Listen Well

A  heart  to  heart  on  dyslipidemia  part 2

Episode Summary

We’re picking up right where we left off in Part 1 of this 2-part series on dyslipidemia.

Episode Notes

We’re picking up right where we left off in Part 1 of this 2-part series on dyslipidemia. Our experts on heart health, Dr. Peter Lansberg and Katherine Wilemon, discuss preventing cardiovascular disease, the demographics who are most at risk, treatment options, and supportive lifestyles. We learn it’s never too early to start implementing heart-healthy measures and preventative behaviours – particularly with hereditary diseases. 

The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris.

Episode Transcription

Disclaimer: This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past as or may be current members of an advisory group for Viatris. 


Mo Alsuwaidan:  Welcome back to Listen Well, where we connect you to the world of health and wellness. I'm Dr Mo Alsuwaidan. In this episode we're not skipping a beat. We're picking up where we left off from part one of this two-part series. Episode five covers a lot of terminology and explains some of the phenomena that lead to poor heart health. So, I highly recommend listening to that episode first. It's okay, we'll wait.

Mo Alsuwaidan: Then come on back and join me and my guests Katherine Wilemon – Founder and CEO of the FH Foundation, and lipidologist, Dr Peter Lansberg, who return to talk about the concept of risk. What increases our chances of heart disease and how to reduce those odds? 

It's time to Listen Well.



Mo Alsuwaidan: So Dr. Lansberg, let's talk about risk when it comes to heart disease. First of all, who's at risk?

Dr. Peter Lansb...: Roughly half of the people that die, 45%, die from cardiovascular causes. The other half dies from cancer and trauma, or infectious diseases, but if you would do post-mortem examinations in those patients that died from other causes, you would probably find in quite a few already extensive atherosclerosis as well. So, it's an omnipresent disease that can affect us in more or less ways, and that creates causes of deaths, or causes of morbidity, or less high- quality of life. There's always a lot of emphasis on reducing mortality, making sure people don't die of cardiovascular disease. And I always say if you don't die of cardiovascular disease, you're more likely to die of other causes. And what our primary focus should be is to increase your quality of life over the period that you are living.

Dr. Peter Lansb...: So compressing the disease part of cardiovascular disease or forms of disease, that's our ultimate goal. It's not to become 150, but within the 80, 85 year lifespan, have 79 or 80 years of a very happy, healthy life. The thing is, we should start at a very early age to make sure we can achieve that. The best example I can think of is brushing your teeth. You don't start preventing your teeth from getting holes or falling out when you're 40, or 50, or 60. We've been trained to start taking care of your teeth as soon as they occur, in infancy almost. And when you do that properly, we now know that you can keep your teeth in a healthy condition up until a very old age.

Dr. Peter Lansb...: And for cardiovascular disease, I think that is the same approach we should try to aim for. Not throw everything that's in our toolbox when people are 50 or 60 to stop the process and to make sure that there's no additional serious problems, but very early in life, very simply make sure that people have a healthy diet, do some exercise, don't smoke, sleep well, have a balance between work and relaxation.

Mo Alsuwaidan: A work-life balance?

Dr. Peter Lansb...: Yes, exactly. Have a good social life. If you look at populations that became very old, and are very nice examples in Italy and in Asia, you can see that these people have a very healthy lifestyle. They eat from the land, they don't eat too much, they put a lot of energy in gathering food. Even in their 70s or 80s, you can still see them outside in their gardens, taking care of it. They have a good social interaction. They adhere to a simple day- night rhythm, where  they usually get up when the sun gets up and they go to sleep at 8:00 or 9:00. And they do that in a very regular basis for a long period of time. These are the ones that live for a very long age. And I think that is not unachievable, but it's a very big challenge in our modern Western society, for sure.

Mo Alsuwaidan: So, to really live unaffected by heart disease, what you're saying is it's a long-term investment.

Dr. Peter Lansb...: Absolutely. We can't reverse the damage that has been done. We can slow it down, we can sometimes even stop certain processes, but the damage done is there. And ultimately the damage will continue at maybe a less fast pace, but it will continue to create more havoc in the organs effected. The earlier you start, the bigger the impact is of reducing that risk.

