April 6, 2022

Is High Cholesterol Hereditary?

Your family tree may increase your risk of high cholesterol and heart disease

Familial high cholesterol

Genetics paint the color of your eyes, assign your blood type and carve out those adorable dimples in your cheeks. But mom and dad may have passed along something else, too: high cholesterol.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

An inherited condition known as familial hypercholesterolemia (FH) can increase your risk of heart disease at an early age. For some, that can mean their 20s.

About 1 in 250 people are born with high levels of low-density lipoprotein, or LDL (the bad kind), cholesterol. The good news? Lifestyle choices and medications can help keep your cholesterol in check if you have FH.

The key, though, is knowing you have FH. Unfortunately, an estimated 90% of people with FH lack that knowledge.

Could you be in that group? Let’s find out with interventional cardiologist Leslie Cho, MD.

How to tell if you inherited high cholesterol

For starters, don’t overthink this question. Most people don’t have genetically high cholesterol levels. “If your cholesterol is high, odds are you got it the old-fashioned way through a questionable diet, a lack of exercise and the process of aging,” notes Dr. Cho.

But FH does exist and deserves to be taken seriously. “You can have people at age 18 have a heart attack because of it,” she says.

So, what can you do to find out if you’re at an increased risk? If possible, gathering your family’s health history is the first priority. If your biological parents have FH-based high cholesterol, you might, too.

People with FH lack a specific protein — an LDL receptor — that works to get the bad cholesterol out of their blood. (A defective LDL receptor also can cause FH.) It’s a genetic condition that can be passed from generation to generation.

The most serious form of the condition is called homozygous familial hypercholesterolemia. This occurs when both parents have the altered DNA that causes FH and pass it along to their children.

Advertisement

A second type of FH, known as heterozygous familial hypercholesterolemia, is more common. This condition happens when one parent lacks the LDL receptor.

FH is more common among specific populations in Lebanon, South Africa and Lithuania, too.

When to start testing for high cholesterol

The American Academy of Pediatrics recommends that all children get their first cholesterol screening between ages 9 and 11. Testing can begin as early as age 2 if risk levels are high. (Cholesterol screenings are done through what’s called a lipid panel blood test.)

“That’s just to get a baseline,” says Dr. Cho. “It helps find people who have a higher risk, so they can be monitored more closely and adjust their diet.”

Now, let’s say you’re already beyond the elementary school years. At that point, the American Heart Association and American College of Cardiology advise getting a cholesterol level screening at age 20.

If you have elevated risk factors, screenings should be done annually. Otherwise, look to get tested at least once every five years.

“I know many young people feel invincible, but it’s important to get checked,” advises Dr. Cho.

Early warning signs and symptoms

There’s a reason why so many people don’t know they have high cholesterol: The condition doesn’t announce itself in small or simple ways to let you know that it’s present, explains Dr. Cho.

Cholesterol is a waxy, fat-like substance in your blood. If there’s too much cholesterol in your blood, it tends to build up in your blood vessels. (Basically, think of it like gunk building up in a water pipe.)

Advertisement

Eventually, that buildup can clog your blood vessels and prevent blood from flowing to your heart or brain. That can lead to a heart attack or stroke. Without a screening, that’s how many people learn they have high cholesterol.

“That’s why it is important to get a lipid panel, and to get it done early,” stresses Dr. Cho.

There can be visible signs of FH in extreme cases. These symptoms include:

  • Skin bumps from cholesterol building up on your Achilles tendon, elbow, knee or hands (xanthomas).
  • Yellow cholesterol deposits around your eyelids (xanthelasmas).
  • A white ring around the cornea in your eyes (corneal arcus).

Managing familial hypercholesterolemia

Knowing you have FH or high cholesterol is key to keeping it in check. “There are absolutely proven ways to manage high cholesterol,” says Dr. Cho. “And even if you have a significant family history, you can prevent heart disease.”

Cholesterol-lowering medications and a healthy diet can lower your risk of heart disease by a whopping 80%. “It’s truly amazing what can be done,” he adds.

Medication for FH

Prescription medications known as statins can decrease LDL levels by 50% or more, which is often enough to bring high cholesterol into the normal range. Most people with FH need medications beyond just statins, though.

Heart-healthy eating

Filling your plate with the right foods can help control your cholesterol. The top objective is to avoid saturated fats, which are abundant in:

  • Meats like beef, lamb, pork and poultry.
  • Dairy products such as butter, cheese and ice cream.
  • Tropical oils (coconut oil and palm oil).
  • Fried foods.

Interested in a diet that targets high cholesterol? Find out a registered dietitian’s recommendations and thoughts on several popular eating plans that can get you on track.

Related Articles

person in wheelchair lifting weights in gym
December 26, 2023
7 New Year’s Resolutions To Improve Your Heart Health

Resolve to move a little more, drink a little less, eat a little healthier, sleep a little better and destress a lot

A bowl of high fiber lentil salad
March 9, 2023
31 High-Fiber Foods You Should Be Eating

From blackberries to barley, healthy high-fiber foods are plentiful

Person eating a poached egg out of an egg cup holder.
August 9, 2022
Is It Safe To Eat Eggs Every Day?

If you’re eating more than one egg per day, you might want to cut back

An illustration of two vials labeled "HDL" and "LDL"
March 27, 2022
What’s the Difference Between ‘Good’ and ‘Bad’ Cholesterol?

Understanding the difference between ‘lousy’ and ‘healthy’ cholesterol can help you keep your heart healthy

wine and cholesterol the connection
March 6, 2022
Does Alcohol Affect Cholesterol?

Spoiler alert: The potential benefits of drinking alcohol may be a tad overstated

Senior woman looks in a small mirror while examing the skin beneath her eyes
February 2, 2022
Can Cholesterol Affect Your Eyes?

An expert explains the link

various low-cholesterol foods on a table including avocado, beans, oil, nuts and fish
January 17, 2022
8 Cholesterol-Lowering Foods To Try

Here’s what to try when looking to lower your cholesterol

Sweaty, muscular individual in workout gear rides a stationary spinning bike
November 2, 2021
Does Exercise Lower Cholesterol?

The right lifestyle changes can make all the difference

Trending Topics

glass of cherry juice with cherries on table
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Exercise and diet over three months is hard to accomplish.
Everything You Need To Know About the 75 Hard Challenge

Following five critical rules daily for 75 days may not be sustainable

Person in foreground standing in front of many presents with person in background holding gift bags.
What Is Love Bombing?

This form of psychological and emotional abuse is often disguised as excessive flattery

Ad