Living with Hypercholesterolemia

A high cholesterol level in the blood (hypercholesterolemia) usually has no signs or symptoms. The only way to know whether or not you have high cholesterol is to have a healthcare professional conduct a blood test to check your cholesterol level. FH may be suspected early in life in those with cardiovascular disease and high cholesterol in the blood.1

 
Desirable Cholesterol Levels2-4

Total cholesterol

Less than 200 mg/dL

Low-density lipoprotein-cholesterol (LDL-C, or “bad cholesterol”)

Less than 100 mg/dL

High-density lipoprotein-cholesterol (HDL-C, or “good cholesterol”)

Greater than or equal to 60 mg/dL

Triglycerides

Less than 150 mg/dL

Patients with FH, particularly the homozygous (more severe) type, have LDL-C levels that are much higher than recommended levels (often over 400 mg/dL). As a result, they are at much greater risk for cardiovascular events and their levels are more difficult to manage.

Although cholesterol numbers are important, they are just part of the overall health picture. It is important to consider family history, age, gender, and other lifestyle or health factors, such as smoking, that can increase your risk for high cholesterol.

Common conditions, comorbidities, and behaviors associated with hypercholesterolemia include5:

  • Type 2 diabetes, which lowers high-density lipoprotein-cholesterol (HDL-C, or “good cholesterol”) levels and raises low-density lipoprotein-cholesterol (LDL-C, or “bad cholesterol”) levels; this combination increases the risk of heart disease and stroke
  • Obesity, which is linked to higher triglyceride levels, higher LDL-cholesterol levels, and lower HDL-cholesterol levels and can also lead to heart disease, high blood pressure, and diabetes
  • Eating a diet high in saturated fat and trans fat, which may contribute to high cholesterol and related conditions, such as heart disease
  • Not getting enough physical activity, which can contribute to weight gain and can lead to high cholesterol
  • Smoking, which damages blood vessels, making them more likely to collect fatty deposits, and may also lower HDL-C levels

If you have high cholesterol – even FH – you are not alone. In many cases, high cholesterol is preventable and treatable. Adopting a healthy diet, getting regular exercise, and, in some cases, taking medications—statins, ezetimibe, PCSK9 inhibitors, etc—can go a long way to help lower your cholesterol and protect your heart.6 In other cases, such as homozygous FH, control of LDL-C is more difficult and requires much earlier intervention. Fortunately, new agents such as the ANGPTL3 inhibitor evinacumab, have been released or are being studied for this difficult-to-treat population.7

It is essential to work closely with your healthcare professional to develop a plan to address your high cholesterol.

References

  1. Ose L. National Lipid Association (NLA). Familial Hypercholesterolemia. An Educational Booklet for Patients with Familial Hypercholesterolemia. Accessed March 25, 2021. http://nlaresourcecenter.lipidjournal.com/Content/PDFs/FA-Patient-Book-English.pdf
  2. Centers for Disease Control and Prevention (CDC). Getting your cholesterol checked. Reviewed September 8, 2020. Accessed March 25, 2021. cdc.gov/cholesterol/cholesterol_screening.htm
  3. Grundy SM, Stone NJ, Bailey AL, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/
    AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e285-e350.
  4. US Department of Health and Human Services (HHS). My Get your cholesterol checked. Updated October 15, 2020. Accessed March 25, 2021. https://healthfinder.gov/healthtopics/category/doctor-visits/screening-tests/get-your-cholesterol-checked
  5. Centers for Disease Control and Prevention (CDC). Knowing your risk for high cholesterol. Reviewed January 31, 2020. Accessed March 25, 2021. cdc.gov/cholesterol/risk_factors.htm
  6. American College of Cardiology (ACC) CardioSmart. High cholesterol. Last Edited November 30, 2018. Accessed March 25, 2021. www.cardiosmart.org/Heart-Conditions/High-Cholesterol
  7. Regeneron [press release]. FDA Approves First-in-class Evkeeza™ (evinacumab-dgnb) for Patients with Ultra-rare Inherited Form of High Cholesterol. Published February 11, 2021. https://investor.regeneron.com/news-releases/news-release-details/fda-approves-first-class-evkeezatm-evinacumab-dgnb-patients
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