Help - cholesterol panic

[SunnyC41]

Hi guys, can anyone offer some input?

45 year old female. Don't drink or smoke. I'm around a stone overweight and my chocolate addiction means that my diet really isn't great.
Just found out my cholesterol is 6.9
HDL is 1.4
LDL is 4.9
(Not sure about triglycerides yet)

History of heart disease on both my parents' sides.

What do I do? Less fat? Less sugar? Fewer eggs?

I'm panicking and filled with more than a little self-loathing (regretting all that chocolate now).

Thanks in advance.

@SomeGarlic what dose are you taking? I managed to persuade them to give me 10mg which was sufficient to halve my cholesterol.

Re side effects.
I am on a stupid number of drugs. My experience has been that side effects tend to occur straight away and in the majority of cases they wear off after a few weeks. Some of the worst drugs I have to take < methotrexate> also had immediate and positive benefits so there's a motive to persevere.

If you're not seeing or feeling any benefit from the drug it's tempting to give up immediately you notice side effects. Statins fall into this category imo although I never actually had any side effects from them.

I’ve name changed for this, but I’m an internist with a specialism is vascular medicine and I’m married to a cardiologist. Some of the opinions you’ve received here are not only poorly informed but quite dangerous.

Your LDL (bad cholesterol) is quite high, and with a family history of heart problems I’d be concerned you have familial hypercholesterolaemia, which can lead to premature cardiovascular disease. Improving your diet, increasing exercise, and losing weight are never bad things to do, but won’t bring your levels to a normal range (unless you are eating very very poorly every day).

Statins are safe and excellent medications that can help lower circulating cholesterol as well as reduce the burden of existing plaques, giving you more time to live. I hope you are able to get sound advice from your GP and/or a referral to a specialist near you.

Yes, if you have genetic cholesterol, the lp(a) test is really worthwhile.

@Doctordoctor2 I really appreciate you taking the time to send me this information. It's made me properly stop and think. If my levels are still high at my next test in six months, and they recommended statins, I'll take them. To be honest, I suspect you're right about the FH. I asked them to test me for the gene but she said they only do that for patients whose cholesterol is above 8.

Can I ask a question? @Doctordoctor2 I've eaten perfectly this week. If I keep it up and exercise more, and manage to get my overall cholesterol down to the low sixes (or below) does that suggest it isn't FH but poor lifestyle instead? Excuse my ignorance - I'm just finding my way with all this.

I've been vegan for years and with FH and no statins it was high. When I was trying out different statins a locum GP started advising me about diet. The conversation went...
Cut down on cheese - I don't eat cheese
Cut down on processed and red meat - I don't eat meat
Cut down on butter and full fat dairy - I'm vegan
Oh.

I’m sure this is correct. They are prescribing them to get funding

Honestly, just take statins. eg Crestor / rosuvastatin. I had even higher cholesterol than yours, finally got persuaded to try a statin, and, boom, within weeks with no change in diet the numbers were right down in normal range. Like magic. (I'm a chocolate addict too)

@NoNewsisGood Am I likely to have to go private to get the test? (I'm in Scotland)

Also, out of interest, is FH more severe if you inherit it from both parents?

One of the problems with genetic testing is there is a fairly high rate of false negative; that is, there are only so many gene mutations we can test for but likely many more that can cause problems clinically—we actually miss around 30% of cases if we rely on DNA testing alone.

There are other factors we consider when looking at your blood values: I would want to know your triglycerides, HDL, and Lp(a), whether your bloods were fasting, and what sorts of heart problems are known in the family and from what age. Ultimately we have to have cutoffs for diagnosis and testing but really we are (or should be!) trying to provide personalised care based on your risk modifiers. If, for example, you have several people on one side of the family with premature coronary disease, and/or a high Lp(a), I’d be much more worried about your values and inclined to retest you sooner than six months, as a statin will likely be highly beneficial for you.

