FROM: www.Dr.

Even though familial hypercholesterolemia–a genetic condition that causes very high cholesterol levels–has been linked to the early onset of heart disease, the risk of early death may vary significantly among people with the disorder.

Moreover, researchers speculate, the findings suggest that other factors such as diet and exercise help determine the overall death risk of people with the genetic condition.

In a study of an extended family affected by familial hypercholesterolemia, investigators found that, over two centuries, about 40% of family members lived normal life spans.

During the 1800s, members of the family tended to live longer than average for the time, but the rate of early death began to rise in 1915, reaching a peak in the 1950s, according to the authors. Since then, the life expectancy of the family members has been increasing.

But the investigators found that death rates varied considerably from branch to branch of the family tree. During the decades when the family as a whole had shorter-than-average life spans, some branches of the family had normal life spans and others had extremely high rates of premature death.

The wide variations in risk suggest that environmental factors, such as

* diet

* smoking

* physical activity

may interact with genetics to affect the risk of cardiovascular disease and early death.

It is possible that high levels of “bad” LDL cholesterol might have protected 19th century family members from infections common at the time, while the lack of other heart disease risk factors, such as widespread cigarette smoking or fatty diets, might have reduced their risk of death.

Since death rates varied from branch to branch of the family tree, other genetic factors might have affected the risk as well. Variations in social class and in where different branches lived may also have had an effect.

Whatever the reasons for the variations, the study shows that even though genes are important in determining life expectancy, environmental factors also play a major role.

British Medical Journal April 28, 2001;322:1019-1023


About one in 500 people have a genetic defect in which they have elevated cholesterol levels of 350 or even higher. This level seems to be resistant to every type of dietary modification. Yes, even the no grain, no sugar approach.

Eating eggs will NOT raise one’s cholesterol.

This is an important study in that it shows that just because one’s cholesterol is elevated, even as high as 350, it does NOT mean that one will die of heart disease.

Stress also can play a huge role in cholesterol oxidation, as can lack of sleep and too little or too much exercise.

So the issue of whether or not to treat cholesterol is much more complex than it appears to be. It is certainly not as simple as putting everyone with an elevated cholesterol on medication.

I believe this is a major piece of research in that it fully emphasized the critical nature of lifestyle and NOT genetics on the influence of chronic disease (in this case heart disease, the number one killer in the US).

That is why it is important to check for other risk factors like homocysteine, ferritin, and Lp(a)/

It is interesting to note though that the researchers and journal editors conclude that since they can not identify which factors are responsible, they advise ALL of these individuals be treated with cholesterol-lowering drugs.

ADDITIONAL COMMENT: Unless one has a genetic defect of LDL which usually results in cholesterol levels above 350, the total cholesterol level is just about worthless in determining one’s risk for heart disease. This study done in the prestigious cardiology journal used a drug to “prove” this point. One does not have to pay the price with their income or loss of health though by using these drugs to achieve this benefit. It can be done with diet for just about everyone.

It is important to note what lab values ARE associated with risk for heart disease. The two most important are the HDL/Cholesterol and Triglyceride/HDL ratios. Generally the HDL ratio should be above 25 and preferably in the 30s. If it is in the 40s, that nearly guarantees immunity from heart disease. Whereas if it is below 15, and certainly below 10, a heart attack is inevitable. It is just a matter of when, not if, it will happen. The triglyceride ratio should be below 2.0.