Somewhere between what the traffic to the Jersey Shore was like and whose kid is applying where, your family will get through an entire holiday meal without touching the one subject that tells me the most about your future health. How old was your grandfather when he had his first heart attack? Your aunt probably remembers. Nobody ever asks her.
The U.S. Surgeon General made this official back in 2004, when Thanksgiving was named National Family Health History Day. The thinking was simple: It’s the one day a lot of families are all in the same room. I’m double board-certified in emergency medicine and longevity medicine, so I’ve seen both ends of this. In the ER, family history is what relatives tell you after the heart attack. In my practice, it’s what we act on 20 years before one. This year’s research makes that work matter even more.
You Inherited More Than We Thought
For years you’ve probably heard that genes account for about 20% of how long you live and the rest is up to you. One widely cited analysis put it at under 10%.
That thinking is out of date. In January, researchers at Israel’s Weizmann Institute published a paper in the academic journal Science arguing that the classic twin studies had a flaw. Those studies followed people born in the 1800s and early 1900s, when infections and accidents killed so many people that the biology got lost in the noise. Correct for those deaths and the heritability of lifespan comes out at around 50% or higher, more than double the old estimate.
Don’t cancel the gym membership. Heritability is a population statistic, so it can’t give you a personal expiration date, and about half of the variation still comes down to lifestyle, environment, medical care, and luck. But it does mean family patterns tell us more than we thought. If your relatives tend to get heart disease at 55 or memory trouble at 70, I want to know that decades ahead of time, while we can still do something with it.
The Blood Test Every Adult Should Now Have
The most practical change came in March. The new American College of Cardiology and American Heart Association cholesterol guideline says every adult should have lipoprotein(a), or Lp(a), measured at least once. That’s a first for a U.S. guideline.
Lp(a) is a cholesterol-carrying particle, and your level is about 90% genetic. Roughly one in five people worldwide have a high one, and that includes marathon runners with perfect cholesterol panels who eat like Mediterranean fishermen. Most adults have never had it checked, and it isn’t part of a standard cholesterol panel, so you usually have to ask for it.
The number stays fairly stable through life, so one test is usually enough. That said, we have noticed improved Lp(a) in some patients who have taken certain peptides, an observation from our practice rather than a clinical trial finding. If your result is high, your parents, siblings, and children should be tested, too.
In September, the first major trial of an Lp(a)-lowering drug came up short. The drug lowered the number but didn’t reduce heart attacks and strokes in people who already had heart disease. Full results were still pending when I wrote this, and other drugs are still being tested, so there’s no Lp(a) pill to reach for today. The trial didn’t change the fact that high Lp(a) is a clear risk factor for heart attack, stroke, and aortic stenosis, and it has been linked to sudden cardiac death. We clearly need more studies.
None of this changes my advice: Get your number. If it’s high, I treat what we can control earlier and more aggressively, starting with LDL, ApoB, and blood pressure. Find out at 42 in my office, not from a cardiologist after a stent.
5 Questions to Ask Before the Pie
“He had a heart thing.” … “She had some kind of female cancer.” … Every family has these, and medically they’re useless. What matters is the actual diagnosis and the age it happened. Here are the answers I want.
Who had heart disease or a stroke, and how old were they? The age often matters more than the event. If a father or brother was affected before 55, or a mother or sister before 65, a routine cholesterol panel isn’t enough.
Who had cancer, what kind, and at what age? Colon cancer screening normally starts at 45. If a parent or sibling was diagnosed before 60, it generally starts at 40 or 10 years before their diagnosis, whichever comes first. So, if your father was diagnosed at 48, your first colonoscopy is due at 38. Several relatives with breast, ovarian, prostate, or pancreatic cancer means it’s time to talk about genetic testing, and your father’s side counts as much as your mother’s.
Mom, when did you go through menopause? In one survey, only about half of women knew the answer, and those whose mothers had early menopause had about six times the odds of having it themselves. A separate mother-daughter study put the heritability of menopausal age at 44%. Earlier menopause means more years without estrogen protecting your bones and heart, so if you’re in your 30s or 40s, ask now.
Did anyone break a hip? A parent’s hip fracture goes into the standard tool doctors use to estimate fracture risk. That includes sons. Men tend to get left out of the bone conversation until they’ve already broken something.
Who had memory problems, and when did they start? A grandmother diagnosed at 91 and a father diagnosed at 62 are very different stories. The answer determines how aggressively I manage blood pressure, blood sugar, sleep, and hearing in midlife.
One more, and people enjoy this one: Who in the family was still sharp and driving at 92? Ask what they ate, how much they moved, and who they spent time with.
Some relatives will tell you everything. Others won’t want to get into it over dessert, and that’s fine. Write down what you learn that night, even if it’s a note on your phone, because you won’t remember the details by New Year’s. Put down who it was, which side of the family, the diagnosis and how old they were when it happened. For relatives who have died, add the cause and their age. Smoking history helps, too. And don’t stop at the older generation. Your first-degree relatives, meaning your parents, siblings and children, matter most.
If Something Seems Different About Mom or Dad
The holidays are often when adult children who live elsewhere first notice a change in a parent. She tells the same story twice in an hour. A recipe she’s made for 40 years goes wrong. The mail is piling up on the counter unopened.
That used to mean a long, uncertain road through specialists. In August, the FDA cleared a blood test for a protein called pTau217 that helps primary care doctors and specialists assess the amyloid changes linked to Alzheimer’s disease. It’s cleared for people 55 and older with signs, symptoms, or complaints of cognitive decline, and it’s available through both LabCorp and Quest.
This test is for people with symptoms, as one part of a physician’s evaluation. It isn’t a screening test for healthy adults who are curious. Memory changes aren’t always Alzheimer’s, either. Low thyroid, low B12, poor sleep, depression, and medication side effects can all look like it, and some of those are very fixable. If you noticed something at the table, don’t wait until next Thanksgiving to bring it up.
From Family Story to Personal Plan
In a typical office visit, family history is a checkbox on an intake form. In my practice, it’s where we start. A standard physical is built to find disease once it’s there, and your labs can look normal for years before anything shows up.
Most of my patients feel fine when they walk in. Many are at the top of their game and want to stay there for as long as possible. They refuse to be surprised. My job is to find the threats to your longevity years before they show up.
So, I put the family story next to data most physicals never include: Lp(a) and ApoB, fasting insulin, hormone levels, inflammatory markers, bone turnover, genetic testing, and advanced imaging when it’s warranted. A strong cardiac history can mean a much lower LDL target than your last physical suggested. A mother’s early menopause can move the hormone conversation up several years. A family pattern of diabetes means we watch your insulin long before your blood sugar looks abnormal.
If your father had a heart attack at 54 and you’re 44, you have 10 years to work with.
So, this year, somewhere between the turkey and the pie, ask the questions and write down the answers. Then bring them to me in Bryn Mawr in January for a longevity consult. Your family history tells us what you may have inherited. Your biomarkers tell us what’s happening in your body right now. We’ll go through both, from your hormones and metabolic health to inflammation and Lp(a), and build your plan from there. To schedule your longevity consult,
visit wellness-doctors.com.
Save the surprises for under the tree.
