Inherited risk for high cholesterol can be overcome with lifestyle changes and medication.
Dr. Robert Hegele has a name for the patients who come to his clinic with a family history of heart disease or stroke, or with genes that put them at risk for high cholesterol.
He calls them “Energizer Bunnies” because they keep going and going. “These patients are living for decades; they’re watching their grandchildren grow up and having a good quality of life,” says the professor of medicine and biochemistry at the University of Western Ontario.
“People have this idea that if they have bad genes, it’s predestined and there’s nothing you can do,” he adds. On the contrary, he believes that a healthy lifestyle – and sometimes medications – can overcome most genetic flaws. And he should know, after almost 30 years of studying the genes that regulate the cholesterol that circulates through the blood and can end up blocking arteries, leading to heart attacks and strokes.
“What we’re finding is that for most patients, even patients who have had a heart attack or stroke, the genes are not destiny. In the right patient, cholesterol lowering medications together with diet and lifestyle, can prolong life by 15 or 20 years. We can bring their expected lifespan back to normal.”
Meanwhile, Dr. Hegele and other scientists are working to unlock the mysteries of the genes that increase risk. In 1986 he discovered that the gene controlling a protein called apo B increases a person’s risk of a heart attack. Now thanks in part to this work, apo B is among the blood tests your doctor can order to assess your risk of heart disease and stroke.
Another important discovery – there is no such thing as a single cholesterol gene. “In the last 25 years, we’ve learned cholesterol regulation is done by dozens or maybe 100 different genes,” Dr. Hegele says.
“Today, what we’re doing with our Heart and Stroke Foundation-funded research is to try to break down the DNA code to really learn what does family history mean, what is actually happening at the molecular level that explains why heart disease runs in families,” he says. “And a lot of what we’re learning about cholesterol is transferrable to other risk factors.”
He believes the drug treatments of tomorrow will come from a genetic understanding of the pathways that contribute to heart disease and stroke.
- Family history can double your risk of heart disease and stroke. Know your risk.