FH is otherwise known as Familial Hypercholesterolaemia.
Now, Familial you kind of understand that, it runs in families but that’s a really key
point. You inherit it. Because it runs in your family, you actually get it from the
time you are born. The Hypercholesterolaemia bit is a typical long medical word but it
kind of makes sense. So the Hyper just means too much, cholesterol just means cholesterol
and aemia means in the blood. So Familial, it runs in the family, too much cholesterol
in your blood. But really importantly, it runs in your blood from the day you were born
and that means by the time you reach your 20’s and 30’s, you are at greatly increased
risk of heart attack and stroke. Most people think of high cholesterol as being
related to lifestyle and they therefore think that they can change it by improving their
lifestyle. The problem with FH is that you don’t develop high cholesterol because of
the way you lived or as you get older, you’ve got it from the moment that you’re born because
of the way your body processes cholesterol. It just can’t process cholesterol in the right
way. That means that no matter what you do, no matter how healthy you are, you are unfortunately
still without treatment going to be at greatly increased risk of heart attack or stroke.
When I first became a doctor, all we really knew about was cholesterol because that’s
all we measured. We actually know now is that there’s an awful lot more to it. Cholesterol
is made up of all different kinds of cholesterol. You have your total cholesterol measure, then
you have something called your LDL or low density lipoprotein. That’s the bad guy, that’s
the one that gets laid down in the inside of your arteries and furs them up, a bit like
limescale blocking up the pipes. Then there’s a good kind, the good kind is called HDL or
high density lipoprotein. What that does, is that if you’ve got a plaque, a lump of
cholesterol, it makes it less likely to spill open and block your arteries causing heart
attack. But it also interestingly, sucks up bad cholesterol from the arteries and carries
it back to the liver where your body can’t get hold of it. So in fact, HDL protects you
against heart attack and stroke even though it’s a kind of cholesterol. Sadly, the vast
majority of people in this country and certainly those with FH, have too much of the bad kind.
About 1 in 500 people have FH although a lot of them, of course, don’t know it. We have
several things that we look for in the surgery, in my surgery as a GP. So, the first thing
I’m going to look for is what somebody’s level of cholesterol is, if it’s above 7.5 and their
an adult, then it will make me prick up my ears and think, should I be looking further?
Next, I’m going to look for, have other members of your family, parents, sisters, so on had
heart attacks young or have they had raised cholesterol. Then I’m going to look for the
physical signs at an early stage, so these fatty deposits under the eyes and they’ll
also get little deposits here, on their tendons, the back of the elbows and the back of the
ankles. If you have combinations of those, we start to wonder either if you might have
FH or, in some cases, we can be fairly confident that you do.
It’s never fun hearing that you’ve got something wrong with you, it’s certainly never fun hearing
that you’ve got something wrong with you that can’t be cured and that means you’re going
to have to take medication for the rest of your life. But if you get a diagnosis and
therefore you can be treated, that can be an enormous weight off your shoulders, because
you know that you may be the first generation that breaks the trend, the first generation
who doesn’t leave their kids without a parent. If you’ve been diagnosed with FH, we do need
to get you onto treatment and you do need to take that treatment regularly and for the
rest of your life. It’s really important to do what everybody else should be doing, which
is to take care of your heart so exercise, keeping your weight to healthy levels, keeping
your diet healthy and heart-healthy particularly and, of course, not smoking. Very important.
For most people, a heart-healthy diet is really a Mediterranean Diet. Now I’m not talking
about eating lots of those little Greek pastries or the rich stews or whatever. But what we’re
talking about is lots and lots of fruit and vegetables, and ideally more salads or under-cooked
or relatively little cooked vegetables. Not quite so much meat, more fish, particularly
oily fish can be really useful. Mono or poly unsaturates, now what we mean by those are
the oils, the heart-healthy oils, olive oil, rapeseed oil, that sort of thing can be really
good. And if you’re going to have carbohydrates,and they are fine, but make sure that they are
what we call unrefined carbohydrates so basically, if it’s white, it ain’t great white sugar,
white flour, white bread. Really, think about alternatives, you should be thinking about
things that have got multi-grains: wholemeal bread, granary bread, brown rice, whole wheat
pasta, that sort of thing. That can make a really, really big difference.