High LDL · Familial hypercholesterolemia · Statin intolerance
High cholesterol, handled with precision.
LDL cholesterol is the particle that builds plaque in arteries, and the evidence is unambiguous: lower LDL for longer means fewer heart attacks and strokes. The art lies in deciding how low, for whom, and with what, especially when statins have not agreed with you or when a hormone problem is driving the number. Dr. Hasan is experienced in managing high cholesterol as part of whole-person metabolic care.
Understanding your numbers
Genetics set most of your LDL; diet moves it by 10 to 15 percent. Very high LDL (190 mg/dL or more) suggests familial hypercholesterolemia, an inherited condition affecting 1 in 250 people that causes heart disease decades early if untreated. Secondary causes are checked before treatment escalates: hypothyroidism, nephrotic syndrome, liver disease, menopause, excess cortisol and medications.
A coronary artery calcium score of zero can safely defer medication in intermediate-risk adults; a high score argues for treating sooner and harder.
Treatment options
- Eating pattern: a Mediterranean-style pattern rich in olive oil, nuts, legumes, fish and fiber, with less saturated fat and refined carbohydrate. Soluble fiber and plant sterols add a further 5 to 10 percent LDL reduction.
- Statins remain first-line and lower LDL 30 to 55 percent. True statin intolerance is uncommon; most muscle symptoms resolve with a different statin, a lower dose or alternate-day dosing.
- Ezetimibe adds 15 to 25 percent lowering and is often combined early rather than pushing statin doses up.
- Bempedoic acid lowers LDL about 20 percent without muscle side effects and reduces cardiovascular events in statin-intolerant people.
- PCSK9 inhibitors (evolocumab, alirocumab) and inclisiran (a twice-yearly injection) lower LDL by 50 to 60 percent for familial hypercholesterolemia and very high risk.
- Lipoprotein(a): an inherited risk factor present in 1 in 5 people. It does not respond to statins; knowing it is high changes how aggressively everything else is treated.
Dr. Hasan is experienced in managing high LDL cholesterol, familial hypercholesterolemia, statin intolerance and elevated lipoprotein(a), and in treating the thyroid, hormonal and metabolic conditions that raise cholesterol.
Common questions
My HDL is high. Does that protect me?
Less than once thought. Very high HDL is no longer considered protective, and raising HDL with medication has not reduced heart attacks. LDL, non-HDL and ApoB are the numbers that drive risk.
Do statins cause diabetes or dementia?
Statins raise glucose slightly in people already close to diabetes; the cardiovascular benefit outweighs this. Large studies show no increase in dementia, and some suggest a modest reduction.
Can I stop medication once my LDL is normal?
The LDL is normal because of the medication. Stopping returns it to baseline within weeks. Lifelong lowering is what produces lifelong benefit.
Should my children be tested?
If you have familial hypercholesterolemia, yes. Children of affected parents should have a lipid panel by age 10, or earlier with a strong family history.
Related conditions
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