How family history affects your cholesterol 

Dr. Nouran Sorour is a cardiologist at UK HealthCare’s Gill Heart & Vascular Institute and an assistant professor of internal medicine in the UK College of Medicine. 

When I meet with patients who have high cholesterol, one of the first things I ask about is their family history. Why? Because for many people, cholesterol isn't just about diet or exercise — it’s about genetics. 

If high cholesterol “runs in your family,” it’s important to understand what that means and how you can act early to improve your health. 

What is cholesterol? 

Cholesterol is a fat-like substance your body needs to build cells and hormones. Too much of the wrong kind can build up in your arteries and increase your risk for things like heart disease, heart attack, and stroke.

In discussions of cholesterol you will often hear about LDL, HDL and triglycerides. 

• LDL (low-density lipoprotein) or “bad” cholesterol, contributes to plaque buildup in arteries. 
• HDL (high-density lipoprotein), or “good” cholesterol, is associated with reduced cardiovascular risk.
• Triglycerides are another type of fat that can also raise risk. 

Managing your cholesterol is one of the most important ways to protect your heart. 

Genetic influence on cholesterol

Genetics play a major role in how your body processes cholesterol. Some people are born with genes that cause their liver to produce too much LDL or fail to clear it efficiently. 

The most common inherited condition is called familial hypercholesterolemia (FH). This condition affects about 1 in 250 people but often goes undiagnosed. Symptoms of FH may include: 

• LDL levels over 190 mg/dL (even in childhood) 
• Early heart disease — sometimes in a person’s 30s or 40s 
• A strong family history of heart attacks or strokes 

So, how do you know if high cholesterol “runs in the family?” Here are some red flags to look for:  

• Parents, siblings, or grandparents with heart disease before age 55 (men) or 65 (women) 
• Relatives with high cholesterol despite a healthy lifestyle 
• Family members on cholesterol-lowering medications from a young age 
• You’ve been told your LDL is “very high” (>190) with no other obvious cause 

If any of these apply, talk to your doctor. You may benefit from earlier testing and more aggressive management. The general recommendation for testing is age 20 or earlier if you have a strong family history. 

For children of a parent with FH, the recommendation is between the ages of 2 and 10. At UK HealthCare, we often start screening earlier and more frequently for patients with a known family history. We also use advanced lipid testing when needed. 

Inherited vs. lifestyle driven

Inherited high cholesterol (like FH) comes from a genetic mutation, often causes very high LDL levels regardless of your diet and requires lifelong treatment with medications. 

Lifestyle-driven high cholesterol develops over time due to diet, weight, lack of exercise or smoking. It may be milder and easier to reverse with lifestyle change, but it still increases heart risk. It is not uncommon for this type of high cholesterol to be managed without medication. 

Sometimes, people have a genetic predisposition made worse by lifestyle factors. That’s why early detection is key. 

Even if genetics are working against you, lifestyle still matters. I recommend: 

• Eating a heart-healthy diet (low in saturated fat, high in fiber and plant-based foods) 
• Exercising regularly (150 minutes of moderate activity per week) 
•  Avoiding tobacco in all forms 
• Maintaining a healthy weight 
• Limiting alcohol 
• Managing other conditions like high blood pressure or diabetes 

These changes don’t always replace medication, but they reduce your overall cardiovascular risk. 

Treatments for high cholesterol 

At UK HealthCare, we take a comprehensive and personalized approach to cholesterol management. We believe in treating the whole patient, not just the numbers, and that means considering your family, your lifestyle, and your long-term heart health. 

Here’s how we stand out: 

• Family-based screening for FH and early intervention in children 
• Access to genetic counseling and specialized lab testing 
• Collaborative care between cardiology, endocrinology, and primary care 
• Enrollment in clinical trials and registries for cutting-edge therapies 

The best treatment depends on your LDL levels, family history and personal risk. Several effective options are available, and treatment is usually long-term:

• Statins (e.g., atorvastatin, rosuvastatin): first-line therapy 
• Ezetimibe: lowers cholesterol absorption from food 
• PCSK9 inhibitors (e.g., alirocumab, evolocumab): powerful injections for severe cases 
• Bempedoic acid: a newer oral medication for patients who can’t tolerate statins 

If high cholesterol runs in your family, don’t panic but don’t ignore it either. Genetics may raise your risk, but you’re not powerless. The earlier you know your numbers, the sooner you can take action. 

Talk to your doctor and ask about testing. If needed, see a cardiologist. We’re here to help you protect your heart no matter what your DNA says.