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Preventive treatments for heart disease, which are aimed at reducing or eliminating risk factors, have shown to be effective in preventing heart disease altogether or decreasing the risk of disease recurrence in older populations. Yet rates of cardiovascular disease, such as heart attack or coronary heart disease, in adults under 55 years of age have not decreased over the past two decades. Current screening approaches are effective in identifying older individuals who are at high risk of heart disease and will benefit from preventive treatment; however these approaches do not perform as well in younger adults.

Risk of heart disease is strongly influenced by genetics, particularly when it occurs at a young age. Consequently, when an individual develops heart disease under the age of 55 years, their first-degree relatives (siblings, children and parents) are also at increased risk of developing heart disease. However, because all current risk assessment tools are highly dependent on age, many young adults remain undiagnosed and untreated.

Genetic predisposition influences not only initial development, but also the progression of disease and success of preventive treatment. Individuals with high genetic risk may be at higher risk of recurrent heart attacks despite receiving recommended treatment and may benefit from more intensive treatment or usage of stronger, newly developed medications.

The main findings of this research are:

1)           Patients with early-onset heart disease who had a genetic predisposition to high blood cholesterol were less likely to achieve adequate control of their cholesterol levels in the three years following presentation with a heart attack than patients without genetic predisposition, despite receiving treatment of the same or even higher intensity. This puts them at higher risk of recurrent heart attacks and death.

2)           First-degree relatives of patients with early-onset heart disease who didn’t have a personal history of heart disease, but had a genetic predisposition to it on genetic testing, were at higher risk of having silent plaques in the blood vessels of their heart than those without a genetic predisposition, even when they had similar clinical risk factors that can be assessed by doctors via routine methods. This puts them at a higher risk of developing heart disease at a younger age and requires more aggressive risk factor management to prevent it.