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Cholesterol, a Daily Struggle against an Invisible Disease

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Geoff led a healthy, active life, ran regularly and didn’t drink or smoke. So when an excruciating pain in his chest woke him up, he had no idea what was wrong. Geoff had just had a heart attack. It was 2007 and his life had changed in an instant.

Geoff’s cholesterol levels were checked in 1994 for the first time and found to be slightly raised. His doctor at the time advised him to bring his cholesterol under control through his diet, but because no alarm bells were sounded Geoff didn’t give it a second thought. Like many people, he associated cholesterol with older or overweight people, so he was surprised to discover that he had a very high LDL-C (bad cholesterol) level, exposing him to a risk of cardiovascular disease.

Many people are totally unaware that they are living with a cholesterol problem. A natural substance, cholesterol is created in the liver and also is found in certain foods.1 An excess of it can be significant for the heart and arteries because it can increase the risk of cardiovascular disease.1 It is a silent threat that does not provoke any particular symptoms or altered feelings. As it builds up painlessly in your arteries, your risk of developing a significant coronary heart disease (CAD) increases.2

"Despite its seriousness, LDL cholesterol is not as easy for the general public to understand unlike conditions such as diabetes and hypertension, which can also cause cardiovascular disease. High LDL cholesterol requires prevention strategies and a treatment plan," says Dr. Richard Carmona, former Surgeon General of the United States.

In the United States, someone has a heart attack every 40 seconds.3 In the EU, cardiovascular disease causes over 1.8 million deaths each year.4 Uncontrolled LDL-C levels are a key and modifiable contributing cause of cardiovascular risk.1

Bad cholesterol is one of the risk factors for cardiovascular disease, including heart attacks and strokes, the leading cause of death in the United States.
Richard Carmona, MD, former U.S. Surgeon General

Katherine, from Pasadena, California, was 15 years old when she learned that she had high cholesterol after painful tendons in her ankles made it difficult to walk. Her family doctor prescribed a series of exams that revealed a “hypercholesterolemia of familial origin,” an inherited disease transmitted by one parent. But she only became fully aware of the severity of the disease when she had a heart attack just months after turning 30.

Having a heart attack made Katherine fully aware of the consequences for her two daughters. Tests revealed that her eldest daughter had inherited familial hypercholesterolemia (FH). Katherine’s daughter, and the tens of thousands of children like her, need greater awareness of FH, which is rarely diagnosed, so that they can receive a proper diagnosis and management of the disease to reduce the risk of premature cardiac events.6

Today, Katherine makes sure her daughter manages the condition through her diet.

"People don’t often realize that they have FH and 90% of people who have it are not diagnosed."6

The importance of diagnosis

Early diagnosis is essential because it means providing valuable information to the patient. Having regular check-ups and talking to your doctor enables patients to adapt their lifestyle and treatment to minimize the impact on leading a normal life.

Philippe and his sister both inherited FH. Being aware of his condition means he is already one step ahead when it comes to his 8-month-old son. "It was only when my wife was pregnant that the question arose around the genetic and hereditary aspect of this disease,” explains Philippe. “I know that my son is at risk of inheriting high cholesterol levels, because my grandparents had it.” Philippe hopes his child has not inherited his problem of FH, but there is a 50% chance that he has.6

"I know that my son is at risk of inheriting
high cholesterol levels, because my grandparents had it.”

Today, Geoff has put his heart attack behind him, knowing that ironically, it probably saved his life. He is now fully aware of how bad cholesterol can impact his life so he focuses on living healthily and appreciates every single day to the maximum, knowing how lucky he is to be able to watch his grandchildren grow up.

Understanding cholesterol

1 - What is the difference between LDL-C (bad cholesterol) and HDL-C (good cholesterol)?
Low density lipoprotein cholesterol (LDL-C) is known as "bad" cholesterol. High levels of LDL-C can build up in the arteries and cause atherosclerosis. The causal relationship between LDL-C and the risk of heart disease, including heart attacks and strokes, is well established.
High density lipoprotein cholesterol (HDL-C) is known as "good" cholesterol. HDL-C (good cholesterol) helps transport LDL-C to the liver where it is removed from the body.1

