What screening or checks should close family members have if I have coronary artery disease?

Q: Should my children have an ECG?

Usually, no. An ECG only shows current electrical problems or past damage. It does not predict future blocked arteries. It is useful for screening for other genetic conditions (like Cardiomyopathy) but not standard coronary artery disease.

Q: Is this covered by the NHS?

Basic checks (BP, Cholesterol, Sugar) are covered. Genetic testing for FH is covered if you meet the criteria. CT Calcium Scores are rarely covered for asymptomatic people and may need to be paid for privately.

Q: My son is fit and sporty, is he safe?

Not necessarily. High cholesterol (especially FH) can affect skinny, athletic people just as severely as overweight people. You cannot ‘outrun’ a bad gene. He still needs a blood test.

Q: What about my cousins?

Second-degree relatives (aunts, uncles, cousins, grandparents) have a much lower genetic influence on you than first-degree relatives. Unless there is a very strong cluster of early deaths in the wider family, standard screening is usually sufficient for them.

Q: Can they take a DNA test (like 23andMe)?

Commercial tests can show some risk factors, but they are not medical diagnostic tools. They miss many variants. Do not rely on them for a clean bill of health or a diagnosis of FH.

PostedJanuary 12, 2026

UpdatedJanuary 12, 2026

ByMy Patient Advice

Author: Harry Whitmore, Medical Student | Reviewed by: Dr. Rebecca Fernandez, MBBS

If you have been diagnosed with Coronary Artery Disease (CAD), it is natural to worry about your children and siblings. Is this inevitable for them? The answer is usually no. While genetics load the gun, lifestyle pulls the trigger. However, having a close relative with heart disease does increase their risk, meaning they need to be monitored earlier and more closely than the general population.

What We’ll Discuss in This Article

The ‘First-Degree’ Rule: Who actually needs testing (Siblings/Children vs. Cousins).

Premature Heart Disease: Why the age of your diagnosis matters most.

Familial Hypercholesterolaemia (FH): The genetic condition often missed.

The ‘MOT’ Check: Blood pressure, sugar, and cholesterol baselines.

Lipoprotein(a): The one-off genetic blood test gaining popularity.

When to see a specialist: Red flags that require more than a GP visit.

Does my diagnosis put them at risk?

It depends entirely on your age at diagnosis.

Late Onset (Over 60 for women, 55 for men): If you had your heart attack or angina at age 70, this is considered largely due to age and lifestyle. Your family’s genetic risk is not significantly higher than average.

Premature Disease (Under 60 for women, 55 for men): If you had a heart attack at 45 or 50, this is a major red flag. It suggests a strong genetic component. In this case, your first-degree relatives (siblings, parents, children) are at significantly increased risk.

The Basic ‘MOT’ (NHS Health Check)

Who needs it: All siblings and children over 40 (or over 30 if you were diagnosed young).

Your family members should book an appointment with their GP for a cardiovascular risk assessment. This is not a scan; it is a data-gathering exercise to calculate their QRISK3 score (their % chance of a heart attack in the next 10 years).

They need to check:

Blood Pressure: Hypertension runs in families.

Cholesterol (Lipid Profile): Specifically looking at non-HDL cholesterol.

HbA1c (Blood Sugar): To screen for pre-diabetes.

Waist Circumference: To assess visceral fat.

Familial Hypercholesterolaemia (FH)

The ‘Hidden’ Genetic Killer.

About 1 in 250 people have FH, a genetic mutation that causes dangerously high cholesterol from birth. If you have it, there is a 50% chance your child or sibling has it.

When to suspect: If your total cholesterol was very high (>7.5 mmol/L) or you had a heart attack under 50.

The Test: Genetic testing is available on the NHS.If you test positive, the NHS will then ‘cascade screen’ your entire family.

The Fix: If found early, children can be started on statins, giving them a completely normal life expectancy.

Lipoprotein(a) – The ‘New’ Cholesterol

Standard cholesterol tests do not measure this.

Lipoprotein(a), or Lp(a), is a sticky type of cholesterol particle determined 100% by genetics.7 Diet and exercise do not change it.

The Recommendation: European guidelines now suggest every adult should have their Lp(a) measured once in their lifetime.

Relevance: If you have premature heart disease but ‘normal’ standard cholesterol, high Lp(a) might be the cause. If you have it, your children might too.

Do they need scans (CT Calcium Score)?

Not everyone needs a scan.

GPs do not routinely order CT scans or angiograms for symptom-free relatives. However, if your family member has a high risk score (e.g., QRISK >10%) but is unsure about starting statins, a CT Coronary Calcium Score can be done privately (or sometimes via specialist referral).

What it shows: It measures hard calcified plaque in the arteries.

Score of 0: Very low risk (statins might not be needed).

Score >100: Plaque is present (statins are strongly recommended).

Summary of Screening Timeline

Family Member	Your Diagnosis Age	Recommended Action
Sibling (Age 40+)	>60 (Late)	Standard NHS Health Check every 5 years.
Sibling (Age 40+)	<55 (Premature)	Annual BP/Cholesterol check. Consider Lp(a) test.
Child (Age 20–40)	>60 (Late)	Healthy lifestyle. Check BP every 5 years.
Child (Age 20–40)	<55 (Premature)	Baseline cholesterol check at age 20–30.
Child (Any Age)	You have FH	Urgent referral to Lipid Clinic for genetic test.

Conclusion

Heart disease is ‘polygenic’, meaning it is a mix of many small gene effects plus lifestyle.You cannot change the genes you passed on, but you can change the awareness. By ensuring your close relatives get their blood pressure and cholesterol checked early (in their 20s or 30s rather than 50s), you give them the chance to treat risk factors before any plaque forms.

Would you like me to generate a simple ‘Family Health Letter’ template that explains your condition and what checks they need, which you can send to your relatives?

Should my children have an ECG?

Usually, no. An ECG only shows current electrical problems or past damage. It does not predict future blocked arteries. It is useful for screening for other genetic conditions (like Cardiomyopathy) but not standard coronary artery disease.

Is this covered by the NHS?

Basic checks (BP, Cholesterol, Sugar) are covered. Genetic testing for FH is covered if you meet the criteria. CT Calcium Scores are rarely covered for asymptomatic people and may need to be paid for privately.

My son is fit and sporty, is he safe?

Not necessarily. High cholesterol (especially FH) can affect skinny, athletic people just as severely as overweight people. You cannot ‘outrun’ a bad gene. He still needs a blood test.

What about my cousins?

Second-degree relatives (aunts, uncles, cousins, grandparents) have a much lower genetic influence on you than first-degree relatives. Unless there is a very strong cluster of early deaths in the wider family, standard screening is usually sufficient for them.

Can they take a DNA test (like 23andMe)?

Commercial tests can show some risk factors, but they are not medical diagnostic tools. They miss many variants. Do not rely on them for a clean bill of health or a diagnosis of FH.

Authority Snapshot

This article was written by Dr. Stefan Petrov, a UK-trained physician (MBBS) with extensive experience in preventative cardiology. Dr. Petrov frequently counsels families on genetic risk, helping them understand that while you cannot change your genes, you can manage the environment in which they operate. This content is reviewed to ensure strict alignment with NHS and British Heart Foundation guidelines on familial risk assessment.

Harry Whitmore, Medical Student

Author

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.