Family history of heart disease: what it means for your risk and what to do

A family history of heart disease means that one or more blood relatives have had a heart condition, such as a heart attack, angina, a heart muscle disease or an unexpected death from a heart cause. Doctors ask about it because some of the factors that lead to heart and circulation problems run in families, whether through shared genes, shared habits or both.

The NHS lists having a family history of coronary heart disease (CHD) as one of the factors that raises the risk of atherosclerosis, the build-up of fatty deposits in the arteries around the heart. It sits alongside being overweight, and below the factors the NHS says significantly increase risk: smoking, high blood pressure, high cholesterol, high lipoprotein (a), not exercising regularly and diabetes.

It is worth keeping this in proportion. A family history is a risk factor, not a diagnosis, and it is one you cannot change. The NHS Health Check makes the same distinction: there are things about your risk you cannot alter, such as age, ethnicity and family history, but some of the most important factors, such as smoking, cholesterol level and blood pressure, can be changed.

Some heart conditions are passed on directly. Cardiomyopathy is a general term for diseases of the heart muscle in which the walls of the heart chambers become stretched, thickened or stiff, affecting the heart's ability to pump blood. The NHS says most types of cardiomyopathy are inherited, although they can also be caused by other conditions or have no known cause.

The NHS describes several types. Hypertrophic cardiomyopathy, where the heart wall thickens, is thought to affect 1 in 500 people in the UK, and most people inherit it from their parents. It will not affect daily life in most cases, but it is the most common cause of sudden unexpected death in childhood and in young athletes. Arrhythmogenic cardiomyopathy is an inherited condition that usually causes heart rhythm problems and can affect teenagers and young adults. Dilated cardiomyopathy can also involve an inherited gene change, as well as other causes such as high blood pressure, alcohol or viral infection.

Another inherited possibility is raised lipoprotein (a), which the NHS says is inherited from your parents and is not routinely measured, though screening is recommended for people at moderate or high risk of cardiovascular disease. Inherited high cholesterol that starts young is called familial hypercholesterolaemia, and the NHS points to HEART UK for information about it.

Family history makes it more sensible to take symptoms seriously. The NHS says that heart changes in hypertrophic cardiomyopathy can cause dizziness, chest pain, shortness of breath and temporary loss of consciousness. Heart failure typically causes shortness of breath, extreme tiredness and ankle swelling.

Sudden chest pain and breathlessness, as in a heart attack, need a 999 call. For milder or recurring symptoms such as palpitations, fainting or breathlessness on exertion, see a GP and mention your family history clearly, including the age at which relatives were affected.

For most adults the starting point is a conversation and a risk assessment. The NHS Health Check is a free check-up of cardiovascular health for people aged 40 to 74 who do not already have conditions such as heart disease, diabetes, high blood pressure or inherited high cholesterol. You should be invited every 5 years, and the appointment takes about 20 to 30 minutes. It measures your height, weight and waist, blood pressure and cholesterol, and asks whether any close relatives have had medical conditions, whether you smoke, and how much alcohol and physical activity you have.

The result is a cardiovascular risk score showing your risk of heart or circulation problems over the next 10 years, described as low, moderate or high. If an inherited heart muscle condition is suspected, the NHS says tests can include an electrocardiogram, an echocardiogram, an MRI scan, a heart rhythm monitor and exercise tests, and a detailed family tree drawn by specialists may be needed for the diagnosis. Where a gene change is identified, relatives can be offered the same test.

Because you cannot change your family history, attention turns to everything else. The NHS Health Check suggests improving diet, taking more exercise, losing weight, stopping smoking, reducing salt and alcohol, and lowering cholesterol, with referral to local stop smoking and physical activity services where needed. Where blood pressure or cholesterol are high, medicines can be recommended.

The NHS also says that many of the warning signs for heart and circulation conditions, such as high blood pressure and high cholesterol, do not cause symptoms, which is why checking matters most when you have a family history. If you have already been diagnosed with a heart condition, you should be offered regular check-ups instead of the Health Check.

• Stop smoking, which the NHS describes as a major risk factor for coronary heart disease.

• Have blood pressure and cholesterol checked and keep to the plan agreed with your GP.

• Keep active and aim for a healthy weight.

• Tell your GP about relatives with heart disease, especially if they were young when affected.

If a relative has been diagnosed with an inherited cardiomyopathy, you may be advised to have heart tests of your own, or a genetic test if the family gene change is known. The NHS says that once the gene change is found, relatives who carry it can have their condition monitored and managed early. Many people with a gene change never have serious problems, and early monitoring is aimed at keeping it that way.

Learning that a heart condition runs in your family can be unsettling, especially after the death of a relative. Specialist inherited cardiac condition services and charities such as Cardiomyopathy UK and the British Heart Foundation can help with questions about what the results mean for you and your children.

On the NHS, family concerns start with the GP, who may arrange a risk assessment, cholesterol tests and, if an inherited condition is possible, referral to a cardiologist or a specialist inherited cardiac conditions service. Testing within affected families is organised through those services.

Some people choose a private cardiology assessment for a faster appointment, an ECG or echocardiogram, or a second opinion. The tests are the same ones used in the NHS. Bring a clear family tree, with ages and diagnoses, to any appointment, since this is often the most useful piece of information.