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Angelica Pierce was diagnosed with high cholesterol at 15 and tried for years to unsuccessfully manage it with diet and exercise alone. Then, a genetic test helped her doctor properly diagnose the issue. Catherine McQueen/Getty Images
  • For some people, diet and exercise are not enough to lower LDL cholesterol.
  • Angelica Pierce was diagnosed with high LDL cholesterol at 15 years old.
  • She shares her 5-year journey of finding the proper treatment.

Angelica Pierce was 15 years old when she learned she had high LDL “bad” cholesterol.

“My mom wanted me to be tested for high cholesterol because she was starting to have her own journey with high cholesterol at the time…and my grandmother also has high cholesterol,” she told Healthline.

Her pediatrician told her diet and exercise were the best ways to manage LDL cholesterol. Already into sports, Pierce began upping her exercise routine. She also attempted to eat a vegetarian diet.

“It was a lot of eating packaged vegetarian foods that are marketed as healthy,”
said Pierce. However, packaged foods are often highly processed, which are associated with elevated LDL cholesterol.

Her mom and grandma put effort into cooking her vegetarian meals, but she said it caused a disconnect with her Hispanic culture.

“I wasn’t eating a lot of my cultural foods,” she said.

She also cut back on portions of food and began thinking about food differently.

“I didn’t find enjoyment in food in the same way that I had before…my relationship with food became an issue at that time because I wanted to be able to care for myself especially coming into a new age,” she said.

Around this time, her quinceanera celebration was coming up, which added additional stress.

“[I] wanted to be perfect in all aspects because I was coming to age, so it was the beginning of my relationship with food not being the best, and I guess I tied it to cholesterol, but to my knowledge, the best I could do was diet and exercise,” said Pierce. “I didn’t really understand what that meant for my cholesterol at the time. I just knew I was given these directions, and I was just sticking to them.”

Because high LDL cholesterol can lead to heart attack and stroke, reducing high cholesterol can help with heart health. Like Pierce was told, one way to do that is through diet and exercise.

“It can be empowering to know that better lifestyle choices can lower bad cholesterol and improve some people’s cardiovascular health, in general. However, it’s important to know that diet and exercise behaviors aren’t always enough to adjust bad cholesterol,” Dr. Nihar Desai, associate professor of medicine and vice chief of the section of cardiovascular medicine at Yale University School of Medicine, told Healthline.

In some cases, genetics and family history determine LDL cholesterol.

“There are individuals that have genes that lead to higher cholesterol levels, and it can be difficult to lower cholesterol in these instances with diet and exercise alone,” said Desai.

For about five years, Pierce focused on diet and exercise with the hopes of improving her cholesterol. When she was 20 years old, she transitioned from a pediatrician to a primary care doctor, who tested her LDL levels.

“[She] tells me it’s concerningly high, and she wants to start me on statins,” said Pierce.

However, she decided to give diet and exercise one more try first.

“Ultimately, my diet and exercise mindset led me to injure myself repeatedly, and I realized there is some kind of missing piece that I’m not getting with my cholesterol not going down,” she said.

Pierce was referred to a cardiologist who encouraged her to try statins. However, the medication caused her to experience side effects that both her mom and grandma experienced with the same medication.

“I sat down with [my doctor] and told him…I need something else, and that it wasn’t working and lowering my cholesterol,” said Pierce.

He suggested she get genetically tested to see if genes were a factor. Pierce was on board because she had come across an online community of people who had a family history of high cholesterol.

“So many stories online are similar to mine where you are young and healthy for the most part in terms of dieting and exercising and being at the quote, unquote right weight with BMI, but still have high cholesterol and having stroke and heart attacks,” she said.

The genetic test showed that Pierce has familial hypercholesterolemia, a genetic disorder that causes high LDL cholesterol levels. About 1 in 250 people have the condition.

Dr. Alex Foy, pediatric cardiologist at Children’s Nebraska, explained that the disorder is caused by a defect in the gene for the LDL cholesterol receptor, which is involved in passing LDL from the body.

“Our understanding about the causal relationship between cholesterol and coronary artery disease was developed by studying families with this genetic difference, which may result in incredibly high levels of LDL,” he told Healthline.

He added that a variety of other genetics plays into high cholesterol levels, some known and others unknown.

Genetic testing may be indicated for some individuals, but for most people, the treatment will be similar regardless of what their genetic testing shows,” he said.

While statin medications were developed to reduce cholesterol synthesis, for Pierce, a non-statin cholesterol-lowering therapy that is injected every two weeks helped her condition.

“I finally fought and found the missing piece. It wasn’t my diet, it wasn’t how much I exercised, it wasn’t my weight. It was the fact that I didn’t have access to the medication I needed,” she said.

She now feels more in control of her health and is starting to heal her relationship with food and exercise.

Pierce helped her mom and grandma advocate for appropriate treatment of their high cholesterol by sharing her familial hypercholesterolemia diagnosis with their doctors.

“I’m glad that not only can I get the care I need, but also I can [transfer] that to my mom and grandma,” she said. “My grandmother hasn’t had her cholesterol this low in decades, and she’s been dealing with this a lot longer than my mom and me.”

She hopes her story inspires other women to stand up for their health.

“[Know] that what you feel in your body is your reality, and it should be acknowledged and valued when it comes to your own care,” Pierce said.

If you think your high cholesterol is related to genetics, Desai said there is a free test available that can look specifically for genes that are known to lead to higher levels of bad cholesterol.

“It is important to work with your healthcare provider and/or genetic counselor if you are considering such testing so they can help interpret these studies and provide appropriate context and counseling,” he said.