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Racial Differences for Inherited High Cholesterol Exposed

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Racial Differences for Inherited High Cholesterol Exposed

Quadruple bypass surgery at 27 changed his life

He was healthy, fit and two months away from being married. So Chad Gradney wrote off the recurring pain in his rib cage as anxiety related to his father’s recent death from a heart attack. Then one day in April 2005 severe chest pain knocked him to the ground.

Two days later, Gradney had quadruple coronary artery bypass surgery. He was 27.

Gradney ate healthier and exercised more after the surgery, but seven years later, his cholesterol levels continued to be dangerously high and new blockages again clogged his arteries. Doctors soon diagnosed Gradney with familial hypercholesterolemia, a genetic condition characterized by very high levels of “bad” LDL cholesterol that can lead to early heart disease. It’s a condition researchers now say is twice as common in the U.S. as previously thought, affecting one in 250 adults.

In a study published recently in the journal Circulation, investigators estimate FH affects about 834,500 American adults and impacts racial and ethnic groups differently. It is most common among blacks and whites and, by comparison, half as common among Mexican Americans.

Researchers analyzed health information and family histories of heart disease from 36,949 participants in the National Health and Nutrition Examination Survey. Information about the frequency of FH in nonwhite populations is scant, and the results give researchers a better baseline of the multiethnic population in the U.S., said the study’s lead investigator Sarah de Ferranti, M.D., director of preventive cardiology at Boston Children’s Hospital.

The next step, she said, is to “do more focused testing to try to get a better sense of what’s going on” in specific ethnic and racial groups.

Overall, almost half of Hispanic adults with traditional high cholesterol don’t know they have the condition—and among those with a diagnosis, less than a third are being treated, according to a study published last year in the Journal of the American Heart Association. Data from the Centers for Disease Control and Prevention also show that Mexican-American men are more likely to have traditional high cholesterol than their white and black counterparts.

People with FH have a defective receptor that cannot bind with LDL to eliminate it from the body. Without treatment, LDL can exceed 190 milligrams per deciliter in adults and 160 mg/dL in children.

Doctors use high doses of cholesterol-lowering statin drugs to treat FH. The Food and Drug Administration last summer approved two new targeted drugs to treat adults with FH. Called Praluent (alirocumab) and Repatha (evolocumab), the drugs are part of a new class of cholesterol-lowering medicines called PCSK9 inhibitors.

New Orleans cardiologist Keith C. Ferdinand, M.D., said it is common for patients with a family history of atherosclerosis—the hardening and narrowing of arteries that is the main cause of heart disease—to forgo checkups because they don’t feel sick.

“The lack of symptoms does not mean the lack of risk,” he said.

Ferdinand said the new prevalence findings may help people recognize the importance of having a lipid test that looks at all cholesterol levels—total cholesterol, LDL, “good” HDL and triglycerides—and knowing their family history of heart disease. It also reminds doctors to focus on risk factors to identify patients with FH, he said.

Federal guidelines recommend having cholesterol checked every five years starting at age 20. Children between ages 9 and 11 should also be screened at least once and again between 17 and 21, the guidelines say.

Leticia Perez’s high cholesterol levels can be traced to her father, who died of a heart attack in his 40s. Perez said she regrets not getting regular checkups and taking her medication regularly in the years after she was diagnosed in her 30s.

In 2011, Perez had bypass surgery. The former leasing agent can no longer work because of her poor health and urges others with a family history of heart disease to get their cholesterol checked.

“Honestly, what I am going through, I wouldn’t want anyone to go through,” said the 57-year-old grandmother from Houston.

Gradney is now 38 and lives in Baton Rouge with his wife, Kristen, and their 4-year-old son, Hunter. Testing has revealed Hunter has the markers for FH. Gradney hopes others with similar health backgrounds learn about FH and not wait until they are in an emergency room to take charge of their health.

These days, Gradney continues to exercise and watch his diet. His primary cardiologist is treating him aggressively with medications, and she tells him not to worry.

“She promised me that I would be dancing at my son’s wedding,” Gradney said.

From American Heart Association News

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