How to Fight Genetically Inherited High Cholesterol, According to Cardiologists
October 17, 2025 — CHICAGO – While many adults don’t think about their cholesterol levels until middle age, for some, the risks start much earlier — and the cause is genetic. Familial hypercholesterolemia (FH), a hereditary condition affecting how the body processes cholesterol, puts individuals at a significantly higher risk of heart attacks and cardiovascular disease, sometimes as early as their 20s.
Doctors warn that although FH is one of the most common genetic disorders — affecting approximately 1 in 250 people — up to 90% of those with FH remain undiagnosed. The condition often goes unnoticed until dangerously high cholesterol levels begin to trigger serious health consequences.
What Is Familial Hypercholesterolemia?
FH is a genetic mutation that prevents the body from effectively removing low-density lipoprotein (LDL) — often referred to as “bad” cholesterol — from the bloodstream. The condition can be inherited from one or both parents, but the severity varies depending on how the gene is passed down.
- If one parent carries the FH mutation, there’s a 50% chance their child will also inherit it.
- If both parents carry the mutation, the child may develop homozygous familial hypercholesterolemia (HoFH) — a much rarer and more severe form of the condition that can appear in childhood and is significantly more resistant to treatment.
The danger lies in how FH affects arteries. Unlike high-density lipoprotein (HDL) — the “good” cholesterol that helps clear excess fats from the bloodstream — LDL builds up as plaque on artery walls. This buildup restricts blood flow and can eventually lead to life-threatening blockages, strokes, or heart attacks.
When Genetics Work Against You
“In families with FH, it’s common for close relatives to have cholesterol levels exceeding 300 mg/dL,” said Dr. Robert Johnson, a cardiologist at Advocate Health Care. “LDL levels are often over 200 mg/dL, and sometimes much higher. These families also typically have a strong history of early-onset coronary artery disease. Recognizing this pattern in family history is key to early diagnosis and treatment.”
For comparison, the American Heart Association recommends a total cholesterol level of 150 mg/dL and an LDL level of 100 mg/dL or lower. People with FH often exceed these thresholds by two to three times, placing them at serious cardiovascular risk well before the age when most people consider getting screened.
What to Do If You Have FH
Early diagnosis and aggressive treatment are essential for managing familial hypercholesterolemia. Fortunately, having FH does not mean a healthy life is out of reach — but it does require long-term commitment to lifestyle changes and medical management.
“All patients with FH will require pharmacologic therapy along with a very low-fat diet and regular exercise,” Dr. Johnson emphasized. “Depending on the degree of LDL elevation, patients may develop coronary artery disease in their 20s. That’s why early lifestyle modifications are crucial.”
Key Steps to Manage FH:
- Get Tested Early
If you have a family history of high cholesterol or premature heart disease, talk to your doctor about a genetic test or lipid panel. Even children as young as 2 can be tested for FH if risk factors are present. - Start Medication if Necessary
Statins are typically the first line of defense for lowering LDL levels. In more severe cases, additional drugs such as PCSK9 inhibitors or ezetimibe may be prescribed. - Commit to a Heart-Healthy Diet
A diet low in saturated fats, trans fats, and cholesterol can help control LDL levels. Focus on whole grains, fruits, vegetables, lean proteins, and healthy fats like olive oil and nuts. - Exercise Regularly
Physical activity helps boost HDL (good cholesterol) while lowering LDL and triglycerides. Aim for at least 150 minutes of moderate-intensity exercise per week. - Screen Family Members
Because FH is hereditary, it’s important to have first-degree relatives tested as well. Early detection in family members can prevent future cardiac events. - Schedule Regular Checkups
Routine monitoring of cholesterol levels, liver function, and cardiovascular health is essential for adjusting treatment plans and catching early signs of heart disease.
The Road Ahead
There is no cure for familial hypercholesterolemia, but with the right combination of medication, diet, and exercise, individuals with the condition can lead long, healthy lives. Advances in genetic research and therapies are also offering new hope for more personalized treatment strategies.
Public health experts continue to push for increased awareness and earlier screening — particularly since FH remains underdiagnosed despite its prevalence.
“If there’s one takeaway, it’s this,” said Dr. Johnson. “Don’t wait until your 50s to check your cholesterol — especially if heart disease runs in your family. FH is manageable, but only if you know you have it.”