Mo Alsuwaidan: Yeah. What about costs? Whether it's economic or societal costs, what's the cost of achieving this risk reduction?

Dr. Peter Lansb...: The further you go down the disease process, the more expensive the price will be. So we have drugs now that are very effective in lowering cholesterol, the PCSK9 antibodies, but the price ticket is quite impressive compared to other ways of lowering cholesterol, most commonly known as the statins drugs where the price is quite agreeable. It's not very high, they're quite effective, but if your risk is extremely high, or if you're advanced in your disease process and you've already had multiple heart infarcts, then probably a statin alone is not enough, and you need to add something on top of that. And PCSK9 antibodies would then be a solution, with a price attached to it.


Narration: So basically, the longer you wait to take care of your heart, the more it will cost you to deal with what will likely be more advanced issues. All you younger people out there – be sure to take this message to heart.



Mo Alsuwaidan: So you mentioned some of the costs associated with healthcare and medications. Let's start with some of the medications that are very well known, like statins. What are they, and how do they work?

Dr. Peter Lansb...: So statins have been around now for almost more than 30 years, and they lower plasma cholesterol, they lower cholesterol in the blood, and the way they do it is quite ingenious. They inhibit a certain enzyme that manufacturers or that's involved in the process of manufacturing cholesterol, synthesizing cholesterol. They do that predominantly in the liver because the liver is a huge source of cholesterol. We need cholesterol, for instance, to make the particles that transport energy, but also to make bile and bile acids. So the liver produces a lot of cholesterol. It needs a lot of cholesterol. Now, if you give a statin, it will inhibit, to a certain  extent, the synthesis of cholesterol. And then the liver cell starts to panic and says, "Wow, I have not enough cholesterol. What can I do?" And what it does, it tries to find other sources. And one of the sources it uses is actually the circulating LDL particles, what we call the bad cholesterol in the blood. So it creates more receptors to catch these LDL particles

Dr. Peter Lansb...: ... and use them as a source for its own need of cholesterol, and subsequently cholesterol goes down in the bloodstream. So that's how statins work, a very simple mechanism, very effective. 


Narration: And very clever. Statins kind of trick the body into helping itself. Let’s keep going. 

Mo Alsuwaidan: So, there's some newer treatments. So for example, what's Ezetimibe?

Dr. Peter Lansb...: Ezetimibe is an inhibitor of the absorption of cholesterol in the intestine. So in the intestine, when we eat, there are also sources of cholesterol, cholesterol from the foods, but also for instance, cholesterol from bile acids and cholesterol that's being released in the body through the intestine. Normally that is being reabsorbed because cholesterol is considered to be an expensive and very valuable molecule. And there are specific receptors that reuptake cholesterol either from the food or from the liver in the intestine. Ezetimibe blocks that reuptake, and ultimately that again causes a problem with sufficient cholesterol in the liver. And just like statins, the liver will respond by response by creating more of these receptors and reducing plasma cholesterol.

Narration: Right. So cholesterol is removed from the blood because ezetimibe blocks receptors from taking cholesterol from the digestive system. 

Mo Alsuwaidan: And what about these new class of medications that have a long acronym? PCSK9 antibodies.

Dr. Peter Lansb...: Yes. I'm not even going to try to pronounce the full name. It's too complicated, but everybody refers to them as the PCSK9 antibodies. And these drugs are antibodies, so we don't administer them as a tablet, but administer them through an injection in the skin. And then these antibodies will block the protein called PCSK9. What is PCSK9? PCSK9 is also involved with the uptake in the liver of LDL through the LDL receptors. When PCSK9 is around, these receptors when they enter the liver cell carrying LDL particles, normally they will be recycled and then go back to the surface of the liver cell. But if PCSK9 is present, these receptors will be broken down, will be degraded and we'll not be able to use them again.


Narration: PCSK9 antibodies actually create an increase in LDL receptors in the body by stopping them from getting destroyed in the liver. This leads to more LDL, or bad cholesterol, being removed from the blood – which is a good thing. Sticking with the topic of medicines, there’s one thing that is certain: they can’t do their job if you don’t take them. Adherence is the term the medical community uses to describe someone’s ability to stick with their treatment regimen, which – as you can imagine – can be a challenge for someone living with a chronic, lifelong condition like familial hypercholesterolemia, or FH. I wondered what Katherine Wilemon’s thoughts were on this. 

