High Cholesterol

What is high cholesterol?

High cholesterol, also known as hyperlipidemia or hypercholesterolemia, is a medical condition whereby there are excessive fats or lipids in the bloodstream.

For the body to function, it only requires a precise amount of lipids. However, having excessive fats means the body cannot use them all. The surplus will thus begin accumulating in the arteries, combining with other elements in the bloodstream to form fatty deposits (plaque).

While the plaque may not trigger any problems for years, it silently grows larger and larger in the arteries with time. As a result, high cholesterol that is left untreated is dangerous as the excess lips in the blood stimulate fatty deposits enlargement. Undergoing a blood test is the only way of detecting high cholesterol.

A blood test, also known as a lipid panel, measures the amount of lipids that flow in the bloodstream. What constitutes high cholesterol varies based on factors like age, gender and history of heart-related conditions.

Good cholesterol vs. bad cholesterol

There are different kinds of lipids, and 'good cholesterol' and 'bad cholesterol' are the most commonly known.

The good cholesterol is referred to as high-density lipoprotein (HDL). Consider the letter "H" to stand for "helpful." HDL helps transport cholesterol to the liver, where the levels are balanced. The liver produces enough cholesterol for the body's needs and disposes of the excess. Adequate HDLs are required to move cholesterol to the liver. However, low HDL levels result in additional cholesterol remaining in the bloodstream.

Bad Cholesterol is known as low-density lipoprotein (LDL). LDL is responsible for the formation of plaque in the arteries. If LDLs are too many, it can cause heart disease with time.

When to get your cholesterol checked

High cholesterol may begin in childhood or at puberty. For this reason, the present guidelines advise on early screenings.

• Children and teenagers: Check your cholesterol levels every 5 years from the age of nine. Children with a family history of high cholesterol or heart problems might need to start screening earlier.
• Individuals assigned male at birth (AMAB): Check cholesterol levels every 5 years till you reach age 45, then every 1 to 2 years from 45 to 65, and yearly after age 65.
• Persons assigned female at birth (AFAB): Check cholesterol every 5 years till you reach the age of 55, then every 1 to 2 years until age 65, and yearly after 65.

These guidelines are general. Your doctor will, however, inform you of the best course of action for your condition. For instance, if you are in your 20s and have high amounts of cholesterol, you may require annual tests for some time. Likewise, those with risk factors or other heart problems might need regular tests.

Causes of High Cholesterol

Both genes and lifestyle factors contribute to high cholesterol.

Examples of lifestyle factors are:

• Smoking and use of tobacco: This lowers HDL (good cholesterol) and increases LDL (bad cholesterol).
• Too much stress: Hormonal alterations from stress can trigger the body to increase cholesterol production.
• Alcohol consumption: Excessive alcohol in the body can increase overall cholesterol levels.
• Being physically inactive: Activities such as regular aerobic exercise boost cholesterol levels. However, having a desk occupation or sitting a lot during free time lowers the body's production of HDL.
• Diet: Certain foods can affect cholesterol levels. Healthcare providers might sometimes suggest dietary adjustments or consultations with a nutritionist.

Symptoms of High Cholesterol

For many people, high cholesterol usually does not cause any symptoms. Even those who are very active like marathon runners, can have high cholesterol without knowing it. Symptoms generally appear only when high cholesterol leads to other health problems.

Risk factors

Several factors are likely to raise the risk of developing unhealthy levels of cholesterol:

• Poor diet: Consuming a lot of saturated fat or trans fats could lead to unhealthy levels of cholesterol. Saturated fats are normally found in full-fat dairy products and fatty parts of meats while trans fats are present in packaged snacks and desserts.
• Obesity: A body mass index (BMI) of 30 or higher increases the possibility of high cholesterol.
• Lack of enough exercise: Being physically active helps raise the good cholesterol levels in the body.
• Smoking: Smoking cigarettes can lower HDL levels.
• Alcohol: Excessive alcohol consumption can raise total amounts of cholesterol.
• Age: While high cholesterol can as well affect young children, it is most common in individuals above 40. Aging reduces the liver's ability to eliminate LDL cholesterol.

Complications

High cholesterol could lead to dangerous buildup of cholesterol as well as other fatty deposits on artery walls (atherosclerosis). The plaques may lower blood circulation in the arteries, and this might result in several complications like:

• Chest pain: When the coronary arteries, which supply blood to the heart, become affected, one can experience chest pain (or angina) plus other coronary artery disease symptoms.
• Heart attack: Plaques can sometimes rupture or tear. This causes a blood