Hypercholesterolaemia and a family history of heart disease.
Graham tells us about his life and that of his family’s life since his heart attack. Graham is now receiving medication to lower his risk of further attacks, and has changed his lifestyle in terms of diet and exercise to live healthier. Importantly, this has also knocked on to his children and grandchildren who have also modified their lifestyles to be healthier. An important factor to encourage him to change his life has been due to a strong family history of myocardial infarctions and early deaths.
Point for reflection
- If you were approached by a patient with a health history similar to that of Graham’s, what would you say?
- How would you explain the importance of a healthy lifestyle, without unduly worrying him and his family?
- Would you suggest a referral to a colleague and to whom?
- Would you be able to direct him to helpful information resources as Graham had from the British Heart Foundation?
- How would you direct any of this information to other family members?
Quotes to reflect upon
"After having taken my health for granted until then, I thought I had better find out a bit more about my family and heart problems."
"For me, life goes on as before. For my family, the healthier lifestyle will prolong their lives."
"I have two sons and eight grandchildren. What do I do, I can’t change their genetics?"
"It seems to me that people find out about genetic problems when it is too late to take any meaningful action."
- The British Heart Foundation (BHF) http://www.bhf.org.uk/ plays a leading role in the fight against disease of the heart and circulation so that it is no longer a major cause of disability and premature death. It produces information and literature to help people help themselves and improve their health.
- Heart UK http://www.heartuk.org.uk/ supports all those at risk of high cholesterol and cardiovascular disease.
How does this story relate to professional practice?
[We have linked this story to the Nursing Competences in Genetics (NCG) for nurses, midwives and health visitors. Further information on the competence frameworks can be found here]
Graham has briefly described his own family history and NCG 1 reflects on the importance of noting family history as a way of assessing predisposition to disease.
Knowing that he may be at a higher risk of coronary heart disease, Graham decided to seek knowledge and information about risk factors to his health. Armed with this, he has made important lifestyle changes (diet and exercise) and importantly, by discussing this with his family, they too have modified their lifestyles, to prevent ill health. NCG 4 reminds us that in addition to genes, other factors (for example diet) can influence the way in which a disease presents.
Content relating to the midwifery competencies in genetics will appear here shortly.
Learning Outcomes for GPs
We have linked this story to the learning outcomes for GPs listed in the Royal College of General Practitioners Curriculum Statement 6 ‘Genetics in Primary Care’, which describes the knowledge, skills and attitudes that a GP requires when relating to patients and families with genetic conditions. Further information on these learning outcomes can be found at: www.rcgp-curriculum.org.uk/PDF/curr_6_Genetics_in_Primary_Care.pdf
Graham was able to research his family background and identify a history of cardiac problems which he divulged to health professionals during consultations, assisting them in making a diagnosis (GP-1c).
Graham has educated himself about cardiac heart disease and the risk factors involved by using information from various sources such as an NHS cardiac rehabilitation course and the BHF, reminding us of the valuable support and information that can be gained from such sources (GP-1i). Whilst the information Graham obtained about his family history was used as part of his own diagnosis, he says it was not followed up with any of his family and says ‘people find out about genetic problems when it is too late to take any meaningful action’. This not only reinforces the importance of GPs being able to take a family history (GP-3b) and assess genetic risk (GP-3d), but also highlights the point that a genetic diagnosis in an individual may have implications for the management of other family members who may ask for a consultation (GP-7c). It is also important for health professionals to be aware that reassurance is the appropriate action for patients at population risk (GP-3f).
Graham has conveyed his findings on cardiac heart disease and his family history to his sons and as a result, they have made lifestyle changes including regular exercise, a healthy diet and smoking cessation. Graham has also adapted his lifestyle and takes statins to control his cholesterol levels. This provides a good example of a genetic condition for which preventative measures exist (GP-4c).
Learning Outcomes for Medical Students
Content relating to the learning outcomes in genetics for medical students will appear here shortly.