Could your high cholesterol be genetically inherited?
One in 200 – those are your odds of having genetically-high cholesterol.
“It is the most common familial autosomal [genetic] disorder,” said Megan A. Titas, MD, a cardiologist with Cape Cod Healthcare Cardiovascular Center in Falmouth and Sandwich.
According to the American Heart Association, familial hypercholesterolemia (FH) is “an inherited defect in how the body recycles LDL, or ‘bad’ cholesterol. People with FH are born with high LDL cholesterol. Everyone’s cholesterol levels tend to rise with age, but those with FH have LDL levels that start high and get higher over time,” she said.
The tricky thing is that only about 10 percent are aware they have FH (which is sometimes called familial hyperlipidemia). Since people are generally not tested for this genetic condition, the best defense is to be aware of your family’s health history, said Dr. Titas.
“The most concerning thing is anyone in your family who’s had a heart attack or a sudden cardiac death at a younger age,” she said. “If it was in their 40s or 50s, whether it’s a parent, sibling or an aunt or uncle, definitely I raise my eyebrows at that. Even if you know some reason why that person had a heart attack at a younger age, such as they were heavy smokers, you should still be screened for a lipid panel and practice a healthy lifestyle.”
People with the FH gene can have serious cardiovascular issues in their 40s, she said. She suggested talking with your primary care provider when you’re in your 20s or 30s, if you have a family history of heart conditions at young ages, so you can be screened for the genetic condition.
“If someone’s LDL is above 190, most of the time we start thinking this person might have familial hyperlipidemia, especially if they have a first-degree family member who has a heart history,” said Dr. Titas. The recommended LDL level is 100 or lower.
Medications and Lifestyle
The good news: people with an FH risk can be treated with medications and lower their risk with lifestyle changes.
“The mainstay of treatment is statin therapy,” said Dr. Titas. “When people have an LDL greater than 190, regardless of age, you should treat that. The longstanding, well-tested treatment is a statin, such as Lipitor or Crestor. They’re safe and widely available.
“Most people tolerate them well. I do have patients who have some problems, and we have some workarounds. Either we change the statin or we lower doses, or we add different medicines that are non-statins. Once you get referred to a cardiologist or a lipid specialist, we have algorithms to help treat this and put people in a safe range.”
The healthy heart lifestyle tips that apply to everyone are especially vital for people with high LDL levels, she said. This includes not smoking, controlling diabetes and staying physically active. Obesity and sleep apnea should also be addressed, she added.
“It’s really a tragedy if somebody dies in their 40s or 50s. It’s vital that they be as healthy as possible and eat a diet that is low in saturated fat, with lots of fruits and vegetables,” Dr. Titas said.
Using untested supplements is not advisable for this condition, she warned. “Side effects can include liver and kidney problems,” she said. “With this disease, we really need to target it with tried-and-true and safe treatments instead of things that could potentially cause other problems.”
