Need for Family Heart Disease Clinic Model
The link between coronary heart disease (CHD) and inheritance is indisputable. How do we use the available genetic testing to improve patient care and detect high-risk family members?
Dr. Robert Superko and colleagues have written an article published online in the December issue of Clinical Cardiology arguing in favor of a family heart disease clinic model which they have used for 15 years.
The use of a family heart disease clinic to determine high CHD risk phenotypes in adult family members of patients with established CHD is important in at least five ways:
- It can serve to alert family members of their personal risk potential when compared to the family member with established CHD.
- It can alert the family member to important gene environment interactions that may affect their heart health.
- It helps to select the most appropriate screening blood tests for family members and avoids over utilization of laboratory services.
- It helps to identify family members who may benefit from noninvasive imaging.
- It can assist in treatment decisions. For example, family members with the atherosclerosis susceptibility (ATHS) trait respond particularly well to exercise-induced weight loss and dietary changes
Superko and colleagues note “The use of genetic knowledge to improve patient care does not require direct DNA analysis. Some genetic polymorphisms have been linked to increased CHD risk, but for many polymorphisms the link is weak and/or inconsistent. A large portion of family CHD risk screening can be accomplished with phenotypic tests that are clinically available to physicians and their patients.”
Phenotypes that have an inherited pattern of transmission are established as CHD risk factors and are common in the CHD population and in family members. Inherited dyslipidemia has been reported in 77% of CHD patients with 54% of the first-degree and second-degree relatives expressed the same dyslipidemia.
Roadblocks to the widespread clinical adoption of this concept involves un-reimbursed staff time, educational needs, access to a standardized and efficient assessment mechanism, and privacy issues.
Family Coronary Heart Disease: A Call to Action; H. Robert Superko HR, Roberts R, Garrett B, Pendyala L, King S; Clinical Cardiology, Volume 33, Issue 12, pages E1–E6, December 2010; DOI: 10.1002/clc.20684