Ken had just turned 40, and with a little encouragement from his wife, he decided that it was time to have a physical—it would be his first real visit to a doctor since he broke his arm as a kid. Seeing a doctor had not made sense to him before. He was in great shape, felt fine, and did not smoke. Maybe it was his 65-year-old father’s sudden death from a heart attack just a few weeks after his retirement that finally convinced Ken to find himself a doctor. He knew that his father had had high cholesterol, but he was told his own cholesterol level and electrocardiogram results were okay when he entered the military at age 18. Besides, Ken was not big on desserts and only ate a Big Mac when he took the kids out after their soccer games.
The examination was quite uneventful and Ken was reassured when the doctor could not find anything of concern. A few recommendations on nutrition and better ways to exercise were about all that came out of the visit. Then he got the call from the doctor’s office—could he make a follow-up appointment to discuss his cholesterol?
His low-density lipoprotein (LDL, or “bad” cholesterol) was 165 and his high-density lipoprotein (HDL, or “good” cholesterol) was 40.
“We used to think these levels were okay because they are so common,” his doctor began. “However, now we consider your LDL cholesterol too high because it increases your chances of developing heart and other blood vessel diseases. There is no evidence of heart disease at this point, but your cholesterol needs attention.”
“What do you mean by ‘attention’?” Ken replied. “I exercise, do not smoke, and generally keep my fats down.”
Ken soon learned a lot more about cholesterol. He first tried his best at changing his diet—it helped a little, but just did not do the trick.
Ken’s doctor told him: “For some people, there is a strong genetic component to high cholesterol levels, and while diet is still important, it just cannot always reduce LDL cholesterol enough by itself. Exercise helps, especially by increasing the good cholesterol, but it does not do much for the bad cholesterol. Medication may be needed and there is now evidence that if taken regularly, it reduces the chances of having a heart attack or at least delays its occurrence.”
Taking medication every day was not so easy for Ken, but he stuck with the plan. His doctor asked him to have his cholesterol levels checked every few months for the first year. Ken was amazed at how well the medicine worked. His LDL fell from 165 to less than 100 on only a modest dose. In addition to routine cholesterol checks, Ken had his blood tested for potential side effects from the medication, such as impacts to his liver, and he was told to report any long-lasting muscle aches and pains. The good news was that he could not tell he was taking the medication—he felt just fine.
Now that the cholesterol levels had dropped, he thought maybe he could go off the medication if he just watched his diet closely. His doctor let him try that for a month, but after the 30 days were up, his LDL level was back up to 160.
“Looks like you are hooked on medication for life,” his doctor said with a wry smile, adding, “At least the extra cost is worth the extra benefit.”
Ken and his wife were told the high cholesterol levels were a genetic condition. Not only did Ken need to take the medication on a permanent basis, but the pediatricians began testing his kids.
The doctors said, “We are beginning to understand the genetics behind this condition and would like to do some genetic testing on the children, including that new baby of yours.”
Ken wondered if the information on his children’s cholesterol levels would be part of their medical records for the rest of their lives. “You are not planning to put that on the Internet, are you?” Ken joked nervously as they drew blood from his newborn son.