How do I assess my health risks given my deceased mom's history?
May 16, 2018 5:51 PM   Subscribe

Point blank: my mom died of a heart attack in her early 40s, when I was a kid. Prior to that she had a host of pretty significant health issues, but also really bad lifestyle habits. As I approach that age myself, I am increasingly worried about my own mortality. I want to know if any of her health issues/death were genetic things that I should be worried about, or purely lifestyle. How can I research this further?

My family is almost completely close-lipped about health issues, and my mom NEVER went to the doctor. So let's assume I have no prior history to refer to aside from what I remember of her.

As I get closer to my 40s I have become increasingly worried about whether I am also going to die of a heart attack at a young age. It is hard for me to work out whether her death was due to a genetic heart defect that I could also have, due to her just having a crummy body all around, or due to lifestyle. I question my own lifestyle constantly, but I don't want to give up everything and live in fear.

My doctor does annual EKGs on me to see if my heart shows any signs of abnormalities, and I diligently get my cholesterol checked at least once a year. My blood pressure is in the optimal range. I do not currently have any of her health conditions aside from being slightly obese and I do drink more than I should (I'm working on it). I don't smoke, I eat a lower-carb diet, I am reasonably active. But I worry that's not enough to save me.

Is there anything else I can do to set my mind at ease? I would gladly pay some sort of specialist out of pocket if necessary to find out if I am a ticking time bomb like my mom was. I just don't know where to begin.

Here is what I know:
* She died of a sudden heart attack around age 44. Her only prior symptom was feelings of acid reflux for about a week before.

* A few years later, her brother died of a heart attack at the same age as well. An autopsy was performed and it was found he had some sort of anomaly in his heart. My grandmother once referred to it as something that a famous singer or actor also had? But that was the end of that discussion and I don't know more. Also, he was a chronic smoker and alcoholic, and ate a shitty diet... so.

* My mom was a chronic smoker since her early teens. By the time she died she could have easily been up to a carton of menthols a day. If she hadn't died of a heart attack I suspect lung cancer would have been it.

* She was also an alcoholic. She spent most days passed out on the couch, only awake at night long enough to make dinner.

* She was on the low end of obese (let's say 5'6 and a size 16 in today's clothing). She did not exercise and we ate a pretty traditional meat-and-potatoes diet.

* She went bald in her early 30s. She never pursued any medical explanation for this.

* She also got these huge (larger than golfball sized) pus filled cysts on her armpits multiple times a year. She never found out what the cause was.

* She had fertility issues, heavy periods and other symptoms that probably point to PCOS. Again, she never went to a doctor for it so no formal diagnosis.

So in short, it seems like her body was pretty fucked up all around, and she obviously didn't look after herself or seek medical advice that could have detected some things. Aside from continuing my regular doctor checkups, is there anything else I can do to see if I carry the risk of any of these issues later in life?
posted by joan_holloway to Health & Fitness (15 answers total) 8 users marked this as a favorite
Your grandmother might have been thinking of Bobby Darin. He had heart damage from rheumatic fever and died in his thirties.

Dr. Dean Ornish did the only controlled studies, to my knowledge, showing reversal of heart disease with lifestyle intervention. He has published several books. Dr. Caldwell Esselstynn’s similar program reversed heart disease in patients whose cardiologists had given up on them (he did not have a control group). His book is called Prevent and Reverse Heart Disease. Warning: these programs are much more rigorous than typical dietary advice, but in Ornish’s study, control patients, who followed American Heart Association guidelines, continued to get worse, while patients on Ornish”s program showed reversal of disease, not just improved blood tests. I do not understand why every heart patient isn’t informed of these results, and frankly, I think it is criminal. Patients may decide it’s too hard to follow these programs, but that should be their choice. This is not woo. Dr. Ornish’s studies were published in The Lancet, which is as prestigious as medical publishing gets.

There are other theories about heart disease, but no other controlled studies on disease process, not blood tests. There was a study purporting to show that Ornish’s very low fat diet doesn’t work, but if you look at the actual studies, the people involved weren’t really following it. A lot of crap has been published about Ornish, but no one has disproven his results.
posted by FencingGal at 6:37 PM on May 16, 2018 [8 favorites]

Best answer: Holy crap, a carton of cigarettes a day?? Ok. Yeah. The smoking and drinking and obesity are major cardiac risk factors. Whether or not she had a genetic predisposition towards heart disease, she waaay increased her chances. Her brother, too.

