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.
If you do have FH, there’s a treatment called apheresis, in which blood plasma, removed from your body, is passed through filters to remove extra LDL-cholesterol, and then returned to your body; this is a very difficult treatment regimen.
But here’s better news: Researchers have discovered a once-a-month injection of a monoclonal antibody called evolocumab helps your body get rid of LDL cholesterol.
Although it won’t hit the market for a few years, you might log onto www.clinicaltrials.gov to see if there are trials for this drug in which you want to enroll. For now, work with your doctor on a new treatment plan that improves your meds and nutrition, increases physical activity safely and reduces stress.
Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at firstname.lastname@example.org.