Ask the Doctors June 2014 Issue

Ask The Doctors: June 2014

I just turned 67, and my parents turn 90 this year. My father has a pacemaker and my mother has congestive heart failure. They both developed heart problems later in life. Am I likely to develop heart problems because both my parents did, or should I just be encouraged that both my parents have lived so long?

Longevity is a very complex phenomenon, influenced by genetics, environment and chance. Although we know that lifestyle factors such as healthy dietary choices, frequent physical activity, and nonsmoking tend to lengthen life, we still do not know how genetic and environmental components interact. The fact that both of your parents are turning 90 years old is hopeful, and increases your chance of living longer, but it does not ensure that you will be equally long-lived. Regarding certain heart problems which tend to run in families, we can estimate the increased risk for members of such families. For example, if an individual’s male first-degree relative (father/brother/son) experienced a heart attack before the age of 55 years, or female first-degree relative (mother/sister/daughter) had a heart attack before the age of 65 years, that person is approximately twice as likely to experience a heart attack in their lifetime compared to the general population. As people grow older, they are more likely to have heart problems simply because of aging, rather than a result of genetic influences.

From your description, I must assume that your parents developed cardiac issues after the age of 65. If so, we cannot predict your own risk of needing a pacemaker, or suffering from heart failure. However, we should screen you in the same way we would other 67 year-olds, for hypertension, hyperlipidemia, diabetes, and elevated levels of inflammation, as well as for behavioral features such as sedentary lifestyle and smoking. It would be misguided for you or your physician to dismiss such risk factors simply because your parents have had remarkable longevity. As mentioned above, there is no guarantee that you will be as fortunate, but we do know that for individuals in your age group, there is strong data proving that treatment of risk factors reduces the risk of heart attack and heart failure.

I take a statin and exercise to help keep my cholesterol down. But can plaque build-up in an artery ever be reversed, or is it that once your arteries narrow, they can’t get “better?”

First of all, I must commend you for “doing the right thing” with regards to cholesterol treatment and physical exercise. Admittedly, it can be difficult to maintain faith in one’s course of therapy when it seems that every week, a new study emerges which appears to topple the results of older trials. My suggestion is to take the longer view, realizing that medicine is a moving and constantly growing field. Treatment changes reflect the totality of evidence from multiple large, well-conducted clinical trials, and are based upon science.

That being said, the question of whether or not coronary plaques can be reversed is an apt one, which has been studied and discussed intensely for more than 30 years. Cholesterol plaques are one hallmark of coronary artery disease, and they are composed primarily of fatty substances, proteins, and cells. High cholesterol levels and inflammation-related injury to the vessel wall lead to buildup of cholesterol, and high-density lipoprotein particles remove it. Inflammation inside the plaque can lead to rupture, blood clot formation in the vessel, and a heart attack. Aggressive treatment with statin drugs, together with lifestyle modification, can sometimes lead to shrinking of plaques, particularly in their earlier, “soft plaque” stages. While a positive finding, this is probably not the most important result of such therapy. More key is the fact that statins and a healthy lifestyle reduce inflammation and stabilize plaques, which in turn reduce the risk of heart attack.

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