The hair loss and lumps in the armpits could have been related to PCOS if she actually had it (google hidradenitis suppurativa). PCOS can also increase your risk of heart disease.

I think you’re doing the right things with the annual cholesterol testing and whatever else your doctor (who should know your family history) recommends. Watch your weight and alcohol if you really want to feel better about your risks.
posted by amro at 6:38 PM on May 16, 2018

Best answer: I am not a doctor and this is not medical advice, etc.
I can't speak to any of the other symptoms, but on the heart thing, is it possible that she and her brother did not have a "heart attack" but sudden cardiac death/sudden cardiac arrest (SCD/SCA)? There are indicators for an increased risk of sudden cardiac arrest- cardiomyopathy is one and can be checked with a cardiac ultrasound. There are also genetic tests for the genetic markers of SCD/SCA.
posted by dogmom at 6:40 PM on May 16, 2018

I'm still researching this, but my mother (tiny, healthy-lifestyle except the two packs a day lady with genetic triglycerides in the "wtf how are you alive" territory) had a heart attack two years ago and subsequently took herself and my father to this mobile health screening thing and got identified with a (mild but still) aortic aneurysm that her cardiologist had not found, and a couple of other minor but helpful things her family doctor had not been aware of, some thyroid and inflammation markers she followed up on with her docs etc.

I mean, she's 70 but she's pretty sharp, so I think this might be a real thing that is not bullshit, and she claimed it was like $200 and they test the shit out of everything. It seems terrifying to me but might be exactly what you are after? And if it is a scam maybe someone else here can correct me.
posted by Lyn Never at 7:12 PM on May 16, 2018

Baldness and fertility issues are definitely in the the thyroid / endocrine system realm, and iirc severe imbalances in that system can have deleterious effects on the heart as well.

I am so sorry you're worried like this. My mom also died young and I happen to be right at the age that she died now, and I keep thinking I will develop the same affliction. I spend a lot of time trying to educate myself on health issues. When we know better we do better, right?
posted by vignettist at 8:14 PM on May 16, 2018

Response by poster: Dogmom, that is entirely possible. Is there any way I'd be able to find that out? All I know is that she had feelings of heartburn a week prior but otherwise seemed fine. Then she passed out at work and pretty quickly died after that. What I recall hearing was she was barely conscious in the ambulance and at the ER, and by the time we got there a few hours later (this was pre cellphone so it took a while for her work to get ahold of my dad) she'd been long gone.

Is it possible to get records from the hospital where she passed if it's been several decades? I really wish I knew more.

Also, for anyone wondering, I went to therapy for a long time about my subsequent fear of dying young. I feel like that's mostly under control and now I am at a phase of pragmatically wanting to know what I should do to further protect myself.

Thanks for the great replies so far.
posted by joan_holloway at 9:20 PM on May 16, 2018

So you don't have the baldness or cysts issues? Did anyone else in the family? Did the brother? It's possible this is all unique to her/him and not an increased risk for you at all from a genetic sense. If you have access to her full medical records* , you could try to find a specialist/geneticist/GC to work with you on this. If she saw a specialist who is still in practice, you could start there. Part of the underlying issue will be in trying to sort out what was related to her genetics vs her lifestyle. And then what might be relevant to you, given your health and lifestyle. The cholesterol checks aren't harmful but they don't "help" if her cause of death was not-cholesterol. Which is why I would not recommend you venture into "not intended for diagnosis" consumer genetic testing like 23andme, etc.--too much of your relevent background info may be missing to properly sort the kind of "increased risk/no increased risk but only a limited number of variants/genes were studied" results they'll give you.

*if they are available, you may be able to pay to receive them, depends on the institution. You'll need to call and ask for medical records and may have to provide proof of authority to access them.
posted by beaning at 9:29 PM on May 16, 2018

Best answer: Just to recap: your mother was an obese alcoholic who drank until she was unconscious regularly, did not exercise, ate an unbalanced diet, smoked up to TEN packs a day, and had untreated endocrine issues. Btw untreated thyroid issues can also cause heart failure.

Except for being overweight and drinking more alcohol than recommended, you presumably experience none of these issues and your doctor hasn’t found any abnormalities with your heart function. Could you not get an MRI or something to detect abnormalities, just to set your mind at ease?

I am not even remotely a doctor, but it seems obvious to me that your mother and your uncle clearly died of complications resulting from their abysmally terrible lifestyles and medical neglect. Any one of your mother’s problems could have resulted in her death at that age, much less all of them put together. More than that, you only have half your mother’s genes, so there’s no reason you wouldn’t take after your dad and his medical history.

