Okay, so some things you really are born with. For instance, researchers have found several genetic abnormalities that can lead to high cholesterol and make lowering your cholesterol through lifestyle changes alone difficult, if not impossible.
If this is true for you, you’ll probably need cholesterol-lowering medication. That doesn’t mean you can skip the lifestyle changes, however; the two together work best. The following risk factors fall into the category of things you can’t change.
About 1 in 100 people can chalk up high cholesterol to a genetic basis called familial combined hyperlipidemia (FCHL). Although FCHL has been under study for nearly 30 years, many aspects of it remain a mystery. The disease results from defects in the way the body metabolizes lipoproteins; this leads to high total cholesterol, high triglycerides, or both. People with FCHL also have higher levels of small LDL (low-density lipoprotein) particles — the ones most likely to accumulate in the arteries and cause plaque. If you have FCHL, you’re also more likely to have insulin resistance, which itself is a risk factor for heart attacks.
If you’ve made lifestyle adjustments and don’t see any improvement in your cholesterol, talk to you doctor about genetic testing and the possibility of medication.
Other genetic risks include:
- HPA-2 Met. This gene variation makes blood stickier and more likely to clot. It may also predispose men to a blood clot in the heart. If you have it, there’s nothing you can do about it — all the more reason to attack the risk factors you can modify, such as smoking, exercise, diet, and stress.
- Apo-E4. This gene is linked with a higher risk of coronary heart disease. If you have it and you eat a heart-healthy diet, your risk of heart disease isn’t increased (unless you drink too much or smoke). But if you have the gene and you eat the typical high-fat American diet, your cholesterol levels skyrocket. Alcohol tends to increase cholesterol levels in people with this gene, and people with the gene who smoke have a sharply increased risk of coronary heart disease.
- Apo-E2 or apo-E3. Like apo-E4, these genes predispose you to heart disease. And cholesterol levels in people with these genes don’t respond as well to lifestyle changes.
Even if you have no genetic abnormalities (or don’t know whether you do), you may be at increased risk for coronary heart disease if your grandfather, father, or brother developed heart disease before the age of 55, or your grandmother, mother, or sister developed it before the age of 65. Perhaps genetics is to blame for your family history — or simply bad habits like smoking and poor eating. Either way you have the ability to lower your own risk.
Age and Sex
More men than women develop coronary heart disease. And on average, men develop it 10 years before women do. But once women hit menopause, their risk of dying from heart disease equals that of men. In the end, 47 percent of all heart attacks occur in women.
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Before menopause women usually have total cholesterol levels lower than those of men the same age. After menopause, however, women often have an increase in LDL and a decrease in HDL (high-density lipoprotein). After age 50 they often have higher total cholesterol levels than men of the same age. Even what would typically be considered a protective HDL level — in excess of 60 mg/dl — often isn’t enough to guard women from heart disease after menopause. Thus, some experts suspect there may be no such thing as a “safe” HDL level for women; the higher, the better.
Race plays a role in your risk of coronary heart disease. For instance, some African Americans with coronary heart disease appear to have a genetic trait that increases the danger of high triglycerides, particularly in women. One study found that African Americans produce less nitric oxide in response to stress; this substance is critical for opening blood vessels and increasing blood flow. Native Americans, particularly those in North and South Dakota, also face a much higher risk of coronary heart disease than Caucasians, while Hispanics have a lower risk than all of these groups. Whether race-related risks are mostly attributable to genetics or lifestyle habits is uncertain.