That information will be the most help to your doctor.
(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)