Dr. Christopher Quirk

BA Oxon, MA, MBBS Hons, MRCP, FRACP, DDU

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Thursday, 26 November 2009 09:57

Whilst a family history of heart disease is thought of as a ‘non-modifiable’ risk factor (we can’t choose our parents), I do feel it is worth touching on this to help understand the importance of dealing with ‘modifiable’ risk factors. No more so than when dealing with heart disease, whether one develops a disease is a complex interaction of genetic susceptibility (or weakness) with environmental factors, some of which are known and some of which are not.  The strongest influence on heart disease still remains one’s genetic susceptibility.  In certain families who have a strong history of heart disease, particularly at a young age, this implies their arteries and lining of their arteries are very susceptible to damage by environmental factors.  The converse of this occurs in some families with longevity and no heart disease, whereby their arteries and their linings of the arteries are quite resistant and to some degree the environmental modifiable risk factors, smoking, cholesterol, blood pressure etc, have very little impact on the likelihood of them developing heart disease. 

In the genetically susceptible people it is therefore even more imperative to deal with modifiable risk factors and for this reason we should be moving away from the concept of “normal” blood pressure or ‘normal’ cholesterol levels.  The normal values quoted refer to a statistical normal that 90% of the population fall within. Well, sadly 90 % of the population’s cholesterol levels are too high! In these types of high risk patients, even a so called ‘normal’ blood pressure or cholesterol levels are still going to accelerate heart disease because their arteries and lining of the arteries are more susceptible to these environmental factors. In my view, therefore, in certain individuals who have the highest genetic susceptibility to heart disease, we should be lowering blood pressure, cholesterol and dealing with other risk factors, irrespective of what of these levels actually are. 

In other words, when there is a genetic susceptibility to a condition, in the case heart disease, which clearly in non-modifiable, we should be doubly aggressive at dealing with the known modifiable risk factors.

 

Last Updated on Thursday, 10 December 2009 10:28
 
 
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