Tuesday, March 07, 2006

Genetics and heart disease

One of Dr Helen's readers, Patrick, asked

Do you foresee medical technology being able to minimize the effects of genetic inclinations towards heart disease in the future? My family also has a history of heart attacks, aneurysms, etc. and it has made me think twice about having kids of my own for fear of what I might be passing on to them.

Yes Patrick, there is a hereditary basis to many heart diseases, but some heart disease have stronger genetic basis than others. The ones with strong genetic basis includes hypertrophic cardiomyopathy, long QT syndromes and familial hyperlipidemia. Patrick mentioned aneurysms. It's true that Marfan's syndrome, which can manifest as aortic aneurysms and cranial berry aneurysm has a strong genetic basis.

However, it t is important to note the some disease may have genetic linkages, but they may not manifest because of genetic penetrance and recessive genes. I believe that part of the "genome project" was to map out the genes that affect human health including genes that may cause heart disease, and hopefully one day we can modify them for the better. That day is still far off, so don't hold your breathe.

What worries me is that Patrick seems to suggest that due to a strong family history of heart attacks, he is considering not having children. That is not wise. The strong family history will necessarily mean that the children would have to be careful with primary prevention and also regular checkups to pick out CAD early and avoid heart attack. There is much that we can do in terms of primary prevention. Anyway, in CAD, the genes are not dominant genes; It is a mild gene, with variable penetration. So children may or may not get it.

Please go ahead and have children. Any child would be fortunate to have parents who are concerned about their future health prior to their birth.

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