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High Cholesterol, Family Style

Familial hypercholesterolemia – unfortunately, it may be all in the family

By Steve Milano, Tribune Brand Publishing

If you’re close to your parents, chances are there are many things they’ve passed on to you that you’ve taken to heart — and possibly one you hope they haven’t.

If you’ve got poor blood cholesterol levels and you and your doctor have struggled to control them, you might have familial hypercholesterolemia (FH), which is passed from parents to children. Your ethnicity can also increase your chances of inheriting the condition, with South African Ashkenazi Jews, Christian Lebanese, French Canadians among those at increased risk.

FH causes high levels of LDL (low-density lipoproteins, or “bad” cholesterol) in the blood, which leads to severely elevated risk for coronary heart disease. It affects people from birth and can cause early heart attacks (before age 40). Often, FH patients don’t respond adequately to common cholesterol treatments and remedies.

FH affects about one in 200 to 300 people, and according to the FH Foundation is one of the most underdiagnosed and undertreated diseases of the 21st century. As many as 90 percent of people with FH don’t know they have it. You can inherit a mutation in one or more of three key cholesterol controlling genes from your mother, father or both, explains Dr. Seth J. Baum, nationally recognized cholesterol expert and founder of Preventive Cardiology in Boca Raton, Florida. “Most people with FH receive the disorder from only one parent. If you receive genetic mutations from both parents, which is very rare, you might have a far more difficult time dealing with the condition,” says Dr. Baum, who serves on the FH Foundation board of directors.

According to the National Institutes of Health, physical signs in severe FH cases can include fatty skin deposits on your hands, elbows, knees, ankles and eyes; cholesterol deposits on your eyelids and around your cornea; and chest pain — even at a young age.

Work with your doctor

If you’ve been struggling to deal with your cholesterol levels or suspect a family member or friend may have a problem, contact your doctor to determine if you have FH. Your doctor can give you a thorough evaluation to look for physical and familial warning signs. Your family health history can be an indicator of FH, such as whether relatives suffer early onset heart disease and have consistently high LDL levels.

Your doctor might prescribe a number of lifestyle and behavior changes to deal with the condition, including, but not limited to:

  • Reducing your intake of saturated fats (found primarily in animal products)
  • Cutting back on foods with high levels of cholesterol and saturated fat, such as eggs and certain cuts of meats and poultry
  • Taking a high-potency fish oil supplement
  •  Adding regular aerobic and resistance exercise to your weekly routine If these steps don’t help after several months, your doctor will likely prescribe medicines, including statins, to treat the condition. This can be a problem for women planning to become pregnant, who will need to stop these medicines even though cholesterol levels often rise as much as 50 percent during pregnancy.

Visiting a specialist

If the remedies your doctor recommends don’t work, you might need to consult with a lipid (cholesterol) specialist for LDL apheresis or other more specialized and appropriate medication therapy. LDL apheresis is a well-tolerated every-other-week blood cleansing treatment similar to dialysis (but much less stressful on the body) that takes about two hours, and might reduce your risk for cardiovascular disease by as much as 75 percent.

There are only about 70 LDL apheresis centers in the United States, with Preventive Cardiology being the only one located in Boca Raton, Fla. and all of Southeast Florida.

Share the good news

Undiagnosed and untreated FH can significantly increase the risk of a heart attack before age 40. With early diagnosis, proper diet, regular aerobic exercise and the right treatment, people with FH can decrease their risk for coronary heart disease and lead normal, healthy lives.

Most physicians are not cholesterol experts and many are unfamiliar with FH. If you think you might have FH, talk to your doctor.