People with an inherited form of high cholesterol may face a heightened risk of heart attack or stroke long before symptoms become apparent, according to cardiovascular experts.

The warning was raised during the FH Caravan: Detect the Invisible. Prevent the Inevitable., organized by the Philippine Lipid and Atherosclerosis Society (PLAS) in partnership with Organon Philippines.

The forum focused on familial hypercholesterolemia (FH), a genetic condition that causes lifelong elevated levels of low-density lipoprotein (LDL), commonly known as “bad” cholesterol.

Dr. Cecilia A. Jimeno, vice president of PLAS, said FH is often diagnosed only after patients experience a serious cardiovascular event.

“Familial hypercholesterolemia is a preventable cause of early cardiovascular mortality and morbidity,” Jimeno said. “There’s a greater risk of cardiovascular disease because of lifelong exposure to elevated cholesterol levels.”

She urged healthcare professionals to take a closer look at patients with LDL cholesterol levels of 190 mg/dL or higher, particularly those with a family history of early heart disease or physical signs associated with FH.

“If you see an LDL cholesterol of 190 mg/dL or above, don’t stop there,” Jimeno said. “Check the family history, look for physical stigmata and consider familial hypercholesterolemia.”

Jimeno also encouraged healthcare professionals to contribute to the Filipino Heart for Familial Hypercholesterolemia (FH²) Registry, which aims to improve understanding of the condition and support earlier diagnosis in the Philippines.

Dr. Deborah Ignacia D. Ona said lowering LDL cholesterol earlier can help reduce a person’s lifetime cardiovascular risk.

“The earlier you lower your LDL cholesterol, the bigger the lifetime payoff,” Ona said. “The earlier, the faster and the longer you get your LDL cholesterol to target, the better you reduce cardiovascular risk.”

Ona said treatment approaches are evolving, with doctors increasingly considering combination therapies for patients unlikely to reach cholesterol targets through statins alone.

“The philosophy now is: don’t wait,” she said.

She also stressed that cardiovascular risk assessment should go beyond standard risk calculators, with imaging tools, coronary artery calcium scoring and other risk factors potentially helping identify patients who may benefit from earlier or more intensive treatment.

Dr. Federick C. Cheng said advances in lipid management have allowed doctors to go beyond slowing the progression of atherosclerosis and, in some cases, help reduce plaque buildup in the arteries.

“Before, we could only say that statins slowed the progression of atherosclerosis. Now we can say that we can achieve regression of atherosclerosis,” Cheng said.

Cheng said patients with evidence of atherosclerosis or a previous cardiovascular event should be considered for more aggressive LDL reduction.

He also urged doctors to consider a broader range of cardiovascular risk factors beyond hypertension, diabetes, smoking and obesity.

“Prevention is always better than cure. Every patient who walks into our clinic should have their cardiovascular risk assessed,” Cheng said. “If a patient has hypertension, diabetes or a family history of cardiovascular disease, it’s our responsibility to educate not only the patient but also their children. We need to start prevention early and screen those who need to be screened.”

The experts emphasized that while FH can often go unrecognized, its impact may be reduced through earlier detection, comprehensive cardiovascular risk assessment and timely treatment.