Peter on what to ask when gathering a family medical history

This audio clip is from AMA #15: Real-world case studies, originally released on August 17, 2020.

Family history—Questions to ask and what to look for [5:30]

Is 23andMe data comparable to family history data?

“Actually, that pretty much tells me nothing . . . this stuff doesn’t mean Jack compared to your family history.”
With the 23andME data, you CAN look at things like
- i) TOMM40 gene to assess risk of Alzheimer’s disease, and/or
- ii) FOXO3 — a gene associated with longevity
But the genes Peter thinks are important are things that they measure on their own (e.g., MTHFR, APOE, etc.)

Family history data

Peter gives new patients a large form prior to their first visit
He wants to know everything knowable about mother, father, both sets of grandparents, aunts and uncles, and siblings
Cardiovascular disease, for example—does anybody have a history of cardiovascular disease? Did they take any medication for blood pressure, cholesterol? Did they ever have a stroke, chest pain, heart attack?
Same questions around dementia, cancer, metabolic disease/diabetes
Next, they prod the answers to those questions to understand context:
- You may see a family history full of cancer, but then find out that they all smoked three packs a day
- The patient may have a relative die of a heart attack at 50—Is this a case of LP(a)? Was this person an alcoholic and heavy smoker?

Looking for patterns

The more time you spend gathering data, the more likely you’ll understand what’s really at the root of the genetic template that you inherited
You’re looking for patterns—signature of cancer, dementia, cardiovascular disease
Example —
- About 1 in 10 people show up with an elevated Lp(a), but the number by itself doesn’t tell you how bad of a problem it is
- We know Lp(a) is bad, but is this a big problem or just a medium problem?
- For the patients who have family members with a lot of sub 60 year old cardiovascular events AND elevated Lp(a) — you need to be acting on that in the most aggressive manner
- But maybe you can afford to be less aggressive in the case where families have high Lp(a) but nobody’s having any events until their 80s