Issue Date: January 29, 2006
All in the family
If your mom or dad has an illness, will you get it, too? Beat the odds for 9 common diseases.
By the editors of "AARP The Magazine"
About this special issue
USA WEEKEND brings you today's most compelling health reporting through partnerships with America's finest magazines. For this must-read report, we team with "AARP The Magazine," the No. 1 publication aimed at people ages 50 and over.
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Maybe you got your good looks from Mom and your wicked sense of humor from Dad. But what else did your parents give you? Part of their legacy could be a high risk of heart disease, stroke, diabetes or cancer. Your chance of getting most diseases is at least doubled if there's a history of it among your relatives.
But don't just blame your genes. Families share more than DNA: They share meals, habits, attitudes about exercise -- lifestyle factors that can play a more critical role than genetics in increasing disease risk.
"Family history is not your destiny," says Muin Khoury, M.D., Ph.D., director of the Centers for Disease Control and Prevention's Office of Genomics and Disease Prevention. "Think of it as a tool. It could save your life if you do the right things."
Here are nine conditions commonly found in generation after generation. In every case, you can lower your risk by losing weight, increasing exercise, and eating more broccoli and fewer burgers.
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Alzheimer's Disease
The No. 1 risk factor for the common form of Alzheimer's is age -- not genetics -- but no more than 10% of adults over 65 suffer from dementia. A strongly hereditary form is early-onset familial Alzheimer's disease, which strikes before age 60. About 5% of Alzheimer's patients have this type.
What You Can Do: "The last five years have been a very exciting time," says Robert Wilson, senior neuropsychologist of the Rush Alzheimer's Disease Center. "A number of new potential risk factors have been identified, and many of them appear to be associated with lifestyle."
Lifestyle fixes include the big four: eat right, exercise, watch your weight and don't smoke. Each improves your cardiovascular system, and there's a definite link between good circulation and good brain health. (Exercise also boosts levels of brain-nurturing chemicals.) In a study by Kaiser Permanente, adults in their 40s with one or more cardiovascular riskfactors were more likely than their peers in good cardiovascular health to develop dementia in their 60s and 70s. Diabetes had the greatest effect, increasing risk of dementia by 46%.
Mental exercise also is important: Wilson says mind-challenging activities are associated with a lower risk of dementia. Brain-boosting activities include reading, playing cards, solving puzzles and knitting. Getting out of the house -- gardening or going to museums -- stimulates the mind as well. "There's pretty good evidence," Wilson says, "that people who are socially active are less likely to develop Alzheimer's disease and decline cognitively."
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Breast cancer
For most women, a family history means a modest increase in risk. But a small subset has a much higher risk due to rare mutations in genes called BRCA1 and BRCA2 (which also increase susceptibility to ovarian cancer). The lifetime risk for women with these mutations -- most frequently Eastern-European Jewish descendants -- can be as high as 85%, compared with about 13% for other women.
Another important risk factor is the length of exposure to hormones. Women increase their lifetime exposure if they have their first period before age 12, never have children or have a first child after age 30, enter menopause after 55, take hormone replacement therapy (HRT) or are obese.
What You Can Do: If you're under 40 and not at high risk, the American Cancer Society recommends a clinical breast exam at least once every three years. Annual mammograms are recommended beginning at 40. Unfortunately, mammograms aren't perfect: The rate of false positives is high, and the tests miss up to 20% of cancers a physical exam can detect. But mammograms save lives. Breast cancer deaths dropped 24% between 1990 and 2000, and cancer experts say mammograms get much of the credit.
But how can you reduce hormone levels? Exercise. It lowers body fat, which helps trim levels of estrogen and other hormones that fuel tumor growth (fat cells are the primary source of estrogen after menopause). Taking the most common form of HRT, estrogen plus synthetic progesterone, increases breast cancer risk. Because the risk appears to be greatest when therapy continues for years, experts recommend that women taking hormones for menopause use the lowest effective dose for the shortest possible time. Also, the drug tamoxifen reduces breast cancer risk in some women but has serious side effects.
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Colorectal cancer
If you're in the small fraction of Americans who have two first-degree relatives (parents or siblings) with colorectal cancer, our No. 2 cancer killer, your risk of getting it is five times higher than usual. But more than 80% of colorectal cancer patients have no family history.
