Peter on what to ask when gathering a family medical history

Read Time 2 minutes

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

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Show Notes

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
  • 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
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