High Cholesterol: When It’s All in the Family

“Dr. Subramanian, am I going to die of a heart attack before age 30?”

Audrey Aspen had been recently diagnosed with familial hypercholesterolemia (FH), which is an inherited condition that causes high levels of LDL (bad) cholesterol, and the information she found on the internet framed it as a rare, life-threatening disease.

“It’s scary to have high cholesterol. Everyone knows high cholesterol = bad = heart attack,” Audrey said. Fortunately for Audrey, she was receiving care at the only dedicated Lipid Clinic serving Central Minnesota, located at the CentraCare Heart & Vascular Center. Her cardiologist, Sharath Subramanian, MBBS, listened to her concerns and provided peace of mind. “He reassured me that if I take my medications and eat healthy, I have a very low chance of anything happening to me.”

Growing up, Audrey knew her mom’s side of the family had high cholesterol despite eating well and having a healthy weight. Audrey always figured she would suffer the same fate, but being young, she didn’t think too much about it. However, at a recent physical, she discovered her cholesterol level was around 400. Cholesterol is considered high when greater than 240. Knowing this number was unusual for a 23-year-old, Audrey’s nurse practitioner referred her to CentraCare’s Lipid Clinic.

Going from Healthy to Grieving

At the clinic, Audrey met with a team of lipid specialists, including Dr. Subramanian, nurses, dietitians, pharmacists and a genetic counselor. It was through the clinic’s genetic testing that Audrey learned she had an abnormality on her LDLR gene, which is associated with FH.

“Before I got my results, I was holding out hope that my high cholesterol was a fluke or it had to do with eating corn dogs with the kids I nannied,” Audrey said. “While I knew about the high cholesterol, I never put two and two together that it was caused by a messed-up gene. There’s a grieving process that goes with thinking you are healthy and then learning you will be on medication the rest of your life.”

Through the genetics clinic, Audrey also discovered she had a 50% chance of passing the gene along to any children. She learned that she was fortunate to have received the gene from only one parent. If both parents had passed along the gene, her life expectancy might be 20 years or less.

Finding the Path Forward

In addition to her enlightening interaction with genetics, Audrey said her care at the Lipid Clinic was beyond anything she has experienced, everything from Dr. Subramaniam calling her on his day off to discuss medication questions to a nurse calling every few weeks to check on her. When she had difficulty swallowing her medication due to size, a pharmacist provided two smaller pills equaling the same dose. They also give her leeway to trial diet adjustments and medication levels before moving on to any new treatments.

“I tell my patients in lipid clinic, that the path to better heart health is a journey,” said Dr. Subramaniam. “My role is to provide them with individualized care based on the latest available therapies; to educate and empower them to make medical decisions; and guide and support them in their quest for achieving better heart health and a good quality of life.”

Audrey has shared her newfound knowledge of FH with family members, allowing them to compare notes. One benefit of the process was that once Audrey received the positive FH diagnosis, the genetics clinic offers tests and resources to other family members for free.

Since Audrey began the program, her cholesterol levels have decreased by almost 125 points, and she continues to work with the Lipid Clinic to further reach her goal. Audrey recommends that others who have high cholesterol or have a family history of it, look into the program. Other candidates for the program include people who have a family history of coronary artery disease (heart attack, heart surgeries); elevated cholesterol despite diet changes and medication; and intolerance or side effects from cholesterol-lowering medications.

While monitoring her cholesterol, Audrey continues to do what she loves — gardening and working with children. As a middle school music teacher, Audrey would someday like to combine her love of music with special education, saying she has always had a soft spot in her heart for children with special needs — a passion passed down to her from her mother.