Doomed. I'm Doomed. (Am I?)

October 2, 2008 1:45 PM

Every member of my family, save one, has died young from a heart attack. Am I doomed?

YANAD, YANMD.

My parents, grandparents and many other relatives have all died at young ages (40-60) from their first heart attack. All smoked, most were overweight, all led mostly sedentary lifestyles, and didn't do much in the way of "eating healthy foods".

I'm a woman in her 30s who is overweight - due to being fairly sedentary and from a diagnosis of PCOS. This is the bad side.

On the "good" side, I don't smoke cigarettes, I don't drink other than a few times a year (socially), and I eat reasonably well with no fast food or other grease-laden meals. I take my vitamins (including some "heart-healthy" supplements) daily. I floss and get regular dental checkups.

I've had various tests done on my heart over the years and all have come back normal with no problems. At last check, my cholesterol was fine and my blood pressure was on the higher side of normal but my doctor (aware of my family history) is not concerned.

The problem is that I can't stop thinking that I'm going to die - any minute now - from a heart attack. Every twinge in my arm, shoulder, neck or back is surely an indicator that I'm about to drop dead. Every bit of nausea is the first stage of a heart attack. Every sore muscle is a.. well, you get the point.

It doesn't help that women have different heart attack symptoms than men - and that women tend to have vague signs like, "a general feeling of being unwell" or "panic" or "nausea" instead of some strong arm pain and crushing chest pain. Hello, I have that ALL THE TIME because I think I'm about to die!

Second to that, I have a completely fatalistic perspective on it - that there's nothing I can do to change the outcome because, thanks to my family history, I'm doomed due to genetics. I'm related to all these fatal heart attacks!

If I lose weight, get more exercise, and continue to eat healthily, can I prevent a heart attack? Has anyone beat the genetic odds? If I do have a heart attack, can I avoid dying or does the fact that no one else survived mean that, even if I get to the hospital quickly, I'll be toast?

Short of making friends with a cardiologist, do you have any advice for me?

posted by anonymous to health & fitness (24 comments total)

There's no such thing as doomed, just odds. If you really want to diminish those odds, there are a number of different things you can do.

Diet is obviously a big factor. You can go anywhere between simply watching your intake all the way up to the rather radical Dean Ornish diet.

You can find out from a doctor if it would be advisable to get a prescription for some kind of Statin drug. My friend's father is a highly respected vascular surgeon, and he swears by statins. They really do seem to work.

Talk to a cardiologist. This is an area in which American medical science has some expertise, after all.
posted by Doctor Suarez at 2:01 PM on October 2, 2008

some of the cholestorol-lowering medicines are more effective than any of the methods you mention. some doctors think we should all be taking them, regardless of health. I'd recomment that. Lipitor.
posted by alkupe at 2:01 PM on October 2, 2008

IANAD.

A genetic predisposition is rarely the same as a certainty.

However. It does seem likely the more risk factors you have in common with your family members (I cound 2 of 4), the higher your risk of having heart trouble. Being monitored is a smart decision.

The best thing for you to do would be to focus on the things you can control - reducing your weight and becoming less sedentary to improve your cardiovascular fitness. Please talk to your doctor before starting an exercise program of any sort, and don't try to go whole hog wild - start with small realistic goals and keep raising the bar. A personal trainer might be helpful - in conjunction with your physician - in helping you develop new habits.
posted by canine epigram at 2:03 PM on October 2, 2008

The heart is more than a pump. It's often called the small brain. You might want to make acquaintance with this organ and see how to befriend it, what it needs in terms of emotions and how to keep it healthy. Dr. Ornish, renowned heart specialist will inform you about what you need to know when he says *your genes are not your fate* in this video. Be well.
posted by watercarrier at 2:05 PM on October 2, 2008

Have you talked to a therapist about your anxiety? Stress is also terrible for your health.
posted by The Light Fantastic at 2:08 PM on October 2, 2008 [1 favorite has favorites]

I am in a similar situation. All the males in my family had heart attacks by age 50, though not fatal. So far, I have gone several years beyond that without the same fate. When my dad had his attack, I was in my mid-twenties and suddenly became more aware of the family inclination. I joined him in changing my eating habits, exercising regularly, and living a generally more heart healthy lifestyle. Perhaps that is why I am fine so far. It sounds to me like you have undertaken the same dietary regimen for the same reasons.

Speak with your doctor about getting a stress test every five years when you are a bit older. I had my first when I was 48, then again at 53. Continue to do what you are doing with your eating, and establish an exercise program. Most of all, don't let the knowledge of what has happened before hamstring your living. If you become psychologically consumed with dying from a heart attack, you will never allow yourself to have fun. And that's no fun, y'know?
posted by netbros at 2:09 PM on October 2, 2008

Well, anxiety isn't really good for you or your heart, so I would suggest seeing a mental health professional. Being in a constant state of fear sounds pretty unpleasant.
posted by sondrialiac at 2:10 PM on October 2, 2008

This attitude is called genetic determinism.