What You Can Do: Colorectal cancer is very preventable. An important step is exercise, which reduces body fat and blood levels of cancer-promoting chemicals. Exercise also speeds food through the intestines, reducing the colon's exposure to carcinogens and lowering your risk of diabetes, which is associated with increased colorectal cancer risk.
Limiting your intake of red meat, getting adequate folic acid and consuming alcohol in moderation, among other healthy habits, can reduce risk by as much as 70%. An Italian study found that people with a family history of colorectal cancer who didn't overeat, ate less red meat and consumed high levels of antioxidants virtually eliminated excess risks.
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Diabetes
Yes, family is a big factor in diabetes risk. If one of your parents or siblings has diabetes, your risk is double compared with those without a family history. But the biggest factor: obesity. Diabetes and obesity are so intertwined that doctors talk about "diabesity."
What You Can Do: In a 16-year study of 84,000 nurses, Harvard epidemiologist Frank Hu found the best way to fight diabetes is to eat fiber-rich plant foods and healthy polyunsaturated fats (nuts, seeds, plant oils), maintain a healthy weight, exercise for 30 minutes most days, drink alcohol in moderation and not smoke. He says a healthy lifestyle can prevent 91% of type 2 diabetes cases.
If you develop -- or already have -- diabetes, keep blood sugar down to prevent complications affecting the heart, kidneys, eyes and other organs. The American Diabetes Association recommends that all adults, especially overweight ones, get blood sugar tested every three years beginning at age 45. Your doctor may want to test you if you're younger and overweight with a family history, plus have risk factors such as high blood pressure, triglycerides or cholesterol.
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Heart disease
"Cholesterol buildup in the arteries starts in the teen years, so the younger one knows about family history, the better," says Eric Topol, M.D., chairman of cardiovascular medicine at the Cleveland Clinic.
Heart disease in a parent or sibling doubles your risk. It jumps higher if more than one relative is affected -- including grandparents, aunts and uncles -- and if it was early onset (before age 55 for men and before 65 for women). If a parent died before age 50 from heart disease, Topol says, it's "quite worrisome."
Happier news: Genes that raise heart attack risk are not only rare, they eventually may be treatable.
What You Can Do: The American Heart Association says to have your primary care doctor assess your cardiovascular risk starting at age 20. Your doctor should review your family history and check your body mass index and/or waist-to-hip ratio (a measure of abdominal obesity, which is highly predictive of heart disease risk). Check your blood pressure at least once every two years and cholesterol levels every five years -- more often if they're high.
As for strengthening your ticker, the keys are the magic four: no smoking, prudent diet, 30 minutes of exercise a day, normal weight. Harvard's look at disease risks in 84,000 nurses found that women who abided by these guidelines reduced risk of heart attack by 66% compared with women who had less heart-healthy lifestyles.
"If you stay thin and exercise most days of the week," Cleveland Clinic's Topol says, "you'll stay way ahead of things, no matter what your genes are."
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High cholesterol
Scientists have known for 40 years that certain families are prone to high cholesterol levels. "It's one of the unfortunate gene pool liabilities that Americans share," Topol says. About one in 100 of us has an inherited condition that can lead to high total and LDL cholesterol, low HDL cholesterol (the good kind) and high triglycerides.
But don't just blame your parents. At least 100 million Americans have cholesterol counts over 200 but don't have a recognizable inherited disorder.
What You Can Do: Reduce your intake of saturated fats (found primarily in animal foods) and trans fats (culprits include vegetable shortenings, some margarines, snack foods), both of which raise LDL cholesterol. Unsaturated fats actually lower LDL; some even raise levels of protective HDL cholesterol. Friendly fats include polyunsaturated fats (nuts, seeds, plant oils), monounsaturated fats (olive oil) and omega-3 fatty acids (fish, flax seed, canola oil). Other cholesterol-cutters: soy protein and oats.
Drugs such as statins can help. Coming soon: drugs to better raise HDL levels. Studies show that even a small HDL boost reduces the risk of heart attack or coronary death, while a 10% cut in total cholesterol can reduce heart attack risk by about 30%. The American Heart Association recommends that all adults get a cholesterol test at age 20 and at least every five years after that.
