Many of us have a parent, grandparent, or other relative who’s had a heart attack or “heart problems.” But most people don’t know the full story of their family’s heart health, or that there are genetic tests that can tell you whether certain heart risks run in the family and who might be at higher risk.

American Heart Month is a good time to talk with family members about their heart health histories. Understanding both your own health history and your family’s can reveal patterns that suggest inherited risk and help you and your doctor decide whether genetic testing may be appropriate.

Asking the Right Questions

Family history of cardiovascular disease means more than a relative having a heart attack. Certain patterns may point to an inherited heart condition. Ask these questions to get a clearer picture:

• Has anyone in the family had a heart attack, stroke, sudden death due to heart issues, or been diagnosed with heart disease?
• Has anyone needed a stent or bypass surgery?
• Does anyone have an enlarged or weakened heart?
• Is there a family history of sudden death under the age of 45?
• Has anyone had an implantable cardioverter defibrillator (ICD)?
• Does anyone have high cholesterol, high blood pressure, diabetes, or a history of smoking?

“The details matter—when people say someone in the family died of a heart attack, that may not be what actually happened,” says Simone Weinmann, MS, a cardiovascular genetic counselor at NYU Langone Heart. “You need to dig deeper to understand whether it was a heart attack, an aortic dissection, an arrhythmia, or another underlying condition.”

When Genetic Counseling Comes In

Family conversations can reveal patterns that are not always obvious. “There’s a dual picture when it comes to heart health,” says Weinmann. “Taken together, your personal health history and family history can tell you whether you’re at risk for a condition that’s genetically linked versus something that’s controlled by lifestyle factors.”

If you are being treated for a heart condition—and especially if you have a close relative who also has been—where you receive care matters. Cardiologists at NYU Langone Heart work closely with dedicated cardiovascular genetic counselors to determine whether inherited risk is part of the picture and if other family members should be evaluated. Genetic counseling is arranged through your doctor, so any testing is part of your overall cardiac care.

Who Should Be Tested?

Not everyone with family heart disease history needs genetic testing. If relatives developed heart disease later in life and had clear lifestyle risk factors such as high cholesterol, high blood pressure, smoking, or obesity, a primary care doctor can help manage those risks.

But if, for instance, you have multiple relatives with early unexplained heart disease, sudden cardiac death, aortic aneurysm, or an inherited arrhythmia, evaluation by a cardiovascular genetic counselor may be warranted. Such patterns can suggest inherited risk of heart disease that goes beyond lifestyle factors.

“The people who benefit most from genetic counseling are those with a family pattern that doesn’t fit the typical lifestyle-driven picture,” Weinmann explains. “It might be someone who ate well, exercised, and didn’t smoke, but who still had a heart attack in their 40s. Or a family where multiple people have had sudden cardiac death.”

Uncovering Your Genetic Clues

A genetic counselor reviews your family history, often going back three generations, along with your cardiovascular health history. If testing is appropriate, it involves a simple cheek swab, and results are typically available in two to three weeks. Before testing, the genetic counselor discusses what results you might get and what they mean.

“There’s a lot of uncertainty with genetic testing results,” Weinmann notes. “I walk patients through what different results mean, what’s suspicious, what’s just a normal human population variant, and what happens next.”

From Results to a Road Map

If testing reveals a mutation, it will help inform the next steps in your care. That may include imaging tests like an echocardiogram or cardiac MRI, earlier intervention, or starting preventive medications.

Genetic counselors at NYU Langone Heart work directly with cardiologists, heart failure specialists, arrhythmia experts, and aortic surgeons to help guide personalized treatment and coordinated care. “The goal is never just to give someone a diagnosis,” Weinmann says. “It’s to give them a plan—to help them understand what their genetic risk means and what they can do about it.”

The impact could extend to family members. “When we identify a genetic mutation in one patient, we recommend that their relatives—parents, siblings, children—get evaluated and possibly tested too,” Weinmann explains. “This is where we can make the biggest impact: by identifying family members who are at risk before they have symptoms or a crisis.”

Lifestyle Still Matters

Even with genetic risk, lifestyle changes can reduce heart disease risk. Regular cholesterol screening, blood pressure monitoring, a heart-healthy diet, at least 150 minutes of weekly exercise, avoiding smoking and excess alcohol, and managing stress are all important. The Center for the Prevention of Cardiovascular Disease has programs, videos, and other resources to help you reduce your risk and learn more about preventing heart conditions. 

“When you know you have genetic risk, lifestyle changes become an essential part of your medical plan, alongside medications and monitoring,” Weinmann says.

Take Action This Heart Month

Taking action for your heart health starts with a conversation with your relatives. Write down what you learn. If a pattern emerges—early unexplained heart disease, sudden death, or a known inherited condition—talk to your doctor about a referral to cardiovascular genetic counseling within our specialized programs, including our Aortic Center and Heart Rhythm Center.

Heredity is not destiny. When inherited conditions are caught early, before symptoms or complications arise, outcomes can improve dramatically. “If someone has a genetic predisposition to develop heart failure or an inherited arrythmia and we catch it early, their story is very different from someone who doesn’t know they’re at risk until they’re in end-stage disease,” Weinmann explains.