17 Detecting FH Many people with FH don’t know they have it. Instead, they (and their doctors) often think they just have tough-to-treat high cholesterol. Your doctor might want to work you up for FH if you have one or more of the following: ■■ total cholesterol above 300 mg/dL (250 mg/dL in children) ■■ LDL above 200 mg/dL (150 mg/dL in children) ■■ early heart disease or very high cholesterol in your immediate family (a father or brother under age 55, a mother or sister under age 65) ■■ cholesterol deposits in the Achilles or other tendons. Treating FH Cholesterol control is the centerpiece of coping with FH. It starts with diet, exercise, and lifestyle changes, then extends to cholesterol-reducing drugs. Cutting back on foods rich in cholesterol and saturated fat, such as red meat and full-fat dairy products, helps lower LDL. So does eating fish, whole grains, vegetables, and vegetable oils — all good sources of unsaturated fats. Other cholesterol-cutting foods include beans, oats, soy protein, nuts, and foods or supplements containing plant sterols or stanols. Controlling blood pressure, exercising, and not smoking are also essential for protecting the heart and blood vessels. A cholesterol-lowering statin is the usual starting point for drug therapy. Adding a drug such as ezetimibe (Zetia), niacin, or colesevelam (WelChol) can cut LDL even further. The goal is an LDL under 100 mg/ dL or, if that’s not possible, at least a 50% reduction. VIDEO CDC Expert Commentary on FH People with homozygous FH don’t benefit much from statins and other drugs, which work in part by increasing the body’s production of LDL receptors. They periodically need LDL apheresis, a dialysis-like procedure to filter LDL out of the bloodstream. Alerting others “As the name indicates, familial hypercholesterolemia is a family problem,” cautions Dr. Paul N. Hopkins, a professor of internal medicine at the University of Utah and an expert on this disorder. If you have FH, it’s important that your family members be tested for it, too. Children of a parent with heterozygous FH have a 50% chance of inheriting the defective gene; it’s 100% if a parent has homozygous FH. Early testing, followed by aggressive cholesterol control, can delay or prevent the early heart attacks and death that often accompany FH. More information on FH is available from Make Early Diagnosis to Prevent Early Deaths (www.medped.org), a registry and information center hosted by the University of Utah.
P750-A 7 Steps to a Healthy Heart
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