Ashkenazi Cholesterol
Theoretically, I should be able to look at my genetic analysis on ancestry.com and learn directly if I have the DNA for FH (familial hypercholesterolemia). Instead, I learn that due to careful inbreeding for hundreds of years, I belong to an ethnic group that has that problem. Ashkenazi Jews, including all of my ancestors, are Jewish people from Eastern Europe. In my case, they come from Lithuania, Russia, and possibly Poland and Ukraine. By contrast, Sephardic Jews originate in Western Europe, principally Spain and Portugal. Ashkenazim and Sephardim pronounce spoken Hebrew differently.
The high cholesterol due to FH can be very high indeed, or it can be only “elevated,” depending on the exact mix of genetic codes one inherits from one’s parents. I seem to have a fairly mild case.
For most people with FH, a high cholesterol test is the first clue. My cholesterol tests have always been high, but not scary-run-to-the-hospital high. Since going whole food, plant-based in 2009, and even a few years before, I have been distracted by the idea of using lifestyle modifications to control cholesterol and blood pressure. I have had some success with this. The stories in the WFPB community tell of switching from a standard Western diet to WFPB and in 7-10 days lowering total cholesterol from 300 mg/dl to 150 or better, while also removing the need for hypertension medicine. I never did anywhere near that well. However, I feel certain that without my shift to eating whole food, plant-based, I would have had a stroke or cardiac event of my own by now.
The standard treatment for FH is statin drugs. I avoided statins for the reasons I detail in Why I Won’t Take Lipitor. This was based largely on a 2010 paper in JAMA. We have more research now showing that statins do save lives by reducing LDL cholesterol in people with high LDL.
I take drugs for high blood pressure, but don’t like having to, because of side-effects, and because of the stories of people fixing their nutrition getting off of such medicines. I was recently prescribed a potassium supplement for a deficiency caused by one of my blood pressure meds, but that is another story.
It is frustrating that after being somewhat obsessed with this subject for 14 years, I am just learning about this now. A casual remark made by a non-medical friend triggered me to find out about FH, which seems to have been known about since at least 2012. Conventional doctors don’t care why my cholesterol is high. Since it is, they prescribe statins. WFPB doctors admit that some small number of their patients require statins, but minimize it, making me think it would not apply to me. See Open Questions. This reminds me of Apo-B, which has been known since 2011 to correlate better to cardiovascular disease than other cholesterol measurements, but which we never hear about from our doctors.
I don’t have any symptoms of CVD, such as chest pain or shortness of breath. For some 30-40 percent of cases, the first symptom is death. If I had symptoms, I would likely get an angiogram to look for blockages, or angioplasty to try to open up blockages.
It is April 2023. and I get a cardiac calcium scan. This is an indirect way to deduce the existence of cholesterol plaques in the blood vessels of the heart. Plaques tend to draw calcium from the blood, to form a crust which hardens them against bursting. Most heart attacks occur when a plaque bursts. So calcium in the left anterior descending artery of the heart, also known as the “widowmaker.” indicates both plaque existence and the body’s attempt to attenuate the risk.
My LAD calcium score is 115. Zero would be perfect. 40 would be good. 115 is high enough to raise concern, and to reinforce the idea that immediate action should be taken to reduce LDL. The first choice for such action would be to take statins. Often, lowering LDL by taking statins slows the formation of plaques, and allows existing plaques to calcify. So getting another cardiac calcium scan after being on statins for a while often yields a higher calcium score, even though it reduces risk of heart attack.
So statins may work to reduce my LDL, and even my Apo-B. That will reduce my calculated risk of a cardiac event. Will that matter for me personally? I strongly want to avoid heart attack, stroke, stent placement, and bypass surgery. What about side-effects? Some are truly frightening, and if I suffer brain fog, muscle fatigue and weakness, or severe liver damage, I will not consider that the benefits of statins to outweigh the downsides.
All-in-all, I am now open to the idea of taking a statin. The doctor I just saw at Kaiser Permanente agrees. Then I look forward to improved cholesterol test numbers, and dread possible side-effects.
