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Lipids and Your Children: The Good the Bad and the Ugly”

 

“Do you know your numbers” teases a well-known Big Pharma ad for a leading cholesterol lowering medication that globally has amassed 125 Billion in sales over 14.5 years.  Suddenly, with that simple question the burden of monitoring our own vital health parameters and those of our children, such as cholesterol, blood pressure, Body Mass Index and more, was placed squarely on the shoulders of all parents and their families. 

Moreover families have the additional burden of knowing whether or not there exists a genetic predisposition in your family for “familial hypercholesterolemia” or “FH”.    Furthermore, does your family have a positive family history of premature heart disease (< 50 years of age), Type II Diabetes and other comorbidities associated with Obesity?   

Most family’s education and real life experience did not provide them the knowledge to be engaged participants in your own personal health monitoring, much less on the physiological pathways of cholesterol (lipid) metabolism. What are we to do?  How much will our families health insurance premiums increase if our children or other family members are diagnosed with high cholesterol?  Hopefully, the following information will get you started at designing with your physician a “Personal/Family Preventive Health Plan”.

Typically affecting between 5% and 25% of the global population, Lipid disorders or “Dyslipidemias” are often underdiagnosed, undertreated and not well explained by most health care professionals.  The incidence can vary greatly depending on ethnicity, geographical region, genetics, physiology, diet & exercise and a multitude of other variables studied and recognized as confounding variables in our health risk profile.

A simple distribution curve of US Adult fasting lipid levels would naturally place 5% of the “general” population either below or above two standard deviations (95%) of the population “normal”.  But who is normal and what are lipids or cholesterol anyway. When should we seek medical advice or treatment?

To understand the abnormal, of course we first have to comprehend the normal.  Cholesterol is a fat that is synthesized from a chemical that serves as a building block for many physiologic substances and reactions, Acetyl Co-Enzyme A.  Neurotransmitters, hormones, cell walls and energy stores all depend on the “Acetyl CoA” pathways.  Therefore, cholesterol metabolism and synthesis is a vital part of human physiologic remodeling and optimal health.  Development of fatty brain tissue in infants depend the high fat diet provided by breast milk and diet.  All adults require fats for good wound healing and regeneration of all cellular structures.

Abnormalities of cholesterol metabolism, hence abnormal lipid profiles, result from a variety of causes. The most serious are those that are inherited or have a genetic basis.  The “Familial Dyslipidemias” are generally identified by a thorough family and personal health history.   If Uncle John takes medication for his lipid disorder and is known to have “arcus senilius” (a halo of discoloration around pupil caused by excess cholesterol deposits), he may be a carrier of a gene for Familial Hypercholesterolemia (FH).  

Then it gets complicated.  Suffice it to say that if you or your children have a first degree relative (mother, father, brother, sister) that takes medications (or should be taking medication) for an abnormal lipid profile, then all first degree relatives of that “index” case should seek medical evaluation.  Your physician or cardiologist should then provide adequate information to understand your risks of the same condition or any impact the condition may have on your future or current health.

Next, we have a much larger group of the US and global population that have abnormal lipid profiles secondary to an abnormal “Personal Cardiovascular Risk Profile”.  That is overweight/obesity, hi-fat hi-simple carb diet, lack of physical activity, smoking. Hypertension, type II diabetes and we cannot forget stress (the ultimate risk factor).  

The true incidence of lipid disorders due to the “lifestyle” factors is unknown.  This is partly due to the general population not taking a preventive health approach to their lives, partly to physician’s apathy to evaluate medical conditions that are caused by lifestyle and the general attitude in our culture of self-responsibility.

The Journal of the American College of Cardiology last year published a report demonstrating the majority of adult cardiologist and primary care physicians surveyed for the review did not adequately screen for personal and familial risk factors or existing lipid disorders.  The rates of attrition from treatment protocols when treated was unexpectedly high (60-90%) and most primary care physicians never conducted a decent Cardiac Health Risk Appraisal.   So if our health industry is fairing so poorly at watching over our health, how can we be expected to identify, treat and reverse a potentially fatal condition?

The best defense is a good offense.  Know your family’s medical history as if it were your own.  Demand of your health care providers that they conduct a thorough “heart health risk appraisal” and discuss the results and meaning with you in lay terms.  Lastly, there exist a new breed of physician practice known as the Concierge Medical Practice where the emphasis in on personalized health planning where preventive health and wellness are the cornerstone of your quest for optimal health.  Be ready to pay a premium for that special attention and convenience. 

 

As heads of households, it is imperative that we find easy convenient ways to incorporate low cost corporate prevention and wellness strategies for our families.  You should explore available options for your family to complete a family and personal health risk appraisal questionnaires, which will recommend test and labs and inform your primary care physician. This not only makes you a good consumer of health care but engages you in the decision making process of prevention for your family.  Most online sites have large archives of excellent nutritional, physical activity and general wellness information at your disposal.  Many families will load these applications on the family computer for all to use and monitor their health through these virtual preventive health portals which include competition with gaming features that promote self-monitoring and peer support to chronic disease management.

 

It is a fact that we spend more time monitoring our automobiles than we do our own health. With the explosion of applications and wearable devices for monitoring we are seeing a significant paradigm shift.  Unfortunately it would seem that waiting for our health provider to deliver timely, quality, convenient and affordable preventive health advice is a losing proposition.  Families are charged with becoming good consumers of their health care by informing themselves of their health risks for chronic disease conditions such as dyslipidemias and heart disease.  Your health insurance company will ultimately reward you and your small business for preventing costly chronic diseases and hopefully you will see those premiums go down.