High Cholesterol Can Be Genetic—Here’s How To Know if That’s the Case for You
Heart disease has long been the leading cause of death for U.S. adults, according to the American Heart Association, and one of the top risk factors for heart disease is high cholesterol.
When a person has high cholesterol that isn't treated, there's a higher likelihood that "the cholesterol will get into your blood vessels and create cholesterol plaques, ultimately leading to a heart attack," says Dr. Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.
Diet and exercise are commonly recommended ways to keep cholesterol levels in check, but Dr. Ni says genetics can play a role. Unlike eating nourishing foods, you cannot control your gene pool.
"Having a very high cholesterol can indicate a genetic predisposition for heart disease. In that case, your risk for heart disease is increased 20-fold," Dr. Ni says.
The American Heart Association reports that about 1.3 million adults and children in the U.S. are living with familial hypercholesterolemia, which is an inherited issue that affects how the body recycles LDL cholesterol. However, only 10% of people know they have it, and that's a problem for a heart disease risk factor that Dr. Ni says is already considered "silent." When flagged, this genetic high cholesterol is treatable. Dr. Ni says he is looking for a No. 1 warning sign for genetic high cholesterol (spoiler alert: It will involve a trip to the doctor).
How To Know if Your High Cholesterol Is Genetic
High cholesterol is hard to self-diagnose. "Cholesterol is a silent risk factor, so there are no symptoms or signs of high cholesterol," Dr. Ni says. "Rarely, with some inherited cholesterol disorders, there can be some signs of cholesterol deposits in the body, but more likely, the way you will know about high cholesterol is by checking your blood tests regularly."
What are cardiologists looking for when they check your bloodwork? "Cholesterol is considered to be high when the total cholesterol is above 200 mg/dl or the LDL-C is above 100 mg/dl," Dr. Ni says.
Those are a lot of letters and numbers, aren't they? The American Heart Association breaks down what the terms mean:
HDL ("good") cholesterol. HDL cholesterol can protect against heart attacks and strokes.
LDL ("bad") cholesterol. This type of cholesterol increases heart disease risk, and so providers want to see it kept low. Diets high in saturated and trans fat can up LDL cholesterol, but genetics can factor in, too.
Triglycerides. Your body naturally makes triglycerides, a type of fat. You also consume them through food. People with obesity and diabetes and who are on certain medications may have higher triglyceride levels.
Total cholesterol. Add your HDL and LDL levels and tack on 20% of your triglyceride level, and you have your total cholesterol.
Related: 'I Almost Died of a Severe Artery Blockage—This Is the Sign That Saved My Life'
Risks of High Cholesterol
Dr. Ni explains that high cholesterol usually deposits on the walls of blood vessels and builds up as plaque.
"This cholesterol plaque can burst open, causing a sudden heart attack, or it can slowly grow and obstruct the flow of blood over time, leading to a more gradual weakening of the heart," he says.
A 2019 study in the Journal of the American Heart Association found that people with the highest LDL (bad) cholesterol levels were five times more likely to have (an atherosclerotic cardiovascular disease event (like a heart attack) than their peers with optimal LDL cholesterol. As a reminder, no organ operates in a vacuum, and the heart isn't an exception.
"If the cholesterol plaque is in the brain arteries, it can lead to a stroke," Dr. Ni says. "If the cholesterol plaque is in the leg arteries, it can lead to blocked blood flow to the legs, called peripheral artery disease, which leads to leg pain, leg ulcers, and even amputation."
How To Lower Cholesterol
Diet won't solve everything if you have genetically high cholesterol, but Dr. Ni stresses that it's still important to eat as healthy as possible.
"I strongly recommend a heart-healthy diet and weight loss for reducing cholesterol," Dr. Ni says. "From a diet perspective, all animal products have some amount of cholesterol in them. Vegan diets almost always take in zero dietary cholesterol. Short of that, substituting animal protein for plant-based proteins can help."
Plant-based proteins include:
Legumes
Tofu
Tempeh
Beans
Dr. Ni recommends limiting high-cholesterol foods like:
Beef
Pork
Processed meat
Lamb
Shrimp
Shellfish
Egg yolks
However, diet (and exercise, for that matter) alone won't reduce high cholesterol that is genetic to optimal levels. The American Heart Association and Dr. Ni say medications are recommended, typically a statin combined with another drug to lower cholesterol like ezetimibe.
"In instances where arterial blockages are more pronounced, invasive and/or interventional procedures may be recommended," Dr. Ni says.
These include:
Cardiac catheterization, a diagnostic procedure using a catheter to visualize and assess the arteries of the heart and heart chambers used to determine the severity of plaque buildup
Angioplasty, which widens narrowed arteries
Stenting, which involves placing a mesh-like device to keep arteries open
Ultimately, customized care is critical, especially for individuals genetically predisposed to high cholesterol. "This individualized approach ensures that patients receive the most effective and tailored care to manage plaque buildup and enhance their overall heart health," Dr. Ni says.
Up Next:
Sources
Heart Disease and Stroke Statistics - 2024 Update. American Heart Association.
Dr. Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.
What is Familial Hypercholesterolemia? American Heart Association.
What Your Cholesterol Levels Mean. American Heart Association.
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