People living with an inherited form of high cholesterol could be at risk of heart attack or stroke long before they realise anything is wrong, according to leading cardiovascular experts speaking at the FH Caravan: Detect the Invisible. Prevent the Inevitable. event.
The forum, organised by the Philippine Lipid and Atherosclerosis Society (PLAS) in partnership with Organon Philippines, brought together healthcare professionals to discuss the latest thinking on cholesterol management and raise awareness of familial hypercholesterolemia (FH), a genetic condition that causes lifelong high levels of LDL, or ‘bad’, cholesterol.
A hidden risk that can be identified earlier
Experts said FH is often missed until someone has already experienced a serious cardiovascular event, despite being one of the most common inherited disorder causing premature coronary artery disease.
‘Familial hypercholesterolemia is a preventable cause of early cardiovascular mortality and morbidity,’ said Dr. Cecilia A. Jimeno, vice president of PLAS. ‘There’s a greater risk of cardiovascular disease because of lifelong exposure to elevated cholesterol levels.’
Dr. Jimeno said many people are diagnosed far too late, often only after suffering a heart attack or stroke.
‘We make the diagnosis too late,’ Dr. Jimeno said. ‘Most of those enrolled in our registry were diagnosed after they’ve already had an event rather than being identified in the outpatient setting.’
She encouraged healthcare professionals to look more closely at patients with LDL cholesterol levels of 190 mg/dL or higher, particularly if they have a family history of early heart disease or physical signs that may point to FH.
‘If you see an LDL cholesterol of 190 mg/dL or above, don’t stop there,’ she said. ‘Check the family history, look for physical stigmata and consider familial hypercholesterolemia.’
Dr. Jimeno also encouraged healthcare professionals to contribute to the Filipino Heart for Familial Hypercholesterolemia (FH²) Registry, which aims to improve understanding of the condition and support earlier diagnosis across the Philippines.
Earlier treatment can make a big difference
The discussion also focused on growing evidence showing that lowering LDL cholesterol as early as possible can significantly reduce the risk of future cardiovascular disease.
‘The earlier you lower your LDL cholesterol, the bigger the lifetime payoff,’ Dr. Deborah Ignacia D. Ona said. ‘The earlier, the faster and the longer you get your LDL cholesterol to target, the better you reduce cardiovascular risk.’
Dr. Ona said treatment approaches are evolving, with clinicians increasingly considering earlier combination therapies for patients who are unlikely to reach their cholesterol targets with statins alone.
‘The philosophy now is: don’t wait,’ she said.
She added that understanding a person’s cardiovascular risk requires more than simply using standard risk calculators. Imaging tools, coronary artery calcium scoring and other risk factors can help identify people who may benefit from earlier or more intensive treatment.
‘It’s not just plugging numbers into a risk calculator,’ she said. ‘We have to look at all of the patient’s possible risks because determining the patient’s true risk guides our treatment.’
Prevention starts with understanding risk
Dr. Federick C. Cheng said advances in lipid management mean doctors can now do more than slow the progression of heart disease – in some cases, they can help reduce plaque buildup in the arteries.
‘Before, we could only say that statins slowed the progression of atherosclerosis. Now we can say that we can achieve regression of atherosclerosis,’ he said. ‘If your patient already has evidence of atherosclerosis or has experienced a cardiovascular event, aim for an LDL cholesterol of less than 60 mg/dL. You’re not only reducing future cardiovascular events, you are helping reverse plaque buildup.’
Dr. Cheng said doctors should consider a broader range of factors when assessing cardiovascular risk, rather than focusing only on traditional risks such as high blood pressure, diabetes, smoking and obesity.
‘Ten years ago, I focused only on traditional risk factors such as hypertension, diabetes, cholesterol, smoking, obesity and sedentary lifestyle,’ he said. ‘Today, we recognize many more risk modifiers that help us identify patients who need more aggressive treatment.’
He added that identifying cardiovascular risk early gives healthcare professionals an opportunity to educate patients and their families before serious health problems occur.
‘Prevention is always better than cure. Every patient who walks into our clinic should have their cardiovascular risk assessed,’ Dr. Cheng said. ‘If a patient has hypertension, diabetes or a family history of cardiovascular disease, it’s our responsibility to educate not only the patient but also their children. We need to start prevention early and screen those who need to be screened.’
Experts agreed that while FH often goes unrecognised, its impact can be reduced through earlier diagnosis, a better understanding of cardiovascular risk and timely treatment.