:D Yeah I can’t bring myself to reply to those contesting this part of my statement. Look around you, people. Please observe the teaming masses who cannot stop shoveling shit into their mouths at increasingly alarming rates.

Sorry to hear about your dad. How old was he? I assume he was Indian given your username. South Asian ancestry is a risk enhancer for heart disease, unfortunately. Being Indian myself, I have so many stories of relatives (esp male) dying of MIs and sudden cardiac deaths at ages 40-50s. I didn’t even consider this unusual till after growing up and esp after caring for ppl of other backgrounds.

There’s no clear/satisfactory answer as to why South Asian patients have so much more heart disease, but the evidence does suggest we should be adopting more aggressive targets of risk parameters for them (A1c, LDL, BP, weight, etc.), and the clinical guidelines likely will reflect this in the future.

Your family history and extremely elevated LDLs are scary. Diet and exercise are not enough to prevent poor outcomes in familial hypercholesterolemia. The rough estimate we quote patients is that the risk of a heart attack in males with FH is ~50% by age ~50 without medical treatment. This is 20 times (not 20%, but 20 TIMES) the normal risk at that age.

I will not give medical advice over the internet, but if I were you, I would not want to be messing around with anything short of the standards of care given those odds. Statin therapy is a core part of that standard.

Statin adverse effects do exist, but they are found to be quite rare (1-2% prevalence) when assessed for through well designed placebo-controlled trials. Additionally, there are newer statins with fewer adverse effects you could consider. Assuming you truly have FH and truly are statin intolerant (or remain at elevated LDLs despite maximally tolerated statin therapy), PCSK9 inhibitors can be considered. In the US, you would likely qualify for one if these through a good insurance plan, assuming the above criteria are met.

Cardiologist here, can confirm. We’ve long been seeing these promising trends, in the US, Europe, and elsewhere. I would say the greatest reason for this are 1- advances in percutaneous interventions (which is as much about having new tools to fix acute MIs, such as more effective stents, as much as logistically making these tools + the skilled physicians to operate them widely available in any place at any time), 2- relatively cheap & highly effective cardiac medications, & 3- the hugely successful anti-smoking campaign. Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed. Here’s the original article in JACC fyi— https://www.jacc.org/doi/10.1016/S0735-1097%2823%2901585-1