Poor lifestyle choices, not genetics, leads to most premature heart disease: ESC 2019 Update
Poor lifestyle choices are a greater contributor to premature heart disease than genetics -- sums up findings from a study presented at the ESC (European Society of Cardiology) Congress 2019 held together with the World Congress of Cardiology in Paris, France.
According to the study, young patients with physical inactivity, high cholesterol, diabetes and high blood pressure (BP) have a higher risk of developing heart disease than those having a family history of early-onset.
Findings stress that healthy behaviours should be a top priority for reducing the risk of heart diseases even in those with a family history of the condition.
The findings show that healthy behaviours should be a top priority for reducing heart disease even in those with a family history of early-onset.
"Genetics is an important contributor to premature heart disease but should not be used as an excuse to say it is inevitable," said study author Dr Joao A. Sousa of Funchal Hospital, Portugal. "In our clinical practise, we often hear young patients with premature heart disease 'seek shelter' and explanations in their genetics/family history," he added. "However, when we look at the data in our study, these young patients were frequent smokers, physically inactive, with high cholesterol levels and high blood pressure -- all of which can be changed."
The study involved 1,075 young patients aged under 50 years (average age; 87% were men). 555 among them had coronary artery disease (known as premature CAD). Specific conditions included stable angina, heart attack, and unstable angina. Risk factor levels and genetics in patients were compared to a control group of 520 healthy volunteers (average age 44, and 86% men). Patients and controls were recruited from the Genes in Madeira and Coronary Disease (GENEMACOR) database.
The researchers assessed five modifiable risk factors -- high BP, smoking, physical inactivity, diabetes and high cholesterol.
All participants underwent genome sequencing. These data were used to develop a genetic risk score containing 33 variants thought to contribute to CAD or risk factors such as high blood pressure.
Key results of the study:
- Nearly three-quarters (73%) of patients had at least three of these risk factors compared to 31% of controls.
- In both groups, the likelihood of developing CAD increased exponentially with each additional risk factor.
- The probability of CAD was 3, 7, and 24 times higher with 1, 2, and 3 or more risk factors, respectively.
- The average genetic risk score was higher in patients than controls.
- The score was also an independent predictor for premature CAD.
- The contribution of genetics to the risk of CAD declined as the number of modifiable factors rose.
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Dr Sousa said: "The findings demonstrate that genetics contribute to CAD. However, in patients with two or more modifiable cardiovascular risk factors, genetics play a less decisive role in the development of CAD."
He concluded: "Our study provides strong evidence that people with a family history of premature heart disease should adopt healthy lifestyles, since their poor behaviours may be a greater contributor to heart disease than their genetics. That means quit smoking, exercise regularly, eat a healthy diet, and get blood pressure and cholesterol levels checked."
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