Did your father have a heart attack? Knowing your family history can save your life

Genetics plays a role in heart health, so it’s not a surprise that South Florida healthcare institutions are studying genetics and looking for ways to pinpoint risk factors of heart disease and disorders sooner.

While family history is not the only factor — and it is certainly not a death sentence, medical experts say — knowing the risk can encourage you to identify potential symptoms sooner and allow your doctors to look for abnormalities much more often. Most importantly, it can spur you on to make important lifestyle changes that could significantly prolong your life.

The results of Baptist Hospital’s ongoing Miami Heart Study won’t be available for years, but one participant, Judge Jonathan Goodman, already knows one finding: Enrolling in it two years ago saved his life.

The magistrate judge with the U.S. Southern District of Florida has always been physically active and watched what he ate. But family history wasn’t on his side.

“My dad died at 62, he didn’t drink, he didn’t smoke, he was a healthy guy. He was actually leaning over lacing up his sneakers to go running when the heart attack hit him,” Goodman recalled.

An uncle died of a heart attack in his 50s.

So knowing this family history, Goodman jumped at the chance to join Baptist’s Miami Heart Study — which came with thousands of dollars’ worth of free diagnostics for participants.

The Miami Heart Study is a multi-year study following patients between 40 and 65 who enrolled in the study showing no signs of heart diseases or disorders. Baptist researchers will follow patients’ progress for years in order to learn much more about diseases of the heart.

Shortly after taking a battery of tests associated with the study at West Kendall Baptist Hospital, Judge Goodman got a call he will never forget. The tests showed a 95 percent blockage in the left circumflex artery, one of the three main arteries that supply blood to the heart.

“It was certainly troubling and shocking and threw me for a loop and I made immediate arrangements to see my cardiologist the very next day. Shortly thereafter I was going in for an angiogram and an angioplasty and the insertion of a stent in one of my coronary arteries,” said Goodman.

Goodman, now 63, has been doing well since the stent was put in in 2017, says Dr. Harry Aldrich, cardiologist with Miami Cardiac & Vascular Institute, part of Baptist Health South Florida. Goodman had not felt any symptoms of the blockage before he got the tests done as part of the Miami Heart Study.

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Dr. Harry Aldrich, cardiologist with Miami Cardiac & Vascular Institute, part of Baptist Health South Florida.

Baptist Health South Florida

“Some patients do have what is called silent coronary disease; they have a significant blockage. They may not realize it because the symptoms are mild, maybe it’s shortness of breath, and think they are out of shape, or they have heartburn and think it is indigestion. They may not have traditional symptoms of chest pain,” Aldrich said.

“It is very important that if you are higher risk to identify that, and do the best you can by decreasing the risk factors you can control. Some people say genetics is destiny, but it is not. Genetics is only one component — it’s about what you can also do to control that destiny by taking care of your own factors by watching your cholesterol, watching your weight and not smoking,” the doctor added.

Although Judge Goodman had always been active, didn’t smoke and watched his diet, since the health scare he has modified his diet even more, now avoiding dairy. He was only a light social drinker before, but he’s cut out all alcohol. Well, he allows himself one drink a year: For New Year’s Eve it was a 12-year old single malt scotch.

He still keeps up his active schedule — tennis, golf, walking, hiking.

“I go to the gym every Monday, Wednesday and Friday and Tuesday and Thursday I do the elliptical at home,” he said.

The only change is no more downhill skiing. He is taking a blood thinner because he has a stent, and the risk is too high. Aldrich says Goodman is following the steps anyone should be heeding to keep the heart healthy, particularly those with a family history of heart disease.

“No smoking is No. 1. No. 2 is to know your cholesterol and make sure it is under control through diet or drugs if you need it. No 3 is to watch your weight to make sure you don’t get other risk factors like diabetes. Next is have good follow-up and to be cognizant that you are high risk,” the doctor said. “Something we have been doing more recently along with the cholesterol testing is to look at coronary calcium in patients. If you are high risk and are already developing plaque, you should do more to take care of your risk factors.”

Genetics’ role in sudden cardiac arrest

Unlike a heart attack, where blood flow to a part of the heart is blocked, sudden cardiac arrest is an electrical malfunctioning of the heart that causes it to stop beating, preventing blood from reaching the brain, lungs and other organs. Victims lose consciousness within seconds and most die if medical treatment isn’t immediately available.

Sudden cardiac death is more common than you might think.

“If we take the generation over the age of 35, the risk of sudden death is approximately one per 1,000 per year. When you multiply that across the U.S., it is about 350,000 per year,” said Dr. Robert J. Myerburg, cardiologist, cardiac electrophysiologist and sudden cardiac arrest expert at University of Miami Health System.

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Dr. Robert J. Myerburg, cardiologist, cardiac electrophysiologist and sudden cardiac arrest expert at University of Miami Health System

Jorge R. Perez UM Miller School of Medicine

Noting that 200,000 in the U.S. military died during WW2, “this number repeats every year, it’s a very big number.”

Once you have heart disease, the risk of sudden cardiac death goes up, he said. To help identify people at risk sooner, Myerburg started a special screening and genetic testing clinic for athletes and others at risk for sudden cardiac arrest about 18 years ago.

As part of the clinic’s services, patients and their families undergo in-depth screening and a complete genetic workup to identify if patients and their family members carry genes that cause sudden cardiac arrest and death. For some who carry a relevant gene, an implanted defibrillator for prevention may be the answer.

But for all, knowing is power.

For those in the early teen years to age 25, the risk of sudden cardiac death is 1 in 100,000 a year, about 1 percent of the risk in the older population, Myerburg said.

“But if you can identify the people who are at risk and prevent the sudden death, those young people don’t have end-stage heart disease for the most part, so they buy another 40 or 50 or more years of life,’’ he said. “The payback on that small population by recognizing them early is high.”

Recognizing the risk early starts with a very thorough family history. If there’s a family history of sudden cardiac arrest and sudden death, that’s a signal to go looking.

“If this sudden death is clustering, in other words a lot of people are dying suddenly, that’s a clue to do genetic testing,” said Myerburg. “And if we come up with a relevant gene, then we can test other family members to see if they inherited the gene.”

Those who inherited the gene need to be watched carefully and their offspring and future offspring should be tested, he said.

Myerburg said that in Japan, children entering grade school get a mandatory medical evaluation that includes an EKG and the tests are repeated as they enter middle school.

“A lot of these conditions associated with EKG changes can be picked up in children. You know it is there and you can work appropriately for a further work-up with the families.”

UHealth recommends that all athletes have at least one pre-participation EKG to look for unrecognized heart disease. Across the nation, professional sports do them routinely on draftees and colleges are starting to do them too, Myerburg said.

“Where we are falling short is in the high school athletes. They aren’t getting EKG screening in most instances, sometimes in the private schools but not the public ones,” the doctor said. “The biggest numbers of cardiac arrests in athletes occur in high school athletes for two reasons, because those inherited disorders begin to express around puberty in many cases and because there are so many more high school athletes than college athletes.”

Often these inherited disorders and diseases can be picked up with an MRI or EKG. Genetics testing can fill in the gap, showing if the patient and family members carry the same relevant gene. If somebody has one of these inherited disorders and they had a life-threatening heart disturbance, they will almost always get an implanted defibrillator. Others may be treated with a beta blocker. It depends on the way patients manifest the disease.

“Genetic testing is not perfect,” said Myerburg. “But the important point is that the research we do in our field every year adds to our knowledge base. It’s not perfect but every year it gets better.”

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