5 things you need to know if you have a family history of heart disease.

When it comes to familial heart conditions, often it is the case that “the apple doesn’t fall far from the tree”. Being aware of an appropriate diagnosis (if present), and then implementing the appropriate treatment can be life-saving.

After all, it’s better to be prepared and proactive about your health than take a ‘wait and see’ approach.

So, where to start?

signs of a heart attack
Be aware of the appropriate diagnosis. Source: iStock.

Is it really a “Family History”?

If you are approaching the age where other members of the family have had heart attacks, then it’s no surprise you may be starting to wonder if you will be struck with the same affliction. I see many patients who report a family history of “Bad Hearts”. They will report that “Great Uncle So and So” had a heart attack at 85 years of age and just dropped dead in the garden, to everyone’s surprise.

Strictly speaking, this is a history of heart attack in the family, but it is not the “Family History” that we are asking about as doctors.

What we really mean by family history is if there has been premature (occurring at a young age compared to average) heart problems or death in the family from the heart. When we say premature, we are most concerned to find out if men less than about 50 to 55 years of age or women less than 60 to 65 years of age have been affected.

If there truly are “young” relatives in the family who have had heart problems then we, as doctors looking after you, need some detail around the actual circumstances.

signs of a heart attack
Doctor's need detailed information. Source: iStock.

 Were there other factors?

Commonly, a build up of cholesterol in the arteries, called atherosclerosis (like build up of “rust in the pipes”) leading to coronary artery disease runs in families. It is important to be clear if the affected family member smoked, was overweight, had high blood pressure or diabetes or some other risk factor that may have contributed to their risk. For you, this is simple, avoid the bad habits of the “bad heart” relative, don’t smoke, keep your weight down, exercise, have your blood pressure and blood sugar checked.

What about cholesterol?

Well, there is a form of hereditary raised blood cholesterol levels that run in the family in association with premature coronary events (chest pain or heart attack).

The condition where high levels of cholesterol are passed through the family is called Familial Hypercholesterolaemia (Familial = in families, Hyper = high – cholesterol = cholesterol – aemia = in the blood………….so “families with high cholesterol in their blood”). This condition occurs in around one in 300 people in the population, so it is relatively common in the community. It is very common in the patients who have had heart attacks, and in patients who are 50 years old or younger in hospital with a heart attack, it can be as common as 1 in 20.


The reason it is so important to diagnose Familial Hypercholesterolaemia is that it can be treated before a heart attack occurs.

The use of cholesterol-lowering drugs and monitoring through coordinated specialist and local doctor care can make a real difference to the life of people with this condition. So, if there is premature coronary artery disease in the family and high cholesterol levels, get checked out and talk with you local doctor about it. With appropriate diagnosis and treatment, it is an opportunity to make a real difference, not something to be scared of or put off.

Now in 2017, there is a range of new therapies on the horizon for treating cholesterol levels. This means that certain patients will be able to access these new therapies but only through trials and for this reason, if Familial Hypercholesterolaemia is suspected review by a specialist is recommended.

signs of a heart attack
In some families the cause is not always clear. Source: iStock.

What if it’s not clear what the cause was?

In some families it is not always clear what the cause of early coronary disease is related to. These families may have a clear history of premature coronary events but the cholesterol levels may not be particularly high, and other risk factors may not be obvious.

I see patients in this situation regularly in my rooms. They want to know are they at risk as other members of their family have been. This can be difficult to sort out, but often I will speak with these patients about further testing to try to more precisely evaluate their risk.


I will frequently discuss using Cardiac CT imaging to look directly at the arteries to help in understanding the health of their arteries. This testing is not for everyone and currently is not supported by a Medicare rebate, however I have many patients who wish to undergo the testing for their own clarity around their cardiac health.

signs of a heart attack
Your local doctor will help you assess risk factors. Source: iStock.

Lock in with your local doctor

Whether you need to start to exercise, quit smoking, have your blood pressure checked, blood sugar level checked or your cholesterol checked, go and lock in with your local doctor. They will help assess your risk factors but also keep you accountable to your targets.

Your GP will also have supports and even medication to help with smoking cessation, they will help with your preventative planning. They can treat blood pressure, cholesterol and diabetes. They will direct you to specialist care if needed and they can also discuss scanning your heart if appropriate.

Prevention is better than cure, but you have to act before the event!

 Dr Warrick Bishop is a practising cardiologist and author of the new book. Have You Planned Your Heart Attack? (RRP $34.99), now available at Amcal, Guardian, all good bookstores and online