So Katherine, you mentioned this is a chronic lifelong condition, which means adherence to treatments, whether their lifestyle or medications, is very important. What are the challenges to maintaining that adherence?

Katherine: Well, FH is usually asymptomatic, meaning you don't have any symptoms unless you already are exhibiting symptoms of some kind of underlying heart disease. And so I think it's challenging for individuals to every morning take their medications or every month, depending on the medications, they are not just after day, but week after week, month after month, year after year with no symptoms. And I think it really underlines why it's so critical that people with familial hypercholesterolemia understand their condition because they have to understand the risk and the benefits to be a part of their care team and choose to take their medications for the remainder of their lives, to also eat healthy. That's incredibly important for this population as it is for everyone, but because we're high risk and to exercise. 

Mohammad: So, I guess the philosophy has to be in a preventative paradigm, right? Thinking about an investment for the future, not necessarily treating a symptom now.

Katherine: Absolutely. And I don't know what your experience is, but I think that is a hard sell for many people in the modern world. We've become very accustomed to the heroics of modern medicine and making the case for investing now for health later, is a challenge that we all face.

Mohammad: Absolutely. I mean, think immediate gratification is the mantra of this age. And I think to have that ability to have delayed gratification is definitely a challenge in so many aspects of life, especially health.

Katherine: And with of age, the guidelines recommend that children be screened for familial hypercholesterolemia between the ages of nine and 11. And we know that that is not occurring and that they be put on statins around the time of puberty. So, you also have to think, you're asking children to adopt this as a lifestyle, but it's interesting to talk with some of the physicians who are pediatricians and have treated FH children very successfully in some countries like the Netherlands, where they say it actually is a great time to set those life-long habits up, rather than waiting till people are going off to college like I was or busy with a whole host of other things. They can have a lot of support, as children, to set those healthy habits.

Mohammad: And that's a really great point, then I guess a lot of it comes down to health literacy and awareness.

Katherine: Yes. And really the opportunity for family support too. The whole family or some significant portion of the family is impacted and they can support each other.


Narration: Katherine brings up a huge point – a lot of our success as patients relies on the support we have from our family and friends, especially if lifestyle changes like increasing exercise or a modified diet are required. Family and friends motivate us and keep us focused on what’s important. 


Dr. Peter Lansb...: especially when we're discussing lifestyle, family members are very important because it's impossible for a single family member to do a special diet when the rest of the family isn't there. And also to properly address some of the issues. Sometimes it's very effective is, for instance, the spouse is there, that she makes sure that he takes the medicine or she takes the medicine. And that becomes sort of a family problem or challenge as well.

Dr. Peter Lansb...: Many times we have also in our genetic clinics where we see the familial hypercholesterolemia, we have the whole family together because there's usually not only one member, but there's more members of the family that suffer from the same problem. And that sort of enforces the management that we try to administer to the single patient that they can deal with that together. So, that's a very common approach. Yes.


PART III: Lifestyle 

Mo Alsuwaidan: Now, Peter, from the first episode we did together, I know you're very fond of this Chinese proverb that talks about superior medicine or superior healthcare being prevention. So you mentioned lifestyle a lot. When we talk about lifestyle, I've heard this term, the exercise pill.

Dr. Peter Lansb...: Yeah.

Mo Alsuwaidan:               What do people mean? What do you mean by that?

Dr. Peter Lansb...: Well, if you would translate the effects that are associated with exercise, and you would put that in a pill, you would have a fantastic pill because exercise has so many effects on your blood pressure, on your cholesterol, on your muscle cells, on your nervous system, even on your emotions. If you're feeling down, doing exercise does help you to deal with that. So there's a context of almost 50 positive effects that have been depicted in sort of a figure to reflect upon that, that exercise really promotes something that we would love to have in a sort of pill, but that's impossible.

