As a child, Klara repeatedly heard that her grandmother suffered from arteriosclerosis. Since her grandmother was very forgetful, Klara automatically associated the term arteriosclerosis with the general term for forgetfulness. Later, she realized that Alzheimer’s and arteriosclerosis are not related.

Arteriosclerosis involves the accumulation of blood fats, inflammatory cells, and sometimes blood clots on the artery walls, leading to thickening and hardening. This process can occur for decades without symptoms. In advanced stages, vascular narrowing can lead to strokes or heart attacks. The exact causes of arteriosclerosis are not fully understood, but LDL (Low-Density Lipoproteins) cholesterol plays a significant role. Cholesterol is a fatty substance (lipid) produced 80% by the body and also absorbed through diet. Klara, due to a misunderstanding, had banned eggs from her diet for almost 30 years. LDL cholesterol transports fats from the liver to the organs, and HDL (High-Density Lipoproteins) cholesterol disposes of excess LDL cholesterol. Elevated LDL cholesterol levels in the blood lead to deposits on vessel walls, acting as “garbage generators.” Low HDL cholesterol levels, serving as garbage disposal for excess cholesterol, and high LDL levels can increase the risk of arteriosclerosis.

Adding complexity, there is also lipoprotein, a blood fat similar to “bad” LDL cholesterol. Monitoring its levels is crucial as high lipoprotein levels can contribute to cardiovascular diseases. Lipoprotein levels remain constant throughout life, and there are currently no medications to lower them.

Around the age of 40, Klara’s father started taking lipid-lowering drugs (statins) daily. This is the solution to medicinally lower cholesterol levels. Klara was aware from a young age that she might inherit an undesirable genetic gift, forcing her to take pills daily. Considering her strong desire for independence in all areas, this was a terrible prospect. Klara’s father never smoked, maintained a slim physique throughout his life, did not need alcohol, and considered exercise a basic necessity; he always ate healthily. He was the epitome of a healthy lifestyle.

For her 40th birthday, Klara had her LDL and HDL levels measured and found that her LDL level was already approaching the upper limit. She could take action herself, and Klara did. She never smoked, ate healthily, and could perhaps lose another 5 kilograms (yes, she could have been even slimmer, but the sacrifices would be too high). She engaged in sports with pleasure. Every year before her cholesterol check with her doctor, Klara would swim or run in the morning, naively hoping to trick her LDL levels. However, playing tricks with her own cholesterol had its limits. Despite exercising for at least 60 minutes daily, Klara’s LDL levels exceeded the approved limits. Her family doctor knew Klara well and understood that she wouldn’t be happy with medication. He suggested measuring the lipoprotein level, which Klara was not yet aware of. If the level was high, it would be in her best interest to protect herself with pills.

A week later, the bad news arrived. Klara’s lipoprotein level was twice the recommended maximum. Klara hadn’t expected miracles, but such a clear and unequivocal confirmation of the inevitable hit her deeply. She was not yet fully convinced about pills as a solution. She began to think. Medicine, biology, and chemistry had only superficially interested her, and her knowledge in that area (even past knowledge) was non-existent. She started reading and asking questions. Who in her family died of what? With her mother’s help, a long list was compiled. Heart attacks and strokes were never present in her family. Odd! How is it possible that if some in the family have genetically elevated cholesterol levels, no one, including grandparents and great-grandparents as far as she could judge, suffered negative consequences?

If the causes of arteriosclerosis are not fully known today, could it be that cholesterol is not necessarily the culprit? Can one check if the arteries are calcified?

Yes, it is possible to check the extent of deposits. Since Klara paid for this examination herself, she convinced her doctor to perform the CT scan to understand the degree of calcification. In the meantime, she had started warming up to the idea of medication. Perhaps, she thought, she could postpone the start of pill-taking for another year or two. After all, she couldn’t be forced , but she knew that at some point, she wouldn’t be able to avoid it.

The surprise when the results came in was enormous. Her arteries were not “cluttered,” calcified, or negatively affected by high cholesterol. Her arteries were undamaged and unproblematic throughout, with no trace of any deposits. Klara was endlessly grateful (she hadn’t received the bill for the CT scan yet). In the end, the savings were huge – instead of an annual amount for medication, just a one-time payment for an examination.

Klara didn’t become overconfident or arrogant. The feeling of being more of an exception than the rule in this area was characterized by gratitude. The doctor couldn’t explain why she was an exception. But automatic questions arose, like “Is my father, who has been taking statins for 40 years, maybe also an exception like me? Are his arteries perhaps not calcified?” This she now had to find out together with him.

Influencing the genetic lottery is hardly possible. But asking questions, the need to understand things better, and not settling for general truths helped Klara preserve her independence for longer.