DEAR DR. ROACH: I am a 52-year-old woman who was diagnosed with familial hypercholesterolemia in October 2024. I went through a cardiac workup for pain in my left arm and found this out.

My cardiologist put me on a statin (rosuvastatin), baby aspirin and telmisartan. Then, for my cholesterol, I was put on Repatha injections twice a month as well as ezetimibe, and my lipid panel went down into the normal range. However, I am gaining a small amount of weight. They added weekly Wegovy injections for two weeks now, and there’s been no change to my weight.

I am wondering if all these meds are necessary and if they are too much for my liver to take. My father passed away from liver cancer after taking cholesterol medication for one year in 2001. He thinks it was the cause behind his cancer, so I worry about this. I also have some muscle aches from the statin, so I take a smaller dose daily.

What else should I do or look into doing to help myself? — K.Y.

ANSWER: Familial hypercholesterolemia is a serious genetic condition. Prior to modern lipid therapy, the risk of a heart attack by age 60 was more than 50% in men and 32% in women. Treatment is aimed at lowering cholesterol levels (ideally into the normal range) as the best way of preventing a heart attack. The fact that yours are now in the normal range is great news!

In my opinion, all the medicines you have told me about are beneficial for you. Statin drugs like rosuvastatin have been the mainstay of preventive treatment for decades. Ezetimibe (which keeps your body from absorbing cholesterol in food) and Repatha (which, like statins, prevents your body from making cholesterol) have additive effects at reducing cholesterol and preventing a heart attack.

Although Wegovy (semaglutide) is often used as a weight-loss medicine, it is well-known to be protective for the heart. Similarly, telmisartan is in the class of drugs that protect the heart, even in people who do not have high blood pressure.

I do understand your concern about liver cancer given your family history, but you shouldn’t worry about this. The major risk factors for liver cancer are ones that lead to cirrhosis, such as viral hepatitis, drinking alcohol, smoking tobacco, environmental toxins, and metabolic dysfunction-associated steatotic liver disease (MASLD, which is associated with having diabetes or being obese).

Wegovy may not be helping your weight now, but it may be preventing further weight gain. (Or you could take higher and more effective doses.) You will be relieved to know that statins reduce the risk of liver cancer, as does aspirin.

I really do understand that being on six new medications since this past October is a big change as all medicines have the potential for side effects. However, in my opinion, these are all much more likely to be protecting your heart than hurting you.

The prevention of heart disease isn’t all about medicines. A healthy, mainly plant-based diet and regular exercise are also very important. Managing stress and having close relationships with friends and family are underrecognized protective factors.