Dr. Peter Lansb...: Yeah. But the solution is simple, exercise. And that doesn't mean that you have to run a marathon or you have to spend  hours and hours in the gym. It's quite simple. It's just doing like 30 minutes to 45 minutes of strenuous walk every day. And maybe every two or three days, a little bit more exercise where your heartbeat goes up, that you feel that you're sweating. Those kind of simple strategies have a huge impact, as long as you do them regularly, and for a prolonged  period of time. You don't need to be complete muscle mania bodybuilder or a triathlon athlete. No, sometimes that can even be harmful for your cardiovascular system, to be honest.

Dr. Peter Lansb...: But simple, regular exercise. It seems so common, but in our society, it is a challenge because people go to the office in the car, they get into the car and then they sit in the desk all day. Then they get in the car and go home. They sit on the couch. There is nothing of physical activity that comes out of that. Sometimes I advise patients take a dog, buy a dog. And that means you have to go out at least three or four times a day for half an hour. And that will get you the exercise that I think is very, very effective.

Mo Alsuwaidan: So a great companion and personal trainer.

Dr. Peter Lansb...: Absolutely. Yes.

Mo Alsuwaidan: Now in terms of diet, so I mean, you and I both know, and I'm sure our listeners know, we live in the age of fad diets and there's a new diet every year.

Dr. Peter Lansb...: True.

Mo Alsuwaidan: What can you tell us about the best diet for the heart, for heart health?

Dr. Peter Lansb...: I think the best diet in general is, again, looking at the people that became very, very old or looking at populations that were known for absence of cardiovascular disease. And what it boils down to is, again, it's a simple solution, just eat what is natural. Go to the market, don't go to the supermarket, don't buy the processed food, buy the simple foods, unprocessed foods. That's the core of healthy diet. And I know there's a lot of almost wars going on between the low carb, high fat, and the high carb, low fat and the Atkins diet and the-

Mo Alsuwaidan: Keto.

Dr. Peter Lansb...: Keto diets. And I think there are advantages of certain diets in certain type of patients, but not everybody responds in the same fashion. Maybe for some people, a keto diet could be very effective. In some others, it creates very high cholesterol levels. And then you would have to address that and maybe switch to another diet, or if you're really fond of that, make sure that you combine that with something that lowers cholesterol. But simple diet that we used to eat before there were supermarkets.

Dr. Peter Lansb...: I think that's really simple solution. And what's interesting if you eat the unprocessed food, rich in fiber, rich in minerals and vitamins, you will see that it automatically also controls the appetite,  that you don't get these hunger pangs. Having processed food with high sugar, high carb content releases a lot of insulin, then your insulin goes down and that creates again a hunger pang. And you again start to eat the things that increase insulin, and that gets you in a vicious cycle. And that creates the problem with obesity, low quality food, cardiovascular disease.

Mo Alsuwaidan: You know what I love about what you're saying about simple, you're using the word simple, is that it fits with what you also said about sticking with it for a long time. I think it's easier for people to stick with something for a long time, if it's simpler to adhere to.

Dr. Peter Lansb...: Yes, yes.

Mo Alsuwaidan: Rather than having an over-complex diet with lots of rules. Right?

Dr. Peter Lansb...: Exactly. Exactly. And also what I always remember, one of the pediatric cardiologists in our hospital that was responsible for children with FH. So these were children that had these high level of cholesterol. So naturally for them also a healthy diet was very important. And then sometimes these children would panic a little bit, and they said, "Oh, but can I never eat chocolate anymore? Can I never eat potato chips anymore?" And then he would say, "No, you can eat anything you want, but make sure if you eat chocolate, not the whole piece of chocolate but a small piece of chocolate. If you eat potato chip, not the whole bag, but just small bowl of potato chip." And that really put the pressure off and made it also easier for them to adhere to it.

Mo Alsuwaidan:  More realistic.

Dr. Peter Lansb...: Yeah, exactly. Exactly.


Narration: Why does it always sound easier than it feels? Anyway, simple is definitely good when it comes to lifestyle change…

Narration: …Of course, our lifestyle conversation wouldn’t be complete without a discussion of work as well. I knew keeping lifestyle changes simple was bound to get a bit trickier than it all sounded at first.

Mo Alsuwaidan: Yeah. Now we live in an age as well where there's a lot of burnout in the workplace, disruption of work life balance. Does that affect our hearts? And what does relaxation have to do with our hearts?

