Q: I’ve tried a couple of statins, and the side effects — particularly muscle pain — always knock me off them. The problem is my cholesterol is almost 400, and I’m scared I’ll have a heart attack before I’m 45, like my dad did. What do you suggest I do?
— Frank S., Pittsburgh
A: Start by getting the genetic test for familial high cholesterol, also called familial hypercholesterolemia (FH); it affects about 1 in 500 folks. It happens because a genetic mutation makes your body unable to clear lousy LDL cholesterol from your bloodstream. In adults it’s diagnosed when there’s a family history of premature heart disease and lousy LDL cholesterol is 190mg/dL or higher (in kids it’s 160 and up). Genetic testing is recommended to confirm a diagnosis of FH if there’s some doubt about the cause of elevated LDL.
Statins normally would be your first line of defense, and for many people they’re lifesavers, but for you, their side effects are a deal breaker. There are other cholesterol-lowering medications, such as niacin and ezetimibe that you might tolerate, but neither seems to substantially decrease heart attack risk.
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