1. My immediate family has risk factors, how does it affect me? If I inherit a risk factor, is it treatable? Some risk factors are inherited. Most risk factors are treatable. Some non-inherited risk factors are associated with family-influenced behaviors of the patient. Certain genes may cause risk factors to run in families, and patients may or may not inherit these genes. For example, if a patient’s father had high LDL cholesterol (bad) levels and had an early myocardial infarction, the patient’s father’s high LDL may have been caused by the gene and may have been passed on to the patient as well. In this case, extra attention should be paid to the patient’s cholesterol level testing. For accurate test results, the patient must fast for 8-12 hours before taking a blood sample. Finding high LDL cholesterol levels is important if the patient has a genetic predisposition to high LDL: since medications and other treatments can reduce LDL cholesterol levels by more than 50%, this means a more than 50% reduction in the risk of myocardial infarction. Another heritable risk factor is diabetes. A patient may not have no diabetes but inherit some of the diabetes gene, and if the patient is overweight, diabetes can occur. Excessive fat intake is associated with diabetes, and the results of some studies have shown that patients with high blood glucose (blood glucose not high enough to diagnose diabetes) can reduce their risk of diabetes by lowering their weight with regular aerobic metabolic exercise. For example, if a patient’s mother developed diabetes after her weight gain, the patient may have a genetic predisposition to develop diabetes, but if the patient keeps her weight within normal limits, the risk of developing diabetes is reduced and, therefore, the major risk of myocardial infarction is avoided. Prevention and aggressive intervention of risk factors is particularly important in patients with genetic risk factors. Another risk factor for myocardial infarction is smoking. Smoking is not a genetic factor; if a patient smokes or is often in a passive smoking environment, he or she is in a risk factor. It is more difficult to quit smoking, but many smokers are also able to quit successfully. There are also medications available to help quit smoking, and quitting reduces the risk of myocardial infarction. Hypertension is also a significant risk factor for heart disease and death. The causes of hypertension are complex, and some risk factors for hypertension can be inherited. If there is a family history of hypertension, it is important to have your blood pressure tested annually to make sure it is in the normal range. Different methods of controlling blood pressure are now available to help reduce the risk of myocardial infarction and stroke. 2. I have high risk factors for heart disease, is my child also at risk? If a patient has risk factors for cardiovascular disease or negative health problems associated with these risk factors, the patient should be aware that the patient’s child may also be at risk for the effects of heart disease. As in the case of the patient, some of the risk factors faced by the patient’s child are modifiable and some are not. Certain cholesterol disorders can be inherited. Therefore, if a patient has one of these conditions, the patient’s child is also potentially at higher risk. For children of parents with high cholesterol levels, it is recommended that the child be tested for cholesterol levels starting at age 2 to see if the condition is inherited. Other risk factors, such as smoking and poor dietary habits, are not genetic but can influence the child. In this way, parents may pass on these risk factors to their children. Children in a smoking environment may also become passive secondhand smokers, which also increases the child’s risk of future heart disease – something parents who smoke in front of their children should be aware of. Likewise, parents who consume a diet high in fat, sugar and fiber not only increase their own risk, but feeding their children with these foods also increases their risk.