For so many years the message has been that high cholesterol (specifically high LDL) is the predictor of heart disease. However, increasingly it seems that the best predictor is not high cholesterol, but calcification of the arteries. And the take home appears to be that if you have a zero or low calcium score you risk of a heart attack is negligible.
This taken from Doc’s Opinion:
An individual without coronary artery calcification is very unlikely to have a severe narrowing of a coronary artery.
Now, with the diet/heart hypothesis, and of course cholesterol levels coming under increasing scrutiny and the science leading up to the conclusions failing to prove causation, then maybe it’s time to put the spotlight on the alternatives.
So, having said that, are you one of the 500 who has been diagnosed with the commonest form of FH? If so, what are your options? Currently, if we to accept the current paradigm, it’s a lifetime of statins (a huge consideration, especially if your child has the condition).
But hold on! If you have FH and have a calcium score of zero, then your risk of heart disease is negligible. So how does that stack up against the known, sometimes appalling side effects of statins and the likely diminished quality of life (mild to rhabdomyolysis) taking them?
Again from Doc’s Opinion:
One randomized placebo-controlled trial did not find any significant benefit with atorvastatin (cholesterol lowering drug), vitamin C and vitamin E in patients with high coronary artery calcium score.
i.e. Statins will not lower your calcium score.
There is a whole lot of information from the following link, including a 2008 study from the Simon Broome FH Registry UK which is linked to Heart UK: heartuk.org.uk/files/upload...
If then we believe that the risk of a heart attack is greatest in the early to middle years and those over 60 with FH are at the same risk as the population, then why would anyone of that age still be taking statins, especially if they got there without taking them? From this we can conclude that having FH is not an automatic death sentence when you neglect to take statins.
You might say:
’Ah yes, but would you take a chance that your child, or indeed you, might not fall into the lucky category and make it to 60 without statins?’
I’d probably agree with your very real concerns - unless of course I possessed the knowledge that coronary calcification is the primary indicator for predicting a heart attack, and that would be the same for anyone whether you have FH or not.
Statins undoubtably have a part to play in the management of FH but what I guess I’m saying is that there is an argument that anyone diagnosed with the commonest form of FH might just avoid taking a powerful medicine if a coronary calcium scan indicates a zero or low score.