Short answer: Yes, you can still lower your risk. Dr. P. K. Asokan said roughly half of coronary artery disease comes from the genes you inherit and half from risk factors you acquire. You can’t change your genes, but controlling BP, sugar, cholesterol, smoking, weight and lifestyle can prevent early heart disease in at least half of people.
“Both my parents had heart disease. Is it already decided for me?”
If your father had a heart attack at 50, or your mother had a bypass in her early fifties, you’ve probably carried this question for years. Some people panic. Others decide it’s fate and do nothing.
So how much does family history really decide, and what is still in your hands?
In our Dil Ke Doubts session on knowing your heart disease risk, Heart Health India Foundation founder Ram Khandelwal, who had his own heart attack at 33, put this to Dr. P. K. Asokan, Vice President of the Cardiological Society of India and Senior Consultant Cardiologist at Fathima Hospital, Calicut.
This article is based on the questions and answers in Dil Ke Doubts Webinar 01 (7 Sep 2026), part of Heart Health India Foundation’s World Heart Month 2026 series with the Cardiological Society of India and the World Heart Federation‘s Don’t Miss a Beat campaign.
Here’s what he told us, in plain words.
Is heart disease in the family written in your genes?
Partly. Dr. Asokan said that, broadly, about 50% of coronary artery disease is acquired and about 50% is genetic.
The acquired half comes from what he called traditional risk factors, such as high BP and diabetes. These usually build up with age and tend to show up in the fifth or sixth decade of life.
The genetic half is different. He said genetic risk is a main cause of premature heart disease, in people under 40 or in their forties. It is carried in your DNA, passes from parents to children, and stays with you for life. Young people with this risk often have no symptoms at all.
When should family history worry you?
Dr. Asokan named two clear warning signs in a family:
- A first-degree relative (your father, mother, brother or sister) who developed heart disease before the age of 55
- A sudden cardiac death in the family
If either applies to you, he said the aim is simple: detect early and treat early.
“Genetics load the gun, risk factors pull the trigger”
This was the line Dr. Asokan used to explain how the two halves work together. Your genes cannot be changed. But a long list of things that fire the trigger can be:
- lifestyle and food habits
- high BP
- obesity
- smoking
- environmental factors, including pollution
He said that if you control these, you can prevent early heart disease and early death in at least 50% of people. He also reminded us that not everyone in a family with heart disease goes on to develop it.
What is familial hypercholesterolaemia, and how do you spot it?
Dr. Asokan singled out one inherited condition: familial hypercholesterolaemia, an inherited form of very high cholesterol. He said it affects about 1 in 500 people.
The clues he gave:
- LDL cholesterol above 190 in an adult
- LDL above 160 in a child
- xanthomas, which are fatty deposits that can show up on the skin or tendons
In these families, he said, doctors often start medicines early, and the LDL target is very low: below 50.
He also stressed that how long your LDL stays high matters. LDL that stays high for decades more than doubles the risk. And he said a family history of heart disease raises the risk at least 2.6 times in men and 2.3 times in women.
My parents had heart disease before 55. What should I do?
An audience member asked exactly this. Dr. Asokan’s answer started with honesty: “You can’t change the genetics.” What you can do, he said, is make a total lifestyle change and control everything else:
- keep your BP under control
- bring LDL below 70, and ideally below 50 if your chance of heart disease is high
- stop smoking completely
He also explained why a check-up matters even when you feel fine. Early blockages, under about 30 to 40%, usually cause no symptoms. He said Asians tend to get heart disease at a younger age, so people with this family history should be investigated thoroughly to see whether heart disease is already present.
At what age should children in these families be checked?
Dr. Asokan said American and European guidance suggests checks from about age 40 for people with no family history.
With a family history, he said the ideal is to start at around 10 years of age, and even earlier if the family history is severe.
What protects your heart, whatever your genes?
Dr. Asokan’s list for everyone, and especially for families with heart disease:
- moderate to vigorous exercise, at least 150 minutes a week
- a diet low in saturated fat
- quitting smoking
- less stress and enough sleep
- controlling weight and salt
- for people at high risk: medicines as advised, diabetes under control, LDL brought down to the optimal level
- regular follow-up with your doctor
What you can do next
- If you have chest pain, breathlessness or sweating right now, don’t wait. Call 112 or go to the nearest hospital. Our guide to recognising heart attack warning signs explains what to watch for.
- Write down your family history: who had heart disease or a sudden death, and at what age. Take it to your next appointment.
- If a parent or sibling had heart disease before 55, ask your doctor: “Should I be checked now, and what should my LDL target be?”
- Know your numbers: BP, sugar and LDL cholesterol. Our guide on why preventive tests matter before symptoms appear explains why.
- Ask about your children: with a strong family history, Dr. Asokan suggested starting checks at around 10.
- Read about another inherited risk in our post on the Lp(a) test, and explore more sessions on our Dil Ke Doubts World Heart Month 2026 page.
Frequently asked questions
Yes. Dr. P. K. Asokan said you can’t change your genes, but controlling BP, LDL cholesterol, smoking, weight and lifestyle can prevent early heart disease in at least half of people.
Dr. Asokan said to be careful if a parent, brother or sister had heart disease before 55, or if someone in the family had a sudden cardiac death.
It is an inherited form of very high cholesterol. Dr. Asokan said it affects about 1 in 500 people; clues include LDL above 190 in adults, above 160 in children, and fatty skin or tendon deposits called xanthomas.
Dr. Asokan said the ideal is to start at around 10 years of age, and earlier if the family history is severe. Ask your child’s doctor which tests are right.
Watch the full session
Dr. Asokan answers these questions in the first part of Dil Ke Doubts Webinar 01, and takes audience questions on family history later in the session.
▶️ Watch the full session: Know Your Heart Disease Risk · Please also Subscribe on YouTube @hearthealthindia.
Dr. P. K. Asokan: “Genetics load the gun, but risk factors pull the trigger.”
Authoritative sources (for further reading)
These links support general education. They do not replace Dr. P. K. Asokan’s words in the session above, and they are not a personal diagnosis.
- NHLBI (NIH) — Coronary heart disease risk factors
- NHS — Familial hypercholesterolaemia
- WHO — Cardiovascular diseases fact sheet
- Cardiological Society of India
About this article
Disclaimer: The medical information in this article is based only on the views shared by the session speaker, Dr. P. K. Asokan. It is for educational purposes only and is not medical advice. Please consult your cardiologist for advice personalised to you. In an emergency, call 112 or go to the nearest hospital immediately. See also our medical disclaimer.
You don’t have to figure this out alone
Heart Health India is a community of patients, families and caregivers learning together, with India’s cardiologists, how to look after our hearts. If heart disease runs in your family and you’re not sure where to start, come ask your questions, share your story, and hear from people who’ve been there.