Dr. Peter Lansb...: I mean, if look at our language, our literature, heart and emotions are so linked together and  I'm a firm believer that your mental state and especially, again, if it's prolonged, has an effect on your heart. We even have literally a disease which is referred to as a broken heart. Somebody can have a severe cardio problem because of severe grief, a spouse that died or a child that died. And the heart is severely affected by that. Now these are exceptional things that that can happen. But over a long period of time being exposed to stress, being exposed to anger or depression really has an impact, literally because of hormonal changes that are not that favorable for the vasculature and the heart. And I think also the emotional neurological stress associated with that, the tension of the blood vessels, the heart rate, those all have an impact.  So having an approach where it's not just the diet, not just the exercise, but also the sleep, the relaxation that are important and that interact together. I think if you're in an environment where you're constantly stressed and angry and depressed, it's going to be very difficult to do regular exercise and have a healthy diet. You tend to fall back maybe on alcohol or even start smoking again  in such an environment. So it has to be that combined way to make sure that you address those issues. And to be honest, it feels a little bit like a challenge, but once you start out and see how it works, it becomes almost like a reward. One of the things I try to explain to diabetic patients, because for diabetic patients, when they're newly diagnosed with diabetes, they go crazy. They come in, they don't feel anything. And they go out with a big plastic bag with drugs for their blood pressure, for the sugar, for the cholesterol, for... and they think the doctor has gone crazy. "I'm feeling okay."

Mo Alsuwaidan:   Right, because they don't feel a specific pain or yeah.

Dr. Peter Lansb...: No, they don't feel anything. And it's like, why? So I explain to them the following story where there's a famous mountain in Pakistan, it's called Ketu Ketchu and it's the most difficult mountain to climb. Mount Everest is nothing compared to this one. Over the years, I think there were only 300 or 320 climbers that even tried to climb this mountain. And on average, 20% never came back. 20% died climbing the mountain, showing how difficult it is. 

Dr. Peter Lansb...: So if I would try to climb Mount Keto Ketchu, I would be very well-prepared. I would train my brains out, my body out. I would make sure that I know exactly what supplies to bring. I'd bring oxygen, I'd bring clamps. I need a guide to show me where to go. And if everything is there, yes, I have a fair chance of surviving that. And I say it's the same with diabetes. This is your Ketu Kechu. That means you have to prepare yourself. You have to train yourself. You have to have a healthy diet. You need extra equipment to make sure that you survive, not so much oxygen, but maybe medicine or insulin. And of course you need a proper Sherpa to guide you, and your Sherpa, that's me. I'm going to tell you where to go, but again, it's your choice.

Dr. Peter Lansb...: If you don't want to follow me, go off on yourself. I don't advise you to do it, but it's your own choice to do so. But if you do what I tell you to do, it can be a very good experience. Just like climbing Ketu Ketchu can be a very good experience, what you see, what you feel, what you experience, the challenges you get to break through, the same with that. And that's the way I think patients should embrace what they have. Many times patients come back and show me the results, and they say, "Are you happy, Doctor?" I say, "Why should I be happy? It's not about me. It's about you. It's in your results. You should be happy. And it's your responsibility. And I think that is something that we should also put a little bit more emphasis on.

Mo Alsuwaidan: No, what I love about that metaphor you're using with the Sherpa is that you're emphasizing collaborative care.

Dr. Peter Lansb...: Exactly, exactly.

Mo Alsuwaidan: Yeah. And collaboration, not just among different specialists, but between the doctor and the patient.

Dr. Peter Lansb...: Very, very important. Very, very important. One thing, what we've gained with evidence-based medicine is, is tremendous. You know, we share our information. We try to make sure that we do is effective and safe, but we also lost something. And what we lost is what they in the past were very, very good at. And that's the patient trusted them. They felt that the doctor was a value and they believed what he said and what he told them. And that sort of trust and making sure that patients feel that you're trying to do something to help them is also so important in a doctor-patient relationship and making sure that patients do try to do what is important for them.


Narration: Of course, when we talk about collaborative care, it takes two. And if a patient is having a tough time with work life balance, or worse, struggling with a condition like depression, collaboration can be difficult. Not to mention the negative impact poor mental health can have on heart health.


