High cholesterol can be inherited. Here’s what you can do about it
Experts estimate that 1 in 250 people have a genetic form of high cholesterol called familial hypercholesterolemia—and that 70 percent or more may be undiagnosed.
Most people associate high cholesterol with an unhealthy diet and a sedentary lifestyle—a condition that develops over many years and you only need to worry about as you get older.
However, this isn’t always the case. For some, high cholesterol isn’t the result of their habits, but rather their genetics—a disease called familial hypercholesterolemia (FH).
“In this condition, people have a genetic mutation that causes high LDL cholesterol levels in a lifelong manner,” says Ashish Sarraju, a preventive cardiologist at the Cleveland Clinic. The U.S. Centers for Disease Control and Prevention reports that 1 in 250 people have FH. Sarraju estimates that 70 percent or more of them may be undiagnosed—while some research suggests the number is upward of 90 percent.
Recognizing the signs and symptoms of high cholesterol is crucial so you can take steps to manage it. National Geographic spoke with three cardiologists to explain what you need to know about inherited high cholesterol.
What is cholesterol—and what makes it so dangerous?
Cholesterol is a fatty, waxy compound that every cell in our body needs multiple doses of every day to function, according to Stephen Kopecky, a cardiologist at the Mayo Clinic and author of Live Younger Longer.
“Our cell walls are made of cholesterol, our hormones use cholesterol to be made,” Kopecky says. “A human adult has about 30 trillion cells in their body. And basically, every one of them needs tens of thousands of doses of cholesterol a day. So there’s a huge amount of cholesterol going around our body—and it’s essential.”
To transport cholesterol around your body to your cells, it’s packaged in particles called lipoproteins, according to Gregory Katz, a cardiologist at NYU Langone Health.
Most people have heard of “good cholesterol” (high-density lipoprotein, or HDL) and “bad cholesterol” (low-density lipoprotein, or LDL), which everyone has in their body. But cholesterol itself isn’t good or bad, Katz explains—the term refers to how the cholesterol is packaged and how it’s being transported around the body.
HDL cholesterol carries LDL cholesterol away from your arteries and into your liver, where it’s then broken down and excreted, according to the American Heart Association (AHA). But if there are too many LDL lipoproteins floating around, they can get stuck in the walls of your arteries and cause inflammation. And the artery wall isn’t made to be a storage receptacle for cholesterol—it’s a foreign substance, Kopecky says.
“Think of a splinter in your hand—it turns red, it turns hot. It’s the same thing with the cholesterol in your artery wall,” Kopecky says. “Your artery wall gets warmer because the body sends white blood cells in there to get rid of it. And as it does that, it can tear the lining of the artery. And if it tears the lining, it can expose the blood beneath it. And the blood thinks, ‘Oh my god, our whole artery is torn through, let’s clot.’ And when it clots, that’s what causes a heart attack or stroke.”