Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. Unfortunately for people with the genetic disorder Familial Hypercholesterolemia (FH), lowering cholesterol naturally is not enough. Medical treatment and medication, or a combination of medications, are necessary to manage the dangerously high cholesterol levels that put these patients at risk for early and aggressive heart disease.

Cholesterol and the Body

Our bodies have a complicated relationship with cholesterol. Cholesterol does important work, including helping to develop the membranes of cells, composing bile, which digests food in the intestines, and allowing the body to make Vitamin D and vital hormones, including estrogen and testosterone (source: Harvard Medical School Guide to Lowering Your Cholesterol). In fact, cholesterol is so important that much of the cholesterol in our blood doesn’t come from the food we eat; it is produced by cells in the body. The liver is responsible for synthesizing and removing cholesterol, making it central to cholesterol level regulation.

As important as cholesterol is for us, it can’t float loosely in our blood. In order to be transported throughout the body, it needs to be packaged in particles called lipoproteins. High-density lipoproteins (HDL) are often called “good” cholesterol, while low-density lipoproteins (LDL) are referred to as “bad” cholesterol because they can deposit on and cluster in the blood vessels and block the arteries, a dangerous situation that can lead to a heart attack or stroke.

The Challenge of FH

For people who don’t have FH, high cholesterol is often the result of unhealthy lifestyle choices. Lowering cholesterol naturally by eating a healthy diet, exercising regularly, not smoking and limiting exposure to secondhand smoke is often the only treatment they need.

In patients with FH, the same approach of lowering cholesterol naturally is helpful, but is not enough. Their genetic condition makes the liver incapable of removing excess LDL. This causes their LDL cholesterol levels to be three to six times higher than normal. Because these cholesterol readings are so excessive and the cause is genetic, lifestyle modifications can’t lower them enough to fall within a safe range.

When Lowering Cholesterol Naturally Isn’t Enough

As important as it is for FH patients to live a healthy lifestyle and to do all they can to work on lowering cholesterol naturally through diet, exercise and avoiding tobacco smoke, most of them will find themselves on medication therapy. Although statin medications are the mainstay, an FH patient typically is treated with a combination of medications, in which each one has a different role and complements the others. Commonly prescribed cholesterol-lowering drugs include:

• Statins, which inhibit the liver’s production of the enzyme responsible for making cholesterol
• Cholesterol absorbers and bile acid sequestrants, which decrease and prevent cholesterol absorption in the intestine

New clinical research trials will hopefully set precedence for newer or different cholesterol-lowering medications in the future. If you have FH, consult an FH Specialist about the right treatment options and medication combinations for you.

For more information about FH and how to treat it, contact theFamily Heart Foundation, a patient-centered non-profit organization dedicated to education, advocacy and research, at (626) 465-1234 or visit their website at https://familyheart.org/.