Mohammad: So with FH, is this something for you and for other people who have FH, is it always on your mind? Do you worry?

Katherine: I do have a certain level of existential kind of anxiety that I was programmed to have heart disease when I was young and that I remain vulnerable now that I have had a heart attack. Also, my oldest daughter is impacted by FH. So certainly I worry about her. FH is a family condition. And for many people, they have seen their parents or their aunts or uncles die, or need bypass surgery, or develop heart failure early in their lives. So I would say that for me personally, yes, there is a small underlying level of anxiety that I carry with me. And certainly we hear that from others as well.

Mohammad: And in terms of day to day, are there challenges that face people with FH on a day to day basis?

Katherine: Yes. I think that living with a chronic condition that is invisible to most other people is very interesting. You don't look sick, but you do have to be on medical treatment for the duration of your life beginning ideally in adolescence. And so I think that has a certain burden to it. But the biggest barrier to care and the biggest burden for people living with FH is that 90 plus percent of them here in the United States and much of the world have never gotten an accurate diagnosis. So they have a vague sense that something's wrong, they know they have high cholesterol, they know their family history, but they don't have the tools and the knowledge they need, and you know that the unknown does produce anxiety in people and it doesn't empower them. So I think the biggest barrier is lack of diagnosis, and then people who are lucky enough to be diagnosed and beginning the care they need, there are some challenges with getting the therapies they need paid for, and this is a lifelong condition. 

Mo Alsuwaidan: So Dr Lansberg, when we think about the complex interaction between depression and heart disease, how do you make sense of it all this two way street?

Dr. Peter Lansb...: Well, I think it's a very important aspect that has somewhat been neglected. We tend to focus on our specialties or subspecialties and then tend to forget about the interactions  that a human being as a whole complex organism has. And psychology is a very important aspect of that as well.

Dr. Peter Lansb...: The example of depression or stress in a person's life has, of course, really strong effects on their physiology. Their stress hormones as we know can become elevated that increase the blood pressure, increase vascular tension, increase inflammation, heart rate, have a negative effect on removing some of the harmful substances in the bloodstream and that can impact the blood vessels as well.

Dr. Peter Lansb...: So from that perspective, it can contribute not only to the progression or accelerated progression of atherosclerosis and cardiovascular complication. But also in patients that already have manifest cardiovascular disease, it can trigger events much more frequently as well.

Dr. Peter Lansb...: And realize also that in the context of being in a situation where you're depressed or anxious, it's not that easy to make proper choices. Maybe you drink more alcohol, it's difficult to stop smoking, or you start to smoke more. Fast food instead of healthy foods,  medicines that you have to take to control blood pressure, cholesterol or cardiovascular problems can be forgotten. Or just people don't want to bother taking them anymore. So it shows that there's an organic completeness here that we need to address.

Dr. Peter Lansb...: And in terms of clinical practice, I think we, as clinicians that see patients with cardiovascular risk factors, have to be aware of that as well. In the Netherlands in our medical system, the GP is sort of the doorkeeper. So what we usually do in cases where we feel there needs to be additional care for this aspect of the patient, we refer him back to the GP and explain a little bit about our calculations and our judgments. And ask them to either, take care of it in their own practice, or maybe refer patients to a psychologist or a psychiatrist to properly address that as well.


Narration: So, just like our arteries, physicians have to remain flexible, and allow for a healthy flow of the latest information to pass to themselves and their patients. See what I did there? Alright, now seems like the right time to go over what we’ve learned. 

PART IV: Take home points

Mo Alsuwaidan: So what are your take-home points, gathering together everything we said, maybe in episode one and two? if you were really to give some advice to the listeners to take home with them? What would you say?