2 - What are the risk factors associated with high cholesterol and heart disease?
Risk factors for developing heart disease include smoking, obesity, hypertension and diabetes, as well as age, sex, family history and diet.7,8
In particular, diabetes and high blood pressure contribute to the severity of high cholesterol.9,10 Diabetes tends to lower good cholesterol and increase bad cholesterol, while high blood pressure can cause cholesterol to build up in the arteries.9,10

3 - Can cholesterol be hereditary?
People with familial hypercholesterolemia (HF) have very high cholesterol levels caused by an inherited disease.6 High levels of low-density lipoprotein in the blood are present from birth and can lead to the early development of coronary artery disease (CAD) or thickening of the arteries.11 The disease is hereditary according to an autosomal dominant pattern; brothers and sisters and children of an individual with FH have a 50% chance of inheriting the predisposing mutation.6

4 - Why is it important to know and understand your cholesterol?
High cholesterol, particularly high LDL cholesterol, is a serious condition that can lead to heart disease, including heart attacks and strokes, the leading cause of death in the United States.1,3 Patients should work with their doctor to lower their high cholesterol levels to an optimal range. A doctor may prescribe medications in addition to lifestyle changes, but even with this, patients may still be at risk and need to further reduce their cholesterol levels.

5 - What about cholesterol levels in children?
It is also necessary to measure the cholesterol levels of a child, especially when we suspect a FH.6

6 - Do diet and lifestyle impact the level of bad cholesterol on our health?
A healthy diet can help lower blood cholesterol levels. People should maintain a healthy weight because being overweight or obese can increase your bad cholesterol levels, while weight loss can help lower your cholesterol levels. Physical activity can also help maintain a healthy weight and lower cholesterol.8

7 - Can the risks of cardiovascular disease be reduced?
WHO estimates that a 10% drop in cholesterol in a 40-year-old man would allow for a 50% reduction in cardiovascular disease over a 5-year horizon.12

Key facts about cholesterol infographics

References

  1. American Heart Association. About Cholesterol.
    http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.WrPgJGrwbIU. Accessed March 2018.
  2. Centers for Disease Control and Prevention. Coronary Artery Disease (CAD).
    https://www.cdc.gov/heartdisease/coronary_ad.htm. Accessed March 2018.
  3. Centers for Disease Control and Prevention. Heart Disease Fact Sheet.
    https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm. Accessed March 2018.
  4. European Heart Network. European Cardiovascular Disease Statistics 2017.
    http://www.ehnheart.org/cvd-statistics.html. Accessed March 2018.
  5. Wong ND, Young D, Zhao Y, et al. Prevalence of the American College of Cardiology/American Heart Association statin eligibility groups, statin use, and low-density lipoprotein cholesterol control in US adults using the National Health and Nutrition Examination Survey 2011-2012. J Clin Lipidol. 2016;10:1109-1118.
  6. The FH Foundation. What is FH?
    https://thefhfoundation.org/about-fh/what-is-fh. Accessed March 2018.
  7. Centers for Disease Control and Prevention. Knowing Your Risk: High Cholesterol. https://www.cdc.gov/cholesterol/risk_factors.htm. Accessed March 2018.
  8. Mayo Clinic. High cholesterol.
    https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800 . Accessed March 2018.
  9. American Heart Association. Cholesterol Abnormalities & Diabetes.
    http://www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/Cholesterol-Abnormalities-Diabetes_UCM_313868_Article.jsp#.WrF31Grwapp. Accessed March 2018.
  10. American Heart Association. How High Blood Pressure Can Lead to a Heart Attack.
    http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/LearnHowHBPHarmsYourHealth/How-High-Blood-Pressure-Can-Lead-to-a-Heart-Attack_UCM_301823_Article.jsp#.WrF34Wrwapp. Accessed March 2018.
  11. Centers for Disease Control and Prevention. More Detailed Information on Key Tier 1 Applications - Familial Hypercholesterolemia.
    https://www.cdc.gov/genomics/implementation/toolkit/fh_1.htm. Accessed March 2018.
  12. World Health Organization, Global Health Observatory (GHO). Raised cholesterol. Situation and trends.
    http://www.who.int/gho/ncd/risk_factors/cholesterol_text/en/. Accessed March 2018.
  13. World Health Organization. Cardiovascular diseases (CVDs).
    http://www.who.int/mediacentre/factsheets/fs317/en/. Accessed March 2018.