In general, we can achieve a maximum 10% decrease with diet and exercise; people with FH can never achieve a normal value on their own. Statins are often cast in a bad light but all medicines can have side effects (and most statin-users do just fine!) but have greatly reduced cardiovascular disease burden worldwide. The reason so many people with FH have premature cardiovascular disease in the family is because statins weren’t available before the mid-1980s so there was no way to treat high cholesterol. I have so many patients who lost their parents and grandparents far too soon.

Kind regards.

Look for cholesterol lowering foods. Some are really unexpected - cooked tomatoes, for example. Bamboo shoots another. Psyllium husk.

Anyone had experience where HRT lowered theirs?

This is worrying but fascinating @Doctordoctor2
Overall cholesterol: 6.9 (unfasted). HDL: 1.3. LDL: 4.9. Triglycerides: 1.3. Ratio: 4.9.
Blood pressure is spot on.
Dad had first heart attack in his 30s (but suffered from alcoholism). Fatal heart attack at 59. His dad died of heart problems (following triple bypass) aged 53.
Mum diagnosed with angina in her 50s. Her brother died of a heart attack in his 50s. Her sister had a heart attack in her 50s.
But these relatives smoked and drank. I don't. Am I as well trying to live really well for 6 months, then retaking the test (fasted this time)? Was toying with the idea of having a private lipid profile test before then and requesting statins if I have the gene, but I didn't realise they were prone to false negatives.
The 10% decrease is disappointing. I stupidly thought if I was really good I could it below 6 in just 6 months.

Did he tell you to cut down on anything with coconut oil or palm oil? Because vegan food are often full of one or the other, and coconut oil especially, is far worse than butter.

It isn't.

Don't use either coconut or palm oil.
However, the family history of heart disease is high on both sides of the family. One grandmother with angina, the other had a heart attack and died in childbirth and one grandfather was dead at 54 with a heart attack. Mum has heart failure.

There's a great summary of how diet affects cholesterol, and how you can reduce it, on this podcast by Sarah Berry of Zoe. Interestingly, cheese doesn't affect cholesterol, but butter definitely does:

I am not in the UK, so I don't know there, I'm sorry.

Also not sure what FH is for the same reason.

@Seaoftroubles well done! Can I ask how long it took you to get your levels down?

@SnackQueen sorry to hear that. Did they suggest a statin for you?

Your LDL is still reasonably high (I’m not sure how old you are but probably around the 90th percentile), your triglycerides and HDL are good, which tells me a couple of things: you don’t have a mixed hypercholesterolaemia and your diet is also good. So good news there but then probably not much room for improvement in the LDL and that points more towards FH (or clinical FH). Again no harm in repeating a fasting value and working on lifestyle, but I wouldn’t expect too much difference (unless there is something else extreme in your diet you haven’t shared here!)

Give that your dad had his first heart attack at 30, and a fatal one before 60, that greatly raises suspicion for a genetic cholesterol issue., especially given that your grandad also had a bypass at an early age. And on your mum’s side too. FH (Familial Hypercholesterolaemia) has. 50% chance of being passed on and it is possible to receive a copy of a faulty gene from both parents. Generally we see much higher levels (LDL of 10) so I wouldn’t suspect you have two faulty copies. (Many people with homozygous FH or compound heterozygous will have heart attacks as children because of so much excess circulating cholesterol).

It’s wonderful that you are living a healthy lifestyle, it may be that has helped you avoid disease for so long. I would also request the Lp(a) test based on a strong family history of cardiovascular disease on both sides of your family.

@Doctordoctor2 Thank you so much for taking the time to share this info. I really appreciate it. I'm 45 and I haven't eaten well for five or six years. To be honest, I think I have binge eating disorder and sugar has been my vice. The other thing giving me hope that it might not be FH (though I suspect it is) is that I come from a long line of heavy smokers and drinkers. When my dad took that first heart attack, he was actually going through alcohol withdrawal. I was tempted to contact the GP, ask for the test (if they'd allow it) and immediately begin statins if I have it. But I thought maybe it's no bad thing to live really well for six months and see. (If you were in my position, would you do the same?) It's been really challenging giving up everything I enjoy, but I'm doing it.