Dr. Peter Lansb...: I think if  you're interested in preserving your health and having a healthy heart and making sure that you live a long time without the consequences of infarctions, myocardial infarctions, or stroke, first and foremost, start with a healthy lifestyle. I think all the guidelines do exactly the same, healthy lifestyle first and foremost. And I would love to include in a healthy lifestyle also the things we discussed about rest, relaxation, social interaction, making sure that you address the psychological issues and aspect of health, just as much as you do the physiological aspects of health. And they do interact, for sure. Depending on the risk you have, depending on the risk factors you have, we do have additional pharmacological interventions that can help to reduce your cholesterol in a stepwise approach

Dr. Peter Lansb...: Realize also that these treatments are very well established treatment. I think worldwide there's over 300 million people that are using statins. They've been used for more than 30 years. So we know exactly about not only their efficacy, but also their safety and tolerability. One of the challenges we sometimes face, there's a lot of information in Dr. Google and in a lot of advocacy groups that religiously almost adhere that cholesterol is not bad. It's similar to the anti-vaxxers movement. I do hope that people will try to address the

Dr. Peter Lansb...: Proper channels, the proper information channels to know what is good and what is not good. And not just the people shouting from the roofs that statins are really bad and cholesterol is something that should be high. Definitely not. It's a lifelong treatment. If you start with statins, realize it's something that you have to take for the rest of your life. Doesn't mean you can't stop. But as soon as you stop, you lose the protective effects.

Mo Alsuwaidan: Any other take home points?

Dr. Peter Lansb...: I think we have learned over the years that if you adhere to the simple regimens of the lifestyle. And for some people with the drugs, the chances of having a healthy life for a longer period are there. They cannot be guaranteed because there's many more factors that can have a negative impact as well. So that's something we have to realize as well. It's not the panacea that cures it all and cures everything, but it does contribute to a reduced risk.

we should try to start early because when we envisioned what I said before, how we can protect our teeth by starting brushing when we're very young. We can protect our heart when we start doing healthy habits at a very young age as well.

Narration: The earlier you can start doing those “right things” to protect your heart, the lower your risk will be. As we start to wrap up this episode, I wanted to get Katherine’s perspective on what we can learn from living with high cholesterol.

Mohammad: So Katherine, what can FH teach us about other types hyperlipidemia and how to intervene?

Katherine: So, what we see in the FH population is the importance of the role that LDL cholesterol plays in heart disease. Basically the FH population is just an accelerated picture of how LDL cholesterol results in heart disease. So, it's very important that we use this kind of prototype for the importance of lowering LDL and think about it for all individuals. Lowering one's LDL is the opportunity, one very important opportunity to keep heart disease at bay.


Cholesterol doesn't sound very scary to most people and it doesn't have any symptoms in the short run, but what it leads to is plaque buildup in the arteries and heart attacks and strokes. And so, it's really an opportunity to control our own destiny if we can keep our cholesterol low.


Mohammad: And so I guess FH shows us what the outcomes would be for someone who had a less extreme form of hyperlipidemia.

Katherine: It does. It just happens we've kind of accepted heart disease as a disease of the elderly. And I think what FH shows us is maybe that we don't have to accept heart disease, and lowering one's cholesterol is key in fighting it.

Mohammad: And it does work.

Katherine: And it does work. It really does.

Mohammad: I'm wondering how you're doing now. How's your health? What's your journey been like with FH so far?

Katherine:I am very lucky I'm celebrating 14 years of being event-free, and I now take several-

Mohammad: Congratulations.

Katherine: Thank you. Thank you. It's nothing that I take for granted. And I now take several cholesterol-lowering medications, and my cholesterol is at the lowest that it's ever been. And so honestly, I feel much safer, but this is a lifelong journey, so I have to continue to do all the right things.

Mohammad: That's fantastic. Thank you so much for joining us.

Katherine: Thank you.

Mo Alsuwaidan: Well, Dr Peter Lansberg, thank you so much for joining us today.

Dr. Peter Lansb...: Thank you very much. I enjoyed our little discussion here. I hope that the people who are listening find some useful information. 

Mo Alsuwaidan: Without a doubt, your heart is the hardest working organ in the body. It carries a heavy burden every day. And more often than not lifestyle choices make it more difficult for the heart to do its job well. It deserves a little bit of tender, love, and care, don't you think? And there are so many simple ways we can reduce the risks like increasing the number of times you exercise, making better food choices and reducing stress. So what steps are you going to take today, tomorrow, and in the days to come to take a load off your heart? I'm Dr Mo Alsuwaidan, thanks for listening.

Mo Alsuwaidan: If you're looking for more information or resources about the topics covered in this or other episodes, you can visit

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