Since February is “American Heart Month”, much focus will be on these conditions that affect millions of Americans in the coming weeks. That’s a good thing, as the trends have not changed in the last several decades. According to the CDC’s Health, United States Data Finder in 1980, heart disease was the leading cause of death for adults 45-64 years old and 65 years and older. In 2019, heart disease remained the leading cause of death for individuals 65 years and older (cancer was the leading cause of death for adults 45-64 years old, followed by heart disease). However, it is more than likely that little attention will be given to the simplest test that can help assess the risk of heart disease – family health history (FHH).
Indeed, the risk of heart disease increases by 75% in patients if one parent has premature heart disease. Conditions including dilated cardiomyopathy and hypertrophic cardiomyopathy are due to hereditary syndromes in the majority of patients. While the current cardiovascular risk calculators do not include FHH, the European and Canadian guidelines adjust for this oversight by multiplying the risk calculator results by up to 2.5 if there is a first-degree relative with premature cardiovascular disease.
Dr. Lori Orlando, Professor of Medicine and Director of the Center for Precision Medicine, has been a strong believer in the benefits of FHH, but recognizes the practical limitations of incomplete information collected from and/or provided by the patient and the lack of utilization of the information by clinicians. For clinicians, with multiple clinical guidelines, often updated every few years, it is difficult to recall the current FHH-based recommendations for every condition. So, Dr. Orlando set out to develop a tool called MeTree that would both help the patient and the clinician to improve the collection of FHH and utilization of the information for medical management, respectively.
“Unfortunately, good intake of FHH is meaningless without appropriate clinician utilization and so, we worked to develop a tool to address both challenges. And it works! At this point, it has demonstrated its value in multiple clinical studies totaling more than 35,000 participants over the last 15 years,” comments Dr. Orlando.
But since the tool needs to incorporate current guidelines and be user-friendly, there are always updates to be made. Her team continues to look for ways to improve accessibility, usability, and comprehensiveness, particularly for underserved populations. Dr. Orlando’s team has reported that when using the tool, study participants are interested in providing more health information than the tool currently asks for.
“It’s particularly rewarding to see them respond this way – it confirms that we are on the right track and we will continue to work to raise awareness that a comprehensive FHH can be collected and is impactful on patient care,” notes Dr. Orlando. In the past year, she has spoken to several academic centers about FHH and will be presenting her work at an upcoming virtual seminar at Duke on Feb 1 at noon [registration link].
While heart disease affects both men and women of all races and ethnicities, there are some groups that suffer more. In particular, heart disease is the leading cause of death for women in the U.S., and a much higher prevalence in African-American. Since women are often more knowledgeable about their family member’s health conditions, with better FHH collection tools, this could make a real improvement in health outcomes.
Sources:
Centers for Disease Control and Prevention. Health, United States 2021-201 (Health, United States – Data Finder). Available at https://www.cdc.gov/nchs/hus/data-finder.htm?&subject=Leading%20causes%20of%20death
Kolber MR, Scrimshaw C. Family history of cardiovascular disease. Can Fam Physician. 2014 Nov;60(11):1016. PMCID: PMC4229162