If you wanted to hedge your bets further, I would recommend losing the weight and ditching the alcohol, but if you’re not displaying any symptoms and not repeating her mistakes, then there’s no reason to suspect you would suffer her consequences. It is well documented that both alcoholism and heavy smoking cause heart disease. Your mother could have had the healthiest heart in the world and still driven herself into an early grave with her substance abuse.
posted by Autumnheart at 10:47 PM on May 16, 2018 [1 favorite]

I think it's likely your mom was mistaking heartburn for heart attack. Can you talk to your doctor about the signs of heart attack in women? Also, sorry but I think of low carb as heart unhealthy. Have you talked to your doctor about It? Maybe for you it is healthy. It sounds like you're being proactive and are healthy overall.

I have a genetic heart disease, and despite eating a balanced (lots of whole grains diet), exercising, health weight, my cholesterol is 389976899. So, you seem way ahead of me. I don't worry about it because I've essentially known my whole life and can't change it. I mean keep talking to your doctor about your health. But also, maybe therapy. We are all going to die, and maybe talking through your fears about it could be helpful. Also, I bet it was hard losing your mom young and that may be playing into this. It seems like you are doing the logical things to stay alive, so maybe do some emotional things to embrace it.
posted by Kalmya at 2:21 AM on May 17, 2018

Best answer: Dogmom, that is entirely possible. Is there any way I'd be able to find that out?

Probably not, to be honest. Not everyone who dies gets an autopsy (although I only know that's true now- I don't know what the protocol was when your mom died). And I work in a practice that specializes in the electrical side of the heart, so I could be projecting. However, I really don't see any harm in asking your doc to send you to a cardiologist for a "peace of mind" cardiac work up. Just make sure they do an echocardiogram (to check for indicators of SCA/SCD) and maybe a stress echo or nuclear stress test (to check for blockages) as part of their testing.
posted by dogmom at 4:11 AM on May 17, 2018

Low carb is a problematic term, since carrots and broccoli are carbs. If by low carb, you mean that you don’t eat donuts and candy bars, that’s great. If you mean that you avoid brown rice and potatoes and that you eat a lot of meat, no, that’s not good for your heart.
posted by FencingGal at 6:27 AM on May 17, 2018 [2 favorites]

Best answer: Color Genomics offers a Hereditary Heart Health panel specifically focused on screening for genetic mutations that affect heart health. They're a legit lab that is used by doctors at major university hospitals. The panel isn't cheap ($249) but it comes with a counseling session with a genetic counselor if any pathogenic mutations are detected, and free follow ups.
posted by mylittlepoppet at 7:23 AM on May 17, 2018 [1 favorite]

Response by poster: mylittlepoppet, thank you for that reference. $249 is honestly a drop in the bucket as far as I'm concerned here. I'll check that out.

For the naysayers, I mostly follow a ketogenic diet. My doctor (and a cardiologist I used to see) fully supports this as there is a lot of evidence to show that a keto diet is incredibly heart healthy for many people. I was vegan (not a "potato chip vegan" but like, I ate tons of whole grains, beans, sweet potatoes, along with veggies and a low/moderate amount of fat) for a decade and had very high LDL, triglyceride and blood pressure numbers on that diet, which was very concerning to my doctor. Once I switched to a keto diet, all of those numbers have gone to the optimal range and stayed there. My body is obviously happy here. So, let's not jump to any conclusions about low-carb diets inherently being Bad for everyone.
posted by joan_holloway at 8:25 AM on May 17, 2018 [5 favorites]

Is there anything else I can do to set my mind at ease? I would gladly pay some sort of specialist out of pocket if necessary to find out if I am a ticking time bomb like my mom was. I just don't know where to begin.

I think a good first step would be to schedule an appointment with your GP and talk about your concerns. It's usually cheaper anyway when your GP refers you to a specialist (instead of just booking an appointment by yourself).
posted by colfax at 2:37 AM on May 18, 2018

Response by poster: Thanks again everyone. I had an appointment with my GP this morning and brought this up. She went through my records and reassured me that I really don't have any indicators of poor health and that the best thing I can do right now is to lose some weight. She wasn't keen on referring me to a specialist or any special tests at this stage unless I start to show areas of concern like elevated triglycerides or blood pressure.
posted by joan_holloway at 9:48 AM on May 18, 2018

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