Have Elevated Triglycerides Level. Lipomas Removed From Thigh And Arm. Family History Of Heart Disease. Any Risk?

Posted on Fri, 12 Apr 2013

Question: Hi, I just want a doctor's opinion on this. My family has a strong history of heart disease. My maternal grandfather died at age 69 of a heart attack. Prior to the heart attack he had several debilitating strokes and minor heart attacks beginning at age 60. My mother's sister passed away suddenly of a heart attack last year at age 55. She had little to no previous symptoms, but had a hysterectomy a few years before her death. My mother is now 48 years of age, and is just above high normal in LDL, HDL, and triglycerides. She also has numerous lipomas on her thighs, arms, and a few on her abdomen. She had 6 removed from her thighs alone last year. She has had a tubal ligation, and has been incapable of losing any weight ever since, when she was a previously physical fit person. My question is, do you think my mother has a form of familial heart disease? Could estrogen play a role? And how are the lipomas connected?

Answered by Dr. Anil Grover (2 hours later)

Hi,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence. To take your specific question my answer is qualified "yes". Reason is that there several risk factors for atherosclerotic coronary artery disease. In women, estrogen has protective role and after menopause this protection is gone. To that extent coronary artery disease is related to woman. All other factors including the genetic are common to both genders. Lipoma's are not related to coronary artery disease. To recount all the known risk factors for coronary artery disease the list shall be as follows:
NON MODIFIABLE
1. Being a Male(for women above 45 Coronary artery disease is as common as men)
2. Increasing Age
3. Genetic predisposition to coronary artery disease
MODIFIABLE
1 Hypertension (high BP)
2.High Bad Cholesterol (LDL, Triglycerides)
3.Low Good Cholesterol (HDL)
4. Diabetes
5. Smoking
6. Stress
7. Obesity and sedentary life style
8. For elderly folic acid deficiency causing increased Homocysteine level is a risk factor

So, you can see more than one risk factor is usually involved in causation. There is nothing like familial coronary artery disease. Good Luck

Best Wishes

Dr Anil Grover

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anil Grover (3 hours later)

There are 3 consecutive generations of individuals dying of heart attack before age 70. None were obese, none were smokers, none were stressed, and they all lived active lifestyles. Aunt died at 55, grandfather at 69, and great grandfather at 43. My aunt is also not a man which eliminates that risk factor. Could there be a case of Familial Hypercholesterolemia? And would it be worth it to get genetically tested to see who has the gene for the defectective LDL receptor?

Answered by Dr. Anil Grover (13 hours later)

Thanks for writing back. I apologize for the delay in responding because of leissues.
I take your point. I did say that genetic factors are partly responsible for coronary artery disease and are non modifiable. The modifiable factors do also have some component which is genetic. However there is no specific gene for finding out predisposition to coronary artery disease. Case can be made for individual risk factors and genetic predisposition and familial hypercholestrolemia is one such example which you have rightly pointed out. My problem is whether there is documentation of hyper cholesterolemia in all three generations? Then there is subset of population who have high cholesterol but no coronary artery disease that is the point I am trying to make. There is a genetic predisposition to obesity but all obese persons do not get coronary artery disease. It has been pleasure interacting with you. As to your question whether it would be worth testing for genetic predisposition for LDL receptor there is published literature on that. What is missing there is no specific genetic basis for coronary artery disease. That research is being pursued as I write this answer. Regards.
With Best Wishes

Dr Anil Grover

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar