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Talking to your doctor about your cholesterol

Most people know that high cholesterol can be a killer, particularly the LDL or “bad” cholesterol that clogs arteries and causes heart attacks. If you receive abnormally high LDL results after a cholesterol check, how should you talk to your doctor about it?

Dr. Josh Knowles, faculty member at the Stanford School of Medicine, and a cholesterol specialist, recommends asking how the problem will be treated, how the results will be  measured, and how long it should take to lower your cholesterol. “You should ask them to explain what the numbers mean,” he says.

Knowles explains that there are general guidelines for cholesterol numbers, but everyone has different risk factors for heart disease, including family history.

Unfortunately, cholesterol management is not as simple as many people think. High cholesterol can’t always be fixed with a Lipitor prescription and a low fat diet.

If your doctor puts you on cholesterol-lowering drugs and they don’t achieve the desired results over time, it could be a red flag that something else is amiss.

For example, there is a genetic mutation called familial hypercholesterolemia, which makes a person resistant to cholesterol lowering drugs. People with FH have a much greater chance of having an early heart attack, according to the FH Foundation.

“FH is vastly underdiagnosed and underappreciated as a cause of heart disease,” Knowles says. “We estimate that fewer than 10 percent of patients who have it have been diagnosed.”

According to the FH Foundation, about 1 in 300 people could have the genetic mutation that causes FH, which they inherit from one parent or both.

FH impacts the way your liver processes cholesterol and its ability to remove it from your blood. There is no cure for FH, but it can be managed.

“The good news is, if we can diagnose it and treat it, patients can live just as long as everybody else,” Knowles says.

There is nothing wrong with asking your doctor about the possibility of your having FH, particularly if you have a relative who has it, or if you or they had a heart attack before age 60.

If your doctor is unfamiliar with FH, you can seek out a local specialist through the FH Foundation at thefhfoundation.com.

“FH should be suspected if LDL cholesterol is over 190 in untreated patients,” Knowles says. “They should be examined for FH and aggressively treated. It should also trigger the screening of all relatives of the patient. If they are not identified, they are like ticking time bombs.”

Neweleen Feldmar, 64, of Highland Beach, is someone who did not get the proper diagnosis and treatment of her cholesterol and her FH until it was almost too late.

“When I was 35 years old I had blood work done at a company I worked for and my cholesterol was 387, but they never told me what to do about it,” she says. (240 is twice the risk of the desirable level, according to the American Heart Association.)

“Even when I was diagnosed with breast cancer at 48, no one ever mentioned cholesterol. Finally, when I was 50, I had a checkup and was told I had a cholesterol problem. I was put on Lipitor, but found out I was allergic to statin drugs. Then I had a heart attack in 2010 resulting in a triple bypass. The cardiologist put me on Zocor. Every visit he kept increasing the amount with little result.”

Eventually, Feldmar heard about Dr. Seth Baum, a cholesterol and FH specialist in Boca Raton, Florida. He diagnosed Feldmar with FH and began treating her with a combination of drugs, fish oil supplements and apheresis—a process that cleans the blood of LDL cholesterol in a dialysis-type treatment.

It is working for her. “I was in the hospital six times last year and have not been admitted at all this year,” Feldmar says. “I try to eat properly, and I take a fish oil supplement. I have apheresis every two weeks. And I’ve worked with a nurse practitioner to lose 28 pounds, with 40 more to go.”

As Feldmar found out, asking questions and finding the right doctor to treat her cholesterol made all the difference and saved her life and possibly the lives of her children, two of whom have high cholesterol. She now volunteers part time for the FH Foundation as a patient advocate.

She recently attended a gathering for FH patients and, sadly, was one of the oldest ones there. “One man was diagnosed at 6 years old,” Feldmar says. “When you’re young, you can do something about it.”

Knowles points out that the U.S. Preventive Services Task Force recommends that all adults have their cholesterol checked at age 20 if they have risk factors for heart disease, such as a family history. If they don’t have other risk factors, the Task Force recommends, men have their cholesterol checked by age 35, and women by age 45. In addition, The American Academy of Pediatrics recommends every child age 8-11 get a baseline cholesterol check. This is partly because FH is starting to be more widely recognized, and starts in the womb, Knowles says. According to Dr. Baum, The National Lipid Association recommends that everyone have their cholesterol checked by age eleven. For family members of FH patients, the suggestion is more stringent; such children should be checked at two years old.

“This is a winnable battle,” Knowles says. “If doctors look for it, they’ll find it.”

— By Lisa Jevens, Tribune Brand Publishing