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Hypertension
This silent killer increases the risk of heart attack, stroke and kidney failure -- usually without causing any symptoms. That's one reason almost a third of Americans don't realize they have it.
Genes account for 30% to 50% of the difference in blood pressure rates between individuals, although which gene variants increase risk has yet to be determined. African Americans have the highest prevalence of high blood pressure in the world, and they have higher rates of stroke.
What You Can Do: Get your blood pressure checked.
On the food front, perhaps the most well-researched dietary regimen is the federally funded Dietary Approaches to Stop Hypertension plan, which emphasizes fruits, vegetables and low-fat dairy products, and limited consumption of saturated and total fat. Combining a low-salt diet (1,400mg or less of sodium a day) with the DASH diet lowers blood pressure as much as taking an anti-hypertensive drug.
If you take blood pressure drugs, don't mess with your dosage. Taking your pills can cut heart attack risk by 20% to 25%, stroke by 35% to 40% and heart failure by more than 50%. Losing weight also can reduce systolic blood pressure (the top number) by five to 20 points; a daily walk can drop it four to nine points.
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Prostate cancer
It's the second most common cancer in American men after skin cancer, and 80% of cases diagnosed are in men over age 65. Scientists still are hunting for individual gene mutations that increase prostate cancer risk.
Your family history may be relevant if two or more men in your family are affected or if one of your male relatives developed prostate cancer before 60. African-American men -- particularly of sub-Saharan African descent -- have significantly higher rates than other men.
What You Can Do: Men who become overweight in their 20s and stay overweight are more likely to develop prostate cancer in their 50s, and it's more likely to be an aggressive form.
Some well-known prostate power foods are tomatoes and tomato products -- and, yes, pizza counts. One study found that men who ate the most tomato products had a third lower chance of prostate cancer than non-tomato-loving counterparts. The secret ingredient may be lycopene, an antioxidant that's highly concentrated in tomatoes. Another mealtime strategy: Eat less meat and saturated fat, and eat more fruits and veggies.
Found early, prostate cancer is very treatable, which is why screenings such as the prostate-specific antigen test or a digital rectal exam are a good idea starting at age 50. Neither test is perfect, however, and the PSA test can give inaccurate results.
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Stroke
It doesn't just affect people late in life: More than a quarter of stroke victims are under age 65. So far, no genes are linked to stroke risk, but family history is still a relevant risk factor, especially for early stroke. A University of Washington study found that women ages 18 to 44 who had a family history of stroke had twice the risk of suffering a stroke as their peers. One reason may be that high blood pressure -- the No. 1 risk factor for stroke -- also tends to run in families. Another inherited risk factor is atrial fibrillation, a heart-rhythm disturbance in which the heart's upper chambers beat rapidly and unevenly. This makes pumping all the blood out of the upper chambers difficult for the heart. Blood can pool and clot, raising the risk of stroke.
What You Can Do: Two stroke-fighting foods that are especially worth adding to your diet are fruit and fish.
A French analysis last year of seven international studies that included 230,000 elderly patients found that each additional serving of fruit per day reduced stroke risk by about 11%.
Harvard researchers reported in 2004 that eating baked or broiled fish one to four times a week reduces the risk of ischemic stroke by 28%. Fried fish? Nice try, but it increases risk.
And forget the after-dinner cigarette. Quitting smoking reduces your risk of stroke to that of a non-smoker within five years.
-- Reported by Kelly Griffin
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Tools for discovery
Create a family health history on your computer: Check out the Surgeon General's Web-based family history tool, "My Family Health Portrait," at familyhistory.hhs.gov. For a paper copy, call 888-275-4772.
Calculate your risk of common diseases: Visit the Harvard Center for Cancer Prevention website at yourdiseaserisk.harvard.edu. The site includes tips to reduce your risk.
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About AARP
To become an AARP member and receive "AARP The Magazine," call 888-687-2277 or visit aarp.org. "AARP The Magazine" and AARP are not responsible for the advertising in USA WEEKEND Magazine.
Cover photograph by Jim Wright for USA WEEKEND
Grooming by Diana Schmidtke, Celestine; photographed at Focus Studio, Venice Beach, Calif.
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