Genomics News Alerts

Genomics News Alert: an Update for Chronic Disease Administrators

The New England Regional Genetics Group (NERGG) Public Health Genomics Task Force would like to support you in your efforts to educate the public about chronic disease conditions which may have a genetic component. Individuals who are aware of their family histories have an opportunity for early diagnosis and intervention, enabling them to institute healthy life styles and preventive measures which will enable them to be as healthy as possible. To that end, this regional task force is piloting a plan to share related information with chronic disease program managers and other interested parties to use as they see fit. These Genomics News Alerts will be disseminated periodically.

We would very much appreciate your feedback as to the usefulness of these “alerts.” Your state’s Task Force representative may contact you for your comments and suggestions.

Please share this Genomic News Alert with others who might be interested in the information provided. Those who wish to be added to the distribution list should contact Mary-Frances Garber at mfgnergg@verizon.net.

Thank you for your interest and collaboration in public health education.

February 2012: February is American Heart Month

The Public Health Burden of Heart Disease

• Cardiovascular disease, including heart disease and stroke, is the #1 cause of death in the U.S. Approximately 815,000 Americans die each year from heart disease.¹
• The economic burden of heart disease and stroke is significant. Nationally in 2010, the healthcare and lost productivity costs due to heart disease and stroke totaled 444 billion dollars.¹

Heart Disease and Family History

• Heart disease is a multi-factorial condition; both environmental and genetic factors contribute to its occurrence.
• Individuals with a family history of heart disease and stroke (parent, sibling) are twice as likely to develop heart disease as individuals without a family history. Those with multiple affected relatives and/or early onset heart disease (before age 50) experience an even higher risk.²
• A population-based study of 122,155 Utah families found that only 14% of those families had a family history of coronary heart disease (CHD), such as heart attacks. This small subset however, accounted for 72% of early age (CHD) events and 48% of all CHD events experienced by the 122,155 families involved in the study.³Similar results were observed for strokes. A small subset with a family history of stroke (11%) accounted for the majority (86%) of all early onset stroke events and 68% of all stroke events.³
• One national study suggests that approximately 16% of US adults (between 20-45 years) possess a positive family history of early heart disease in a close relative (parent, child, or sibling).⁴
• More than 50 inherited cardiovascular conditions caused by harmful genetic mutations have been identified.¹Familial hypercholesterolemia (FH) is one of the most common, occurring in about 1 in 500 people (600,000 people in the US alone).⁵Individuals with an FH mutation cannot effectively remove cholesterol from the bloodstream causing blood vessel damage, blocked arteries, and a very high risk for heart attacks at an early age. FH is an autosomal dominant condition, meaning it passes from one generation to the next with a 50% probability.

Recommendation on the Use of Family History Information to Prevent Heart Disease

• The US Preventive Services Task Force (USPSTF) recommends screening men aged 20 to 35 (and women aged 20-45 years) for lipid disorders if they are at increased risk for coronary heart disease (including a family history of early onset heart disease (before age 50 in male relatives and 60 years in female relatives ).⁶
• The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20).⁶
• Studies have demonstrated that screening relatives of patients with hypercholesterolemia through a methodology called “cascade screening” is cost-effective.⁵Cascade screening identifies individuals at risk for an inherited condition via systematic family tracing.

Ideas and resources to incorporate family history into Your Heart Disease Prevention Efforts

• Incorporate family health history into your Million Hearts Campaign and state heart health planning efforts.
• Tools to integrate family history into your heart disease prevention programming:
• For Clinicians
• Heart Disease and Family History Factcard available at http://www.ashg.org/pdf/Heart%20Disease.pdf
• For the General Public
• Heart Disease and Family History Fact Card : Produced by the Michigan Department of Community Health
• Does It Run In the Family? On-line Customizable Toolkit Allows users to create customized versions of two family health history booklets, “A Guide to Family Health History” and “A Guide for Understanding Genetics and Health.” Booklets can tailored to include personal health stories, pictures, interview questions, disease information, etc.
• My Family Health Tree: Produced by the American Heart Association, the “My Family Health Tree” Tool engages children in looking at their family health history and what they can do to promote their health.

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¹To see a list and a description of these conditions, see Appendix One of the Public Health Genomics Foundation Report entitled “Heart to Heart: Inherited Cardiovascular Conditions Services: A Needs Assessment and Service Review found at http://www.phgfoundation.org/file/4667/.

Bibliography

1. Million hearts campaign: About heart disease and stroke - costs and consequences.
   http://millionhearts.hhs.gov/abouthds/cost-consequences.html
2. Khoury MJ. A million hearts, A thousand genes, and your family history.Genomics and Health Impact Blog. 2011.
3. Hunt SC, Gwinn M, Adams TD. Family history assessment: Strategies for prevention of cardiovascular disease. Am J Prev Med. 2003;24(2):136-142.
4. Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999-2006. Ann Fam Med. 2010;8(4):327-333. doi: 10.1370/afm.1137.
5. Ned RM, Sijbrands EJ. Cascade screening for familial hypercholesterolemia (FH). PLoS Curr. 2011;3:RRN1238. doi: 10.1371/currents.RRN1238.
6. Screening for lipid disorders in adults: US Preventive Services Task Force.
   http://www.uspreventiveservicestaskforce.org/uspstf08/lipid/lipidrs.htm. Updated 2008.

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