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Familial hypercholesterolemia (FH) and high lipoprotein (a), or Lp(a), are two common inherited conditions that increase a person’s risk for early heart disease and stroke.

Risks associated with FH

There are two types of FH: heterozygous (HeFH) and homozygous (HoFH). In the simplest terms, a person has HeFH if they inherited a gene for FH from one parent. A person with HoFH inherited a gene for FH from both parents.

People with HeFH have very elevated LDL-cholesterol levels from even before birth. This leads to narrowing or blocking of blood vessels (atherosclerosis). This can ultimately lead to heart disease, heart attack, or stroke. Because people with FH have excessively high cholesterol levels since before birth, their risk of heart disease is up to 20 times greater than that of the general population.

Those with HoFH are at even greater risk since their LDL levels are extraordinarily elevated. If untreated, many of these individuals can develop heart disease in their teenage years.

Risks associated with high Lp(a)

Individuals with elevated Lp(a) typically reach their adult levels by the time they’re five years old. This means, just like with FH, atherosclerosis can begin early in life. The risk for early heart disease and stroke is roughly 2-4 times higher than the general population.

Know the numbers
  • High Lp(a) occurs in 1 in every 5 people
  • Fewer than 1% of those people know they have high Lp(a)
  • HeFH occurs in 1 in every 250 people
  • HoFH occurs in 1 in every 300,000 people
  • Heart disease is the #1 killer of men and women around the world
  • More women die of heart disease than all forms of cancer combined
  • If untreated, a man with FH has a 50% chance of having a heart attack before the age of 50
Know the treatments

There are currently many medications available to lower LDL cholesterol. On the other hand, the only FDA-approved therapy to lower Lp(a) is lipoprotein apheresis. It’s a dialysis-like procedure where a machine physically removes both Lp(a) and LDL cholesterol from the blood stream on a weekly or bi-weekly basis. This 3-hour process involves removing blood from one arm, passing it through a special column to extract the LDL and Lp(a), and returning the blood to the other arm. For apheresis to be approved, a person must have an Lp(a) greater than 60 mg/dl, have FH, and/or a known vascular disease. Click here to view Lipoprotein Apheresis center locations

Even without medication, people with FH and high Lp(a) can work to reduce all other risk factors. If you are overweight, try to get to a healthier weight. If you smoke, please quit. These are not easy changes to make, but the sooner you do it – the better. If you have other risk factors, like high blood pressure or diabetes, take all prescribed medications.