Your Health Checkup: What’s More Important — Your Genes or Your Environment?

Even if you’re genetically predisposed to certain illnesses, you can greatly reduce their likelihood by adopting a few good habits.

Older man on a bike.
riopatuca / Shutterstock

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“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Bear’s Promise, and check out his website

“Nature loads the gun, but the environment pulls the trigger” is advice I have often given my cardiology patients for over fifty years. By that I meant that even a person born with a genetic predisposition to some sort of illness, say coronary heart disease, can reduce their risk substantially by modifying their environment and behavior with appropriate diet, exercise, lipid and blood pressure control, and not smoking.

One study that supports such a conclusion showed that a lifetime control of LDL (bad) cholesterol and high blood pressure could counter a genetic predisposition to cardiovascular disease.

In a truly remarkable epidemiologic investigation using the United Kingdom’s Biobank, the investigators determined the genetic makeup in almost half a million people (57 years old at entry; 62 years old at last follow up; 54 percent women) to establish their lifetime genetic risk for developing coronary disease, called a polygenetic risk score (PGS).

As the PGS score increased, the investigators found a stepwise increase in the risk of a major coronary event of heart attack, death attributable to coronary disease, or need for coronary revascularization such as bypass surgery. Those with the highest PGS score had almost a three-fold greater risk than those in the lowest PGS group. The risk was essentially the same in men and women.

A critical finding was that, at any level of lifetime major coronary event risk as defined by the PGS, the actual event rate could vary as much as 10-fold depending upon lifetime exposure to LDL cholesterol and high blood pressure. As an example, men in the top PGS level with high lifetime blood pressure and LDL cholesterol had a 93 percent lifetime major coronary event risk. But that risk plummeted to 8 percent if they had low lifetime blood pressure and LDL cholesterol. This was regardless of age, gender, body mass index, and diabetes status. Any reduction in LDL cholesterol and blood pressure, in any combination and to any amount, reduced the cardiovascular disease risk in stepwise amounts.

The outcome confirms the fact that prolonged exposure to modestly lower LDL cholesterol and blood pressure can prevent most adverse outcomes from coronary disease, even at middle age. Imagine the benefits when applying all of the American Heart Association’s “Life’s Simple 7,” including  not smoking, exercising, and controlling diet, body mass index (BMI), blood pressure, cholesterol, and glucose.

Paul Dudley White, the renowned Boston cardiologist acclaimed as the father of modern cardiology, died at the age of 87. He famously said, “heart disease before 80 is our fault, not God’s or nature’s will.” He also said, “A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world.”

Maybe a two-mile walk is more reasonable, but nevertheless, his are wise words to consider, especially in these particularly stressful political and pandemic days.

Featured image: riopatuca / Shutterstock

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