We know that cardiovascular disease can run in families, that if we have a family history of heart disease, we may be at greater risk for heart attack, stroke, and other heart problems. The closer the relative, the greater our heart disease risk. If we have a "first-degree relative", that's a mother, father, sister, or brother or even a son or daughter, who had heart disease at an early age, that increases our risk of developing heart disease.

Generally, heart attacks, strokes, and documented cardiovascular disease in a man under 55, or a woman under 65, raise a red flag. The more family members we have, the higher the potential risks of heart disease.

People with a particularly strong family history of heart disease might be put on aspirin at an earlier age than normal, or blood pressure medication for even borderline blood pressure, but such a risk should also motivate us to improve our dietary and exercise habits. It is not very clear how more-distant relatives, such as aunts, uncles, and grandparents, affect your heart disease risk.

We cannot eliminate the influence of these genetic factors, but by adopting a very healthy lifestyle, eating well, pursuing an exercise program, and aggressively working on lowering your cholesterol and triglycerides, we can substantially reduce our risk. Both heart disease and the contributing risk factors like blood pressure and cholesterol, are controlled by both genetic and environmental factors.

If we have a strong family history of heart disease, we need not wait until we are older to take care of our own risk factors. If we are at substantially increased risk because of elevated cholesterol even as a student , it is the time to start aggressive lifestyle changes and therapy. The longer we do it, the more benefit accrues over time. The younger we are, the more we stand to benefit from therapy.