Family history key in considering heart disease risk

Why It Matters:

  • Too much cholesterol in the blood can build up and lead to narrowing of the arteries, increasing the risk of a heart attack or stroke.
  • Family history is important in evaluating cholesterol levels, as there may be a genetic component that should be treated.
  • Even children should be screened for high cholesterol so that lifestyle changes and medication, if necessary, can bring it under control.

American Heart Association tkc.profilePicture Written by: American Heart Association | Transamerica
April 30, 2019

5 Min readClock Icon

Carl Korfmacher was nine years old when his father, Ron, returned from the Mayo Clinic for a checkup in the early 1970s.

Though he was lean and seemed fit, his father had been experiencing chest pains and coughing. His cholesterol was high. Plus, he was a heavy smoker. As he arrived home that day, July 4th — his 37th birthday — Ron Korfmacher assured his family everything was going to be fine.

The next day, at his belated birthday celebration, amid the sound of firecrackers, he fell over at a picnic table. He struggled to breathe. Then, he died of a heart attack.

The man young Carl so looked up to was gone. He was buried a few days later, on Carl’s 10th birthday.

“He was a very wonderful and unique individual,” Carl Korfmacher recalled. “They couldn’t believe that a man that young could have heart disease.”

Getting cholesterol checked

A few months later, Carl Korfmacher’s mother, Louise, had her children’s cholesterol checked. It was a wise decision. He and his brothers had elevated cholesterol levels, like their father.

Cholesterol is a waxy substance in the blood that can build up in arteries and lead to atherosclerosis, or narrowing of the arteries, which can eventually result in a heart attack or stroke. Other factors, such as high blood pressure, diabetes and smoking, compound the risk.1

Cholesterol-lowering medicine wasn’t readily available then, so Louise made sure the family adhered to a healthy diet aimed at combatting high cholesterol.

“She was pretty adamant and very careful,” Korfmacher said.

They ate very little red meat, used egg substitutes, and drank dehydrated skim milk because that’s what was available.

“We hated that!” Korfmacher recalled. But he would come to cherish his mother’s insistence on safeguarding their health.

About 20 years ago, Korfmacher began taking statin drugs, a type of cholesterol-lowering medication that can help reduce the risk of heart attack and stroke. At the time, his overall cholesterol was around 270 to 280 mg/dL (milligrams per deciliter) and his ratios of HDL, or “good” cholesterol,” and LDL, or “bad cholesterol,” weren’t in a desirable range.

A variety of studies have suggested that the optimal level of LDL in adults is less than 100 mg/dL. Recent research has found that those with LDL of 160 or higher, even with no history of heart disease or diabetes, had a 70–90% higher risk of dying from cardiovascular disease compared with those who had LDL below 100.2

Family history and screening children

New cholesterol guidelines published in November 2018 in the journal Circulation advised that health care providers should look at family history and other health conditions in assessing a patient’s heart disease risk.

“Family history of high cholesterol suggests there may be a genetic cholesterol disorder,” said Sarah de Ferranti, MD, MPH, chief of outpatient cardiology and director of preventive cardiology at Boston Children’s Hospital. “Cholesterol screening can identify the one in 250 people who have a genetic cholesterol disorder,” she said.

“Even young adults and children should have their cholesterol tested. If there’s a family history of early heart disease or high cholesterol, children can reasonably be screened as young as age two,3 with repeat screening every three to five years,” said de Ferranti, a member of the committee that wrote the new guidelines.

“If a child has other cardiovascular risk factors, such as hypertension, obesity or diabetes, that can reasonably prompt a lipid screen that will check cholesterol,” de Ferranti said.

For otherwise healthy children without a concerning family history, it may be reasonable to do routine screening between ages nine and 11, and again between 17 and 21. 3

At the urging of his mother Louise, Korfmacher’s two sons underwent cholesterol screening during routine physicals when they were younger. They, too, had elevated cholesterol levels.

Doctors diagnosed Korfmacher and his boys with familial hypercholesterolemia , an inherited condition of high cholesterol associated with a significant increased risk of early heart attack.

A healthy lifestyle

Today, Korfmacher, 55, and his sons Henry, 18, and Owin 14, keep their cholesterol under control through statins, a healthy diet and exercise. His wife Krista stays active too, encouraging physical activity as a family way of life.

“I think we’re a good example for our boys,” Carl Korfmacher said. “As parents, we try to instill it as a culture: We are not obese people. We work out. We are exercisers. That’s who we are.”

Korfmacher plays basketball three times per week, lifts weights, and likes to hike and spend time outdoors near their home in Evansville, Wisconsin.

Their sons play organized sports and choose an exercise plan to their liking when they aren’t in a sports season. They also limit use of electronic devices to reduce sedentary time.

The family keeps calories under control and limits carbohydrates such as white bread. One night a week they have salmon for dinner; another night they eat chicken; and another night they prepare a vegetarian meal. They eat some beef but choose lean cuts.

Krista Korfmacher makes brownies and muffins using apple sauce in place of butter, and the boys enjoy them. “They think it’s awesome, and they eat them,” Carl Korfmacher said.

“Such lifestyle changes should be tried in nearly all situations when cholesterol is high and should be embraced early in life,” de Ferranti said.

“Following a heart healthy diet and getting sufficient physical activity are the bedrock of promoting cardiovascular health in childhood and adolescents,” she said.

“However,” de Ferranti added,” medications may be needed in addition to lifestyle modifications, as in cases of genetic cholesterol disorders.”

“Sometimes, no matter how optimal your lifestyle is, your body just creates too much cholesterol and statins are needed,” she said.

Carl and Krista Korfmacher encourage their sons to think about how to make good health decisions on their own as they strive to keep their overall cholesterol levels below 200 and their ratios of HDL and LDL cholesterol in optimum ranges.

They all have become involved in the American Heart Association in Madison, and last year told their story as part of the local Heart Ball to raise awareness about the importance of family history and cholesterol.

Their message for others, Carl Korfmacher said, is: “Stay on top of it. No news is not good news – get checked and tested. Learn about a healthy lifestyle and live it. It won't only benefit your heart, but the rest of your life in so many ways.”

"And for your children's sake,” he concluded, “get them off the couch and away from their screens."

1 “Control Your Cholesterol,” American Heart Association, 2017

2 “Bad Cholesterol Can Be Deadly in Otherwise Healthy People,” HealthDay, 2018

3 American Heart Association News, 2018

This article was prepared by the American Heart Association (AHA). Transamerica is not affiliated with the AHA and does not control, guarantee, or endorse the information. This information does not constitute the practice of medical advice, diagnosis or treatment. Always talk to your healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and experiencing a medical emergency, call 911, or call for emergency medical help immediately.



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