My father's father died relatively young of a heart attack that would probably be survivable today. More to the point, we have a better understanding of health today than folks did back then, and can modify our lifestyles to avoid it in the first place. My father was understandably a little spooked when he reached the age when his father died. He got hooked up to a heart monitor, his results were somewhat worrying, so he straightened up and lost a lot of weight. That was 20 years ago, and his health is still good.

For all we know, your relatives died more from the environmental factors you mentioned than genetic ones. Or they were genetically predisposed towards heart attacks, and did everything wrong on top of that, causing that predisposition to be expressed. In short, we don't really know what your genetic odds are. I do know that if I were in your shoes, I'd be trying to beat the odds, whatever they are, not acquiescing to an early death.
posted by adamrice at 2:13 PM on October 2, 2008 [1 favorite has favorites]

My parents, grandparents and many other relatives have all died at young ages (40-60) from their first heart attack. All smoked, most were overweight, all led mostly sedentary lifestyles, and didn't do much in the way of "eating healthy foods".

I would be much more worried if they all died from heart attacks and were fit/in general good health.


Second to that, I have a completely fatalistic perspective on it - that there's nothing I can do to change the outcome because, thanks to my family history, I'm doomed due to genetics. I'm related to all these fatal heart attacks!


Of course there's something you can do. This question is a bit like asking, "All of my family members died of lung cancer. They all smoked. I'm doomed!" You can treat your body well - (eat well, get some heart-healthy exercise, continue to not smoke.) Try not to stress out about it, you're not on dead man's row.
posted by Solon and Thanks at 2:18 PM on October 2, 2008 [1 favorite has favorites]

Yoga perhaps.
posted by philad at 2:18 PM on October 2, 2008

Re: your PCOS - are you taking meds for that? Some of them can help the insulin resistance part of the syndrome and perhaps lower your risk. If you haven't already, check out SoulCysters.

BTW - me too.
posted by Sophie1 at 2:22 PM on October 2, 2008

Exercise level and diet are much better predictors of long term health than body weight. You sound as though you're doing pretty well on the diet front. Add some moderate exercise a few times a week, and you'll be in good shape to avoid the outcome you're afraid of. Don't worry if your weight doesn't change. Just concentrate on developing habits that make you feel good.

Although I know this is easier said than done, try not to stress out about this. My mother died at a young age, and many members of my family have had health problems. That weighs on me. But I try to keep in mind that genes are not deterministic, and that worrying about these problems makes them worse, not better. Taking care of your body is important, but so is having fun and enjoying your life. It's both good for your health and it's what makes the years you have on this earth worth living. Have a good time in life. Find as many things as you can that make you happy, laugh as often as you can, spend time with the people you love, and enjoy yourself. That's the most important thing.
posted by decathecting at 2:40 PM on October 2, 2008

By the way, my mom's parents and many of her uncles died before the age of 50 from strokes. My mom was convinced that she would not survive our childhoods, and she really messed our heads up with the belief that she was going to die at any moment. Well - she's just turned 70, her high blood pressure is under control, and she's stopped freaking out about dropping dead. How I wish she had done it 30 years ago.
posted by The Light Fantastic at 2:48 PM on October 2, 2008

It might be helpful to split this worry out into "what can I control, and what can't I control?"

You can't control your genetics, nor can you control the basic random chance of a heart attack (unlikely, but it occasionally happens). The best you can do is find out whether and how much those two factors influence your chances. The best way to do that is to talk to a cardiologist, who will do a blood workup and a risk-factor workup, and (if they're good) will talk to you about what the possibilities are of various outcomes.

I know, not great for the peace of mind, but it's a bit better than what you're going through right now, where you don't have a lot of that information, as well as (most crucially) lacking someone you can trust to tell you straight-up what the risk patterns are.

However, you can control your lifestyle, your stress, and your general worry about this issue, and that will have an effect on lowering your chances of a heart attack. You can make diet and exercise changes that will foster cardiac health, and help with your cholesterol levels. You can start to engage in meditative pursuits, like yoga, that will not only help your physical flexibility and health but center you and help you deal with the stressors in your life. And you can, either with the help of a therapist, or with some hard work on your own, find ways to better engage with your fears so that you feel more in control than you do now.

Your concern is completely understandable, and you aren't being irrational, but in reading your question it seems like you are undergoing a huge amount of stress. You can do something about that, and maybe by breaking things down they won't seem so overwhelming and unnerving.

Good luck in dealing with this, and feel free to memail me if you want to talk.
posted by scrump at 4:54 PM on October 2, 2008

Oh, and as regards survivability and mortality secondary to heart attacks: emergency cardiac care is generally superb in the United States, between citizen training in CPR and the presence of Artificial External Defibrillators (AEDs) on the streets and in airports. Your odds of surviving a heart attack are better now than they've ever been, and only getting better.
posted by scrump at 4:56 PM on October 2, 2008

1. Make friends with a primary care doctor, not a cardiologist. It looks like you have. Keep in touch.
2. Exercise in whatever fashion you can do it will help. Even a little bit helps. Taking a walk is better than not doing it.
3. Meditation for relaxation and to de-stress.

