Lifestyle or Genetics: Which is More Important for Heart Health?

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It has been a busy day in the Emergency Department. Doctors, nurses, and other staff are bustling about, doing their best to provide excellent care for every patient. Dialogue fills the nursing stations with background noise. I am walking from room to room, tending to several patients, performing my initial evaluation on some, and providing test results to others. As I finally take a few moments to sit down in front of my computer and do some charting, the nurse in charge hands me the EMS phone. 

The paramedic at the other end of the line informs me that they are en route with a 54-year-old male having severe chest pain and difficulty breathing. They have obtained an EKG that is concerning and have given him medications to treat his pain. Their estimated arrival time at our hospital will be in approximately ten minutes. 

Upon receiving this report, I spring into action. I notify the nurses, and we begin preparing a room to care for our next patient, setting up monitors, IV start kits, and other resuscitative equipment. The ambulance pulls into the garage, and within another moment, the doors slowly swing open, and the crew rolls in. A dark-haired man is sitting up and leaning forward on the stretcher. Beads of sweat roll down his forehead, and he appears moderately distressed as he clutches his chest. 

I greet my patient, “Hi, I’m Dr. Piriano. When did your symptoms begin?”

He looks at me with fear in his eyes. “I’m so scared.”

“I know.” I place my hand on his shoulder. “Don’t worry. We’re going to help you.”

“I started to feel pressure in my chest about an hour ago. I feel nauseous, and I’m having trouble breathing.”

“OK, got it. We’re going to be doing a lot of things really quickly to take care of you.” As I utter these words, a technician has already connected the patient to an EKG machine and is printing out the electrical tracing of his heartbeats. Once complete, she tears the paper from the machine and hands it to me. The pattern on the pink sheet is unmistakable—this man is indeed having a heart attack. 

I explain the EKG findings to my patient and tell him that he will need a cardiac catheterization to find the blocked artery and place a stent to open it and restore blood flow to his heart. He is given heart-protective medications, the cardiologist is called, and he is soon whisked off to the catheterization suite—all within thirty minutes from the time he entered the Emergency Department. It is rewarding to know that this gentleman will receive a new lease on life. Modern medicine is undoubtedly incredible, and I am in awe knowing how much progress humans have made. It is truly miraculous to witness the coordinated efforts of a team of people acting so swiftly to save another person’s life.  

However, I still have one critical question—did this person’s heart attack have to happen at all? The answer to this question is where the story changes from one of suffering to one of hope. 

My fictional patient, like millions ofrealpeople, has heart disease. Coronary artery disease (CAD) is the most common type ofheart disease. It is caused by plaque build-up in the arteries supplying the heart with life-giving oxygen and nutrients, causing these blood vessels to narrow. The most recent statistic from February of 2022 reveals that about18.2 million adults in the United States age 20 and older have CAD.Although this is certainly a harrowing fact, it can be drastically changed.

To answer this question, we have to look at the causes of CAD. Without getting into the details of the mechanisms of plaque build-up, suffice it to say that the major players in the development of CAD arecholesterol and inflammation.Thus, if we can lower these two things, we can also reduce our chances of plaque formation. Sounds great—but how can we do this? The answer is that it all comes down to lifestyle, as levels ofcholesterolandinflammationare intimately connected to how we live and what we eat.

Some people may object, citing bad genetics and stating that they have a strong family history of heart disease. They may note multiple relatives who suffered heart attacks at fairly young ages. “It doesn’t matter what I do. I’m doomed to have a heart attack,” they may state. On the surface, it may seem as though they have a valid point. However, digging deeper will reveal an entire realm of evidence and knowledge that refutes this belief. 

Does lifestyle play a more important role in the health of our hearts than our genes do? Let’s take a brief look at some of the research. One of the most prominent figures in this area of study is Dr. Dean Ornish. For more than three decades, Dr. Ornish and his colleagues, in collaboration with major academic institutions, have been conducting research studies investigating the effects of lifestyle on well-being. The participants in their studies made lifestyle changes that consisted of alow-fatvegetarian diet, aerobic exercise, stress management, smoking cessation, and group psychosocial support. Their results were nothing short of remarkable. Thus far, I have been speaking about the prevention of heart disease. These studies demonstrated that a healthy lifestyle couldreverseheart disease that has already developed. Amazing! Two of these research papers have been published in theJournal of the American Medical AssociationandThe Lancet.Anotherstudyalso showed that lifestyle changes, such as those mentioned, improved many of the risk factors that lead to heart disease, such as body weight, blood pressure, and cholesterol. 

Even more exciting is the fact that such lifestyle changes not only reduce the risk factors for heart disease but also affect our DNA. A field of science called epigenetics explores how our environments affect our genes. Moreover, it appears that genes have “switches” and can be activated and inactivated by environmental cues, such as our lifestyles. In other words, live an unhealthy lifestyle, and disease-preventing genes may be deactivated while disease-promoting genes may be activated. Conversely, live a healthy lifestyle, and the opposite may occur. Onestudyexamining prostate cancer found that lifestyle changes affected the expression of over 500 genes.

This information is truly powerful and inspiring. It provides evidence that we are not victims of our genes. An individual is not doomed to have a heart attack solely because many family members have already suffered through one. By changing our lifestyles, we can prevent disaster. We can control our destinies and our lives. We have that capability, and there is extraordinary hope in that. 

Reducing your meat intake and eating more plant-based foods is known to help with chronic inflammation, heart health, mental wellbeing, fitness goals, nutritional needs, allergies, gut health, and more! Unfortunately, dairy consumption also has been linked to many health problems, including acne, hormonal imbalance, cancer, and prostate cancer, and has many side effects.

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Here are some resources to get you started: