Ask the Doctor: ‘I’m a woman in her 40s and with a healthy diet and active lifestyle, but there’s a family history of high cholesterol. Is it hereditary?’

“High cholesterol is something my mother and grandmother suffered from. As a woman now in her 40s and with a healthy diet and active lifestyle, should I still be getting this checked? Is cholesterol something that can be hereditary or is a healthy lifestyle enough to stop me developing high levels?”

Answer from Professor David Burke Director of Cardiology and Consultant Cardiologist at Beacon Hospital.

High cholesterol or hyperlipidaemia is considered a significant risk factor contributing towards our longer term likelihood of both heart disease and strokes. Multiple elements contribute towards our overall total cholesterol, including lifestyle factors such as diet, exercise, fitness, weight, alcohol and smoking, but we all also hold a genetic predisposition, and a family history of cholesterol tends to heavily influence things.

In terms of blood testing, lipid or cholesterol profiles break down into total cholesterol, which comprises the ‘good’ HDL, and the ‘bad’ LDL cholesterol. HDL gives an overall protective benefit, but LDL is the cholesterol that deposits in our system as ‘plaque’ as we age. An ideal total cholesterol is considered less than 4.8 millimoles per litre. Most people have an HDL in or around 1.0, and the ‘target’ in term of LDL cholesterol is less than 3.0, although a lower number is preferable in patients who have had any documented cardiovascular disease.

Women are seen to have less of a cardiac risk until after menopause, at which point they start to catch up with their male counterparts. That said, it remains important to check, monitor, and manage all of the moving parts within our control that influence our longer term chances of running into problems.

The healthcare push in terms of advice to treat cholesterol centres around the fact that higher cholesterol is more likely to run  into difficulties with heart attacks and strokes as we get older. When cholesterol builds up in the blood vessels in our system, there is no way to remove it, and so advice to monitor and treat cholesterol is targeted at a preventative strategy.

A healthy lifestyle is always part of the recommendation for good heart health, with a balanced diet and regular physical activity. If your parents or grandparents have a high cholesterol, a more pro-active approach would be advised, and it would be worthwhile getting checked and discussing lifestyle changes, or with persistently elevated levels, the potential need for medication to prevent issues in the longer term.

The most widely used and certainly most effective treatment for high cholesterol is a family of medications called statins. These are well known and there is a general perception that they are problematic in terms of causing side effects. In fact, this is not common at standard preventative doses, and they offer the best protective effect over time in patients who require them.

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