It looks like you have avoided many of the mistakes that your forebears made. You don't smoke. You see doctors. Keep going in that direction, and improve.
posted by yclipse at 5:02 PM on October 2, 2008

And an 81-mg aspirin once a day would help, if appropriate. Talk to your doctor.
posted by yclipse at 5:03 PM on October 2, 2008

From a psychological perspective, I find the following train of thought helpful whenever I think about dying, or someone close to me dying. Adapted for you: you are thirty years old. For all you know, you will live for another fifty or sixty years. Do you want to spend those years freaked out, or happy? Given that you are taking the appropriate precautions, and will see a doctor at the signs of any serious problems, quit worrying about dying any moment. Despite lowering the quality of your life, the stress isn't going to help your health any.

Twelve years ago, my father, who had numerous heart problems, was told he had only four years to live. My mom mourned his death every single day, before he had even died. She was a mess, it made life a mess. He lived twelve years, not four. Those could have been a good twelve years, especially because my father did not fear death, but they were miserable because she was so tightly wound up in worry.

She still worries about everything. My mom might live another thirty or forty years, worrying about everything that hasn't happened instead of enjoying life. When she dies, that will be the entirety of her life. Please do not do that to yourself. Even if you did inexplicably drop dead tomorrow -- which is unlikely -- would you rather have spent today worrying or enjoying yourself? Being cautious about your health is reasonable, but worrying about things that have not happened is a surefire way to ruin whatever time you have.
posted by Nattie at 5:17 PM on October 2, 2008

Could you perhaps channel your anxiety about this into exercise? That would have the dual benefit of reducing your risk of heart attack and give you a concrete thing you can do to reduce your risk factors. Remind yourself that your relatives lived unhealthy lifestyles, but you don't have to. Think about each exercise session as insurance against following in their footsteps. If you're so anxious and stressed about this that you can't do that, or it really starts to interfere with your life on a regular basis, therapy might be a good option. Or even just talking to people in your position- do you have siblings or cousins? Other options include arranging an appointment with a cardiologist, who can help you reduce your risk factors and (probably) reassure you that you aren't doomed. Remind yourself as well that a genetic predisposition is not deterministic. Think about people who have a family history of alcoholism- they don't (necessarily) freak out about drinking, or being around alcohol, or whatever. That kind of thing can just be a warning that you have to be more aware than other people, which can't be a bad thing.
posted by MadamM at 5:22 PM on October 2, 2008

Talk to your GP about genetic counselling and preventative health. I have a family member going through this right now. They can also do an assessment of your own situation -- you might want to ask about metabolic syndrome, given what you're telling us. In the meantime, you can switch to low fat, low sodium foods, work at being more active and perhaps build up some skills to help you manage stressful situations, if that is relevant. IANAD.
posted by acoutu at 6:40 PM on October 2, 2008

There are blood tests that can be performed to check for various causes of precocious heart attack, not cholesterol, but more esoteric things checking for rare causes that run in families. Some of these are treatable if they are discovered. The key word is 'precocious'. Ask a doc, of course.
posted by ikkyu2 at 10:09 PM on October 2, 2008

You might ask your doctor whether a coronary calcium scan would be appropriate for someone with your risk factors. This is a specialized CT scan that looks for calcium deposits in the coronary arteries that can be precursors of heart disease. It does require a significant exposure to radiation equivalent to about 30 chest X-rays, but might be useful for deciding how aggressively you should be treated with statins.
posted by JackFlash at 10:54 PM on October 2, 2008

This way lies madness. Seriously, I'm not joking. I'm in the same boat as you. I buried my mother when she had a heart attack at 39. I saw my cousin collapse from a heart attack at the age of 16. I've had relatives with such deformed hearts that they failed to live past birth. I'd rather not count the pacemakers in my relatives at this point.

My advice to you? Do what you can to be healthy, and continue seeing your doctor. You know what helps me when I'm trying to decide if that chest pain I feel is the big one coming for me or the repercussion from eating spicy chili? Breathing exercises. I sit there one hand on a vein, taking my pulse, breathing deeply and evenly. You can feel the blood pumping, you can feel your heart working. It's very reassuring.
posted by nulledge at 11:48 PM on October 2, 2008

I know this question is quite old, so I'm hoping you've found some great help. But I'm adding this comment in case someone else stumbles across the question and reads the answers..

I have a similar family history and have often worried about twinges or pains, in particular. This article really helped give me some perspective. If you scroll down to the bottom, you'll find a bunch of causes of chest pain (in women, for the article, but I'm sure much applies to men, too).

When I spoke to my doctor about this issue, his response was that you CAN do a huge amount of good by taking care of things like diet and exercise. That you are NOT "doomed". And that even if you ARE doomed to heart attack, you can shift it from a massive one (death-causing) to something you can heal and recover from if you're already taking good care of yourself and staying in decent shape..

Just don't let that turn into a flip obsession for you...
posted by VioletU at 7:41 AM on December 9, 2008