Last week, one of the doctors at my office missed a few days of work for a funeral. A childhood friend of his died of a massive heart attack at age 41. He woke up his wife in the middle of the night and said he couldn’t breathe… then his heart stopped. She called 911 and then tried to revive him with CPR. It didn’t work. She’ll never be the same, and the lives of his two kids, ages 10 and 13, will be forever changed. It is a tragic story that plays out about 1,600 times per day across the US.
It’s a tragic story, but the medical details in this particular case make it even more painful. This man’s father died in similar fashion at age 50. A strong family history. This young man knew he was at risk. Despite his known family history… he chose to smoke cigarettes. He chose to eat poorly. He chose not to exercise. His dietary and lifestyle decisions amplified his risk factors dramatically. Even with his family history, his untimely death was entirely preventable.
It’s easy to just blame it on genes. We all know people who blame their genes for any symptoms or illness they experience. There is no question that heredity play an enormous role in disease risk… but it is a slippery slope. The “it’s genetic” excuse can easily become a justification for an unhealthy diet or lifestyle. People convince themselves that even if they eat healthy, exercise, etc., there’s nothing they can do to prevent a certain disease. When a family history is strong, some people simply assume they’re next on the chopping block and they just stop trying.
When it comes to cardiovascular disease, that way of thinking is a tragic mistake. There is no question that genes play an important role in heart attack risk, but the story definitely does not end there. New research is making it increasingly clear that the risk of heart disease can be significantly reduced… even when it’s genetic.
A recent study led by researchers at Massachusetts General Hospital and published in the New England Journal of Medicine assessed the relationship between a high genetic risk of heart disease and lifestyle factors. This was a large cross-sectional study: it analyzed data for over 55,500 people across four other large studies. Subjects were assessed for genetic risk using DNA-sequencing technology. They were also scored for four different lifestyle factors:
1) Not smoking
2) Regular physical activity
3) Not being obese
4) Eating a healthy diet
The study authors concluded:
“Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle.”
You read that correctly… living a healthy lifestyle could halve the risk of having a heart attack or being diagnosed with heart disease in people with high genetic risk. Lifestyle plays quite a large role, indeed.
According to Dr. Sekar Kathiresan, the senior author of the study:
“The basic message of our study is that DNA is not destiny. Many individuals — both physicians and members of the general public — have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case.”
Dr. Kathiresan added:
“Some people may feel they cannot escape a genetically determined risk for heart attack, but our findings indicate that following a healthy lifestyle can powerfully reduce genetic risk.”
It’s true that “you get what you get” when it comes to DNA and the genes within it. In other words, your genes themselves are not modifiable… but it is now clear that the disease risk associated with those genes not fixed at all. We really can “nurture nature.” As the recent study detailed above clearly shows, just because a person has a genetic risk factor doesn’t mean they can’t take steps reduce it.
The science that explores this phenomenon comes from a rapidly advancing field called epigenetics. The “epigenome” is like a molecular blanket that is wrapped around the DNA which contains the individual genes.The epigenome influences whether genes within the DNA are turned on or turned off. In heart disease (and in many other diseases as well) it’s the “on or off” that determines the disease risk much more than the presence of the genes themselves.
How the epigenome flips the switches on the DNA is a process that is heavily influenced by diet and lifestyle factors. This means that even if you have a genetic risk factor, a healthy diet and active lifestyle can turn on genes that are protective and turn off genes that are risky. This has a big effect on your epigenome.
Here at Upwellness, I talk a lot about broadening the definition of medicine by recognizing that food, movement, sleep, and healthy living are safe and effective treatments for virtually all illnesses. Heart disease is certainly no exception. It is clear that heart disease risk can be reduced by simple dietary and lifestyle changes.
Your genetics are not your destiny.
– Dr. Joshua Levitt