Is genetics destiny when it comes to heart disease?
A new analysis of data from more than 55,000 people provides an answer. It finds that by living right–by not smoking, by exercising moderately and by eating a healthy diet heavy in fruits, vegetables and grains–people can tamp down even the worst genetic risk.
“DNA is not destiny; it is not deterministic for this disease,” said Dr. Sekar Kathiresan, the director of the Center for Human Genetic Research at Massachusetts General Hospital. “You do have control over the problem, even if you have been dealt a bad genetic hand.”
The research, by Dr. Kathiresan and his colleagues, is the first attempt to use large data sets to tease apart the effects of genes and lifestyle in heart disease, researchers said. It was published on Sunday in The New England Journal of Medicine to coincide with the presentation of the results at the annual meeting of the American Heart Association.
About 365,000 people die of coronary heart disease–the most common type–annually in the United States, and 17.3 million worldwide, making it one of the biggest killers.
The investigators found that genes can double the risk of heart disease, but a good lifestyle cuts it in half. Just as important, they found, a terrible lifestyle erases about half of the benefits of good genetics.
According to Dr. Lawrence J. Appel, the director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins Medical Institutions, you do not have to have an exemplary lifestyle to reap a big benefit. It looks as if the biggest protective effect by far came from going from a terrible lifestyle to one that was at least moderately good.
The new study shows a new way to think about genes and lifestyle, researchers say.
“It’s very important,” said Dr. David Maron, the director of preventive cardiology at Stanford, who was not involved in the new study. “If you are dealt a bad hand, there are things you can do to attenuate the risk.”
Dr. Kathiresan is already using the study’s results when he sees patients, he said. The genetic test is not available outside of research studies, he said, but he often gets an idea of who has a worrisome genetic risk when he talks to patients.
“A poor man’s substitute,” he said, “is: ‘My dad died at 45 of a heart attack. I have a strong family history.’”
He now replies, “You have it in your power to change that risk.”
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