How Healthy Is My Heart Genetically?
By Marina Shanafelt MS CNS
Understanding the Role of Genetics in Heart & Vascular Health
You may have a parent, sibling, or grandparent who has suffered from high blood pressure, high cholesterol, or even a heart attack, and it’s natural to wonder, “Am I at risk too?”
While family history can increase your chances of developing heart-related conditions, it doesn’t mean you’re destined for them. Genetics provides a blueprint, one that can show you where you may be more vulnerable, and just as importantly, how to proactively support your heart for the long term.
Can High Blood Pressure Be Genetic?
Certain genes can influence how your body regulates blood pressure.
For example, the ACE gene plays a key role in controlling blood vessel constriction. Some variants can lead to higher levels of the enzyme that tightens your blood vessels, making it harder for blood to flow — which increases blood pressure. This risk can be even greater when combined with a diet high in saturated fats.
Other genes involved in blood pressure regulation, like AGT, AGTR1, and REN, also contribute to how tightly your blood vessels constrict in response to stress, salt intake, and hormone signals.
Genes like ACE2 and ENOS influence blood vessels' ability to relax. Variants in these genes can lead to a loss of balance between constriction and relaxation, another avenue to high blood pressure.
What this means for you: If you carry variants in these genes, your body may be more reactive to dietary salt, stress, or animal fats, but this also gives you clear insight into how to adjust your lifestyle to better support blood pressure control.
What Genes Affect Cholesterol Levels?
Cholesterol isn’t all bad, it’s essential for building cell membranes, making hormones, and absorbing fat-soluble nutrients. But too much of the wrong type, or a poor ability to clear it from the blood, can increase your risk of cardiovascular disease.
Your genes influence how your body processes, transports, and clears cholesterol. Some of the key players include:
- CETP – affects the balance between HDL (“good” cholesterol) and LDL (“bad” cholesterol).
- LPL – helps break down triglyceride-rich lipoproteins. Certain variants can impair this process, leading to higher levels of triglyceride.
- APOA5 and APOC3 – regulate triglyceride metabolism. Some variants are linked to elevated triglycerides and increased cardiovascular risk.
- APOE – plays a major role in lipid transport and clearance. The APOE ε4 variant is associated with higher LDL and total cholesterol, and greater cardiovascular risk.
What this means for you: If you carry gene variants that reduce your ability to manage cholesterol effectively, you may need to be more intentional with your diet, exercise, and possibly supplements to keep your levels in a heart-healthy range.
Is Heart Disease Hereditary?
Heart disease can run in families, but it’s not just about what you inherit; it’s about what you do with that information.
While lifestyle factors like diet, smoking, exercise, and stress play a significant role in heart health, your genetic makeup can provide key insights into how resilient (or sensitive) your cardiovascular system might be.
If you carry multiple variants across heart-related genes (like those affecting blood pressure, cholesterol, inflammation, or blood clotting), your baseline risk may be higher. But with this knowledge, you can take personalized action to offset that risk and improve your long-term health outcomes.