Is High Cholesterol Hereditary? What You Need to Know About Your Genetic Risk

If someone in your immediate family has been diagnosed with high cholesterol, you may be wondering if you, too, are at risk.

This article will discuss how high cholesterol can be hereditary, as well as how healthcare professionals diagnose and treat the condition.

What Is High Cholesterol?

Cholesterol is a fatty molecule that your cells need to function. These molecules are made in your liver, but they also come from your diet and other sources. While you need cholesterol to survive, having too much of it in your blood can cause health problems.

To understand when cholesterol is bad and when it’s good, you need to understand the different types of cholesterol and their normal ranges:

• Low-density lipoprotein (LDL) cholesterol moves fat cells around the body. When LDL cholesterol is too high—above 130 mg/dL—it can build up in the walls of your blood vessels and cause blockages. This is why LDL cholesterol is known as the “bad” cholesterol.
• High-density lipoprotein (HDL) cholesterol removes cholesterol from your blood and can help clear buildups in blood vessels. HDL cholesterol takes fatty molecules back to the liver, where they are removed from the body. This is why HDL is called the “good” cholesterol and levels should be above 45 to 55 mg/dL.

While elevated LDL cholesterol is bad, high HDL cholesterol is good. Things like stress, high blood sugar, diabetes, and even genetics can cause these numbers to reach unhealthy levels.

High Cholesterol: Signs and Symptoms

If you see your doctor for regular preventive or wellness visits, they may perform a lipid panel to check the cholesterol levels in your blood. This is the best way to tell if your cholesterol levels are unhealthy.

Cholesterol levels can creep up to unhealthy levels with no symptoms at all. Over time, however, cholesterol buildup in your blood, vessels, and tissue will start to be more noticeable and cause the following:

• Fatty deposits: As the cholesterol level in your body rises, bits of fat and cholesterol can collect under your skin and become visible on the surface. These fatty deposits are called xanthomas. They can be found on your hands, elbows, ankles, and around the eyes. Cholesterol deposits around your eyes can also be called xanthelasmas.
• Chest pain: High cholesterol increases your risks of atherosclerosis and coronary artery disease, reducing blood flow to the heart muscle. An oxygen-starved heart muscle can produce chest pain, also called angina.
• Cramping and pain: As your blood vessels narrow as a result of cholesterol buildup, you can develop issues in your circulation, like peripheral artery disease. This can cause problems like pain or cramping, especially in either or both calves when you are walking.
• Slow healing: When your blood isn’t flowing as well as it should be, blood and nutrients that help keep tissues vibrant and healthy don’t get to where they need to go. This can cause sores, especially on the toes or feet, and prevent even small injuries from healing well.
• Stroke and heart attack: High cholesterol is a leading risk factor for sudden stroke and heart attack. This occurs when your blood supply is suddenly cut off from your heart or brain.
  

Is High Cholesterol Hereditary?

While lifestyle choices like your activity level, diet, and whether you smoke affect your cholesterol levels, some people may have elevated cholesterol regardless of their lifestyle choices.

Familial hypercholesterolemia is a hereditary form of high cholesterol. Your doctor may check your cholesterol and monitor you for this condition if you have a family history of high cholesterol or sudden heart attacks. Fatty deposits under the skin, especially around the eyes, are a common symptom of this kind of high cholesterol.

Genetic Risk: Familial Hypercholesterolemia

You can have familial hypercholesterolemia if one or both of your parents carry a genetic mutation that helps control the level of LDL cholesterol in your blood. In many cases, the mutation occurs in one of the following genes:

• LDLR
• APOB
• PCSK9

You have a 50% chance of inheriting the gene mutation that causes hereditary high cholesterol from each parent who carries it. This means that if one parent carries an affected gene, you have a 50% chance of developing familial hypercholesterolemia.

If both parents carry the gene—or have more than one gene mutation that could lead to the condition—your chances of developing the condition are even higher. People who have genes from both parents need appropriate diagnosis and treatment to live a healthy life.

How to Diagnose and Treat High Cholesterol

Cholesterol screenings are part of wellness visits every few years, but if high cholesterol runs in your family, you may need more frequent testing and treatment to avoid complications.

Diagnosing High Cholesterol

The first step to diagnosing high cholesterol is to share a detailed personal and family health history with your doctor. If your parents or other close relatives have high cholesterol and heart disease, your doctor may check your health with lab tests.

Most doctors will complete a routine cholesterol screening during a wellness exam starting at age 20, repeating the test every four to six years. Lipid panels measure your cholesterol levels, but if your doctor thinks you have a genetic risk for high cholesterol, they may perform more frequent tests.

If a child has a known history of familial hypercholesterolemia, their doctor will start checking their cholesterol levels with blood tests around age 2.

Treating High Cholesterol

When your cholesterol is high because of your diet, a lack of exercise, or smoking, lifestyle changes can help lower your bad cholesterol and increase your good cholesterol. If your high cholesterol is caused by a genetic mutation, these changes can help, but will not cure the condition.

If you have familial hypercholesterolemia, you will have to take medications to keep your cholesterol levels in check. Several types of medications might be used to lower your cholesterol, including:

• Statins reduce how much cholesterol your liver makes. Examples include medications like Lipitor (atorvastatin) and Mevacor (lovastatin).
• Bile acid sequestrants help reduce cholesterol by affecting liver function. Examples include Questran (cholestyramine) and Colestid (colestipol).
• Fibrates lower triglyceride levels, a type of fat in your blood, and increase HDL levels. An example is Triglide (fenofibrate).
• PCSK9 inhibitors and ACL inhibitors are a newer class of medications that can change how your body responds to cholesterol. Examples include Praluent (alirocumab), Repatha (evolocumab), Leqvio (inclisiran), and Nexletol (bempedoic acid). These medications are often taken by people who can’t take statins or who are already taking high doses of statins and need to reduce their LDL cholesterol even more.

Ways to Prevent High Cholesterol

Making healthy lifestyle choices can help you keep your cholesterol under control. These include:

• Exercising regularly
• Avoiding high-fat foods
• Eating plenty of fiber
• Maintaining a healthy body weight
• Not smoking

If you know you have a family history of high cholesterol or have been diagnosed with familial hypercholesterolemia, you cannot prevent the condition from developing. However, you can work closely with your doctor to manage your condition well and prevent complications. This includes checking your cholesterol levels regularly and taking medications that can lower your cholesterol.

Summary

High cholesterol can cause a lot of serious health problems, including high blood pressure, heart attack, and stroke. While some people can manage high cholesterol with lifestyle changes, this usually isn’t enough for people who inherited familial hypercholesterolemia. These people will need to manage their condition with medications and lifestyle changes to prevent complications.

A Word from Verywell

A lot of serious health problems can develop because of high cholesterol, and some people might not even know how at risk they are. Familial hypercholesterolemia can go undetected and put you at risk of conditions like heart attack or stroke.

Be sure to review your family medical history with your doctor so that this condition can be caught and treated early. Early detection and proper management can help you keep your cholesterol under control and prevent serious complications.