Adam Cohen and Dr. Rod McEver
Here’s a question from a reader:
Following an annual physical a few years ago, my doctor prescribed cholesterol-lowering medication. I’m 35, and rather than take a daily pill, I opted for lifestyle changes. I lost 60 pounds, eat a Mediterranean diet and exercise daily. Yet, at my physical last month, my cholesterol was still high. Can this be genetic? Are there risks to not taking the medication that my doctor (again) prescribed?
—Ryan Thomas, Oklahoma City
Dr. McEver Prescribes
Cholesterol is a waxy, fat-like substance our bodies need as a building block for our cells, to make certain hormones and vitamins and to digest food. Too much cholesterol can pose problems, and though we can often lower it with lifestyle changes, elevated cholesterol can have a genetic component.
According to a 2021 American Heart Association study, nearly 1 in 3 US adults have high cholesterol. Too much cholesterol can cause plaque buildup in arteries. This can lead to heart disease and, eventually, heart attack or stroke.
Natural cholesterol-lowering interventions include weight loss, dietary changes, and increasing physical activity. When you’ve done those things and see little to no change, you’re wise to suspect your issue may be inherited.
Familial hypercholesterolemia is a common genetic disorder that can cause high levels of low-density lipoprotein, often called “bad cholesterol.” People with this condition, often undiagnosed, are at higher risk for heart disease and usually require medication to lower cholesterol to safe levels. Left untreated, the Centers for Disease Control and Prevention estimates that 50% of men with this disorder will have a heart attack before turning 50, and 30% of women by age 60.
Genetic testing for familial hypercholesterolemia is available, but high cholesterol resistant to diet and exercise can occur in those who don’t have mutations on the genes involved in the condition. There may be many genetic variants that work together to elevate cholesterol that aren’t fully understood.
Discuss your concerns about medication with your doctor. If you elect to fill the prescription, you can retest your cholesterol levels in a few months to check your progress and potentially adjust medication levels.
Although your lifestyle changes may not have impacted your cholesterol levels, they will serve you well in many other areas. Keep it up!
McEver, a physician-scientist, is vice president of research at the Oklahoma Medical Research Foundation. Cohen is a marathoner and OMRF’s senior vice president and general counsel. Submit your health questions for them to email@example.com.