HOW TO AVOID THE ILLNESSES THAT YOUR PARENTS SUFFERED FROM
Whenever I speak to my father, Lawrence, who’s 83, he’s keen to share how well he’s doing in managing his chronic health conditions. “The diabetes nurse is pleased with me,” he says. “And my cholesterol numbers are very good.”
Of course, I’m delighted for my dad’s continuing good health. But Dad probably wouldn’t be in such fine fettle without the large haul of drugs he collects from the chemist every month: a medicine cabinet of statins (for high cholesterol), blood pressure medication and insulin, which he now needs to keep his type 2 diabetes under control.
Type 2 diabetes, high blood pressure, and raised cholesterol – often known as “metabolic syndrome” when they appear together – significantly increase the risk of serious health problems such as heart attacks, strokes, kidney disease and vascular dementia.
Dad is far from unusual in his medical status. We are an ageing nation, so it should come as no surprise that these conditions are becoming more common.
According to NHS England, 60 percent of people over 65 have high blood pressure. There are no exact figures for type 2 diabetes, but it’s on the rise, and a million people are thought to go undiagnosed. The research project, Our Future Health, found that 67 per cent of people in their 50s have raised cholesterol – though this starts to decline in older generations, possibly because so many of them are on statins.
Dad, a retired dentist, didn’t always have these conditions. They developed as he aged, “probably in my 50s or early 60s,” he says.
Which inevitably leads to the question: as my father’s daughter, am I destined to also develop these conditions, and raise my own risk of serious disease, later in life? Is my younger brother; are our children? And are you, Telegraph readers, destined to follow the path of your own mothers and fathers?
Fortunately, I already have some knowledge of my own health status. I feel fit and healthy, but recent blood tests did show that I was one “notch” below pre-diabetes, the condition which is the precursor to type 2 diabetes. My cholesterol – particularly the “bad” LDL cholesterol – was also revealed to be somewhat higher than it should.
But the good news for everyone is that we have the power to maintain our health as we get older. Many of these chronic conditions are preventable – it’s all about how we modify our lifestyles to reduce our risks of eventually developing them. This is something I personally have started to do, with some success, by examining my diet and stepping up my exercise. I aim to continue.
“While some links are understood more than others, it’s true that certain diseases are caused by genetic factors, which you cannot change,” says Dr Joanna Hayman, a GP and director of primary care at the Circle Health Group.
With regards to my father’s high cholesterol, for example, she says this might be due to a condition called familial hypercholesterolaemia, which is caused by a faulty gene.
“How badly you are affected depends on how you modify your lifestyle, and with this, knowledge is power,” says Dr Hayman. “When it comes to safeguarding your future health, it’s never too early to start.”
Which of the four major diseases of ageing are ‘heritable’?
Type 2 diabetes
Dr Abbi Lulsegged, a consultant endocrinologist and general physician who practises at the Sloane Hospital in Beckenham, says: “If one of your parents had type 2 diabetes, you have a 40 per cent risk of developing it. If both had the condition, your risk is 70 per cent.”
Lifestyle modifications (see below) can be very successful in lowering your risk of type 2 diabetes. “It’s really important to catch it early,” says Dr Lulsegged. “If people discover they have pre-diabetes, they tend to be motivated not to move to full diabetes. My job as a doctor is to empower my patients with advice. We tend to talk about type 2 diabetes going into remission, rather than resolving it.”
Heart disease
According to a 2016 review in the World Journal of Cardiology, a family history of myocardial infarction or heart attack can raise your risk of cardiovascular disease by 50 to 60 per cent. But, while genetics are important, non-genetic factors such as smoking, diet, and the control of your cholesterol and blood pressure levels remain crucial.
Cancer
The inheritability of cancers varies widely. “Some cancers have a very strong genetic component, such as the BRCA gene mutation,” says Dr Lulsegged. The BRCA genes, specifically BRCA1 and BRCA2, normally protect against cancer by repairing DNA, but a mutation or “faulty” version can increase the risk of breast, ovarian and prostate cancer.
A parent with a mutation has a 50 per cent chance of passing it to each child. Even without the BRCA gene mutation, some prostate, breast, colon and lung cancers can be inherited.
Dementia (including Alzheimer’s disease)
“Only around one in 100 cases are caused by faulty genes,” according to the Alzheimer’s Society. “Most dementias are not directly caused by genes we inherit from our parents.” In the majority of cases, the disease results from the interplay of multiple risk factors: your genes, as well as your vascular health, age, lifestyle and environment.
How do you find out your risk?
If your parents are still around, the first place to start is by asking them. “Knowing your family medical history – especially your parents’ and grandparents’ – is vital in understanding your own risk in developing these conditions,” says Dr Lelsegged. “The older generation used to see these types of questions as ‘private’, but this attitude is thankfully changing.”
Dr Hayman agrees. “Younger people tend to have no problem talking about their health, but older people can be more sensitive. For example, for a long time, people thought that saying the word ‘cancer’ would manifest the thing itself.”
How should you approach the subject with a parent who isn’t used to openness? “Tell your relative that you aren’t trying to be intrusive, but that the knowledge will help improve the health of you, your siblings, and also their grandchildren,” says Dr Lulsegged. This approach works on my father, who shared his generation’s hesitance when talking about his medical issues.
What tests should you have?
Your over 40s health check
This NHS check test – offered by your GP practice every five years for people aged between 40 to 74 – is probably the best way of picking up signs of the early onset of chronic conditions. “Forty isn’t considered old, and people don’t think they need a check-up,” says Dr Hayman. “The fact is, if your results are good, it’s important for reassurance: it’s always nice to hear you are doing the right thing.”
Probably the most reliable overall view of your health is an algorithm called the QRISK, a number which suggests your risk of a cardiac “event”, such as a heart attack or stroke in the next 10 years.
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A low QRISK score (less than 10 per cent) means that a person has less than a one in 10 chance of having a stroke or heart attack in the next 10 years, while a higher QRISK score (more than 20 per cent) means that you have at least a two in 10 chance of having an event in the next 10 years.
Depending on your QRISK score, you’ll be offered advice on how to change your lifestyle – and possibly medication, which could stop any condition becoming more serious. This check is also a way of picking up high cholesterol.
I had my last NHS health check at the age of 54, around three years ago, and followed it up with a private screening last year.
A health professional measured my blood pressure, cholesterol, height, weight and waist circumference, and asked questions about smoking, alcohol consumption and exercise. These were then put into a computer, which then worked out my QRISK.
When I had my last check, my blood pressure was fine and my blood sugar was in the normal range, but towards the higher end. More of a cause of concern was my LDL (bad) cholesterol, which has started to rise.
I’ll need to keep an eye on all these things. My overall number was nine – in the safe zone – but only just. Because of my cholesterol readings I may have to go onto statins to lower my LDL at some point before I’m 60.
What else is advised?
Attend all your screening appointments
This includes “mammogram and cervical smear [tests],” says Dr Hayman. If multiple close relatives have had breast or ovarian cancer, especially at a young age, or a history or certain other cancers such as sarcoma before the age of 45, you might have the BRCA gene mutation in your family.
To confirm, speak to your GP, who can refer you to a genetic specialist to discuss your family history and determine if genetic testing is appropriate. BRCA-positive women often opt to have a precautionary mastectomy, or have their ovaries removed. It sounds dramatic but can literally be life-saving.
All UK residents are also sent a bowel cancer test through the post when they turn 50.
I’m up to date on my screenings, and thank goodness there’s no history of early breast or ovarian cancer in my family.
Don’t smoke; do practise sun safety
Thankfully, neither I nor anyone in my close family has been a smoker. While my dad hasn’t always been careful with his skin on the golf course, since my sun-soaked 20s, I’ve covered up or worn good sun protection.
The official advice is to wear a minimum of SPF 30 in the UK and SPF 50 abroad (and ideally SPF 50 in the UK on a hot day). Make sure your sun cream protects against UVA and UVB rays. The NHS offers smoking-cessation programmes.
Keep a healthy weight
“After not smoking, the most important thing you can do is keep a healthy weight,” says Dr Hayman. “It can be hard to stay in the suggested 21-25 BMI range, but eating fruit and vegetables, being aware of your calories, and exercising will reduce your risk of diabetes, high blood pressure, stroke and cancer.”
For years, the BMI (your weight in kilograms divided by your height in meters squared) was a way of determining a healthy weight. But a newer school of thought is that the way you carry your weight is more important for future health.
According to Dr Margaret Ashwell, a biochemist and past president of the Association for Nutrition, the most important measurement is your waist-to-height ratio: a person’s waist circumference divided by their height.
A too-large waist is a marker that you might have visceral fat, which wraps around your organs and raises the risk of certain conditions. “It’s long been known that central obesity raises the risk of heart disease, type 2 diabetes and strokes,” says Dr Ashwell.”
You can find your Body Roundness Index (BRI) by measuring your waist circumference (just above the belly button) and divide this by your height. The general guidance is that a waist-to-height ratio between 0.4 and 0.49 is considered healthy.
In this department, I know that I have to take care. Despite being slim and athletic all my life, I put on weight while taking antidepressant medication around 10 years ago. I’m halfway back to my “fighting weight”, but my BMI is an “overweight” 29 (“obesity” starts at 30) and I need to watch the weight around my middle.
Exercise
Keeping active lowers the risk of all chronic illnesses and I’m happy to say I tick the boxes here.
The British Heart Foundation (BHF) recommends that adults aim for at least 150 minutes of moderate-intensity exercise per week, spread over several days. This is equivalent to about 30 minutes, five days a week. You should also include muscle-strengthening activities, like resistance training or carrying heavy shopping, at least two days a week.
I do an hour’s boxing and resistance training a week, march through my local woods for an hour every day, and haul my shopping home on my back, up two flights of stairs to my flat.
Choose your activities wisely though: “Head injury can increase the risk of dementia,” says Dr Lulsegged, so take care if playing a contact sport like rugby. “Plus, always wear a seatbelt in a car.”
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Undergo genetic testing, if necessary
Some private providers are increasingly offering genetic tests for inherited conditions. “A test such as Trucheck looks at your individual DNA to determine the risks of certain cancers,” says Dr Hayman. “But these tests tend to be expensive.”
Genetic testing for dementia remains controversial, unreliable, and is not routinely recommended: there still aren’t any effective drugs for dementia so there is little you can do. However, testing can occasionally be worthwhile within families with a history of early-onset versions of the disease, so that they can prepare for a difficult eventuality.
2025-12-03T08:05:48Z