Ask the Doctor: ‘I am young, fit and healthy, but my cholesterol is always high — could it be genetic?’

”I have read online that genetics can lead to high cholesterol and wonder if there is any truth to this? I am a female in my 30s and am extremely fit and healthy. I do 5k runs regularly and do Crossfit classes five times a week. My diet is healthy, I rarely eat processed foods, desserts or drink alcohol. Despite all of this, my cholesterol always remains slightly high. Both my parents have elevated cholesterol and it seems to be common in my mother’s family. Could there be any truth to genetics playing a part?”

Answer from Dr Aftab Jan, Consultant Cardiologist, Beacon Hospital.

Yes, genetics can play a significant role in the development of high cholesterol levels. Cholesterol is a waxy, fat-like substance that is produced by the liver and is found in all cells of the body. It is essential for the formation of cell membranes, hormones, and vitamin D.

However, when the levels of cholesterol in the blood become too high, it can increase the risk of developing heart disease, stroke, and other health problems.

There are two types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL cholesterol is often referred to as “bad cholesterol” because it can build up on the walls of the arteries and cause blockages, while HDL cholesterol is often referred to as “good cholesterol” because it helps to remove LDL cholesterol from the blood.

Inherited genetic factors can influence the levels of both LDL and HDL cholesterol in the blood. Some people have genetic mutations that can cause them to produce too much LDL cholesterol or not enough HDL cholesterol. These mutations can be passed down from parents to children and increase the risk of developing high cholesterol.

For example, a condition called familial hypercholesterolemia (FH) is an inherited genetic disorder that causes very high levels of LDL cholesterol in the blood. People with FH have a mutation in one of the genes responsible for clearing LDL cholesterol from the blood. This can lead to the accumulation of LDL cholesterol in the arteries, increasing the risk of developing heart disease at a young age.

Even if you do not have a specific genetic disorder like FH, inherited factors can still influence your cholesterol levels. Studies have shown that certain genetic variations can affect how your body processes cholesterol and how much cholesterol is produced by the liver. Therefore, it is possible that your elevated cholesterol levels are due to genetic factors, especially if both of your parents have high cholesterol.

However, it is important to note that lifestyle factors, such as diet and exercise, can also influence cholesterol levels. While you are doing everything right in terms of diet and exercise, it is possible that genetics may be playing a role in your elevated cholesterol levels.

It is recommended that you speak to your doctor about your cholesterol levels and any concerns you may have. Your doctor may recommend lifestyle modifications, such as changes to your diet and exercise routine, or medication to help lower your cholesterol levels. It is important to continue to prioritise a healthy lifestyle, even if you do have a genetic predisposition to high cholesterol, as this can help to reduce your risk of developing heart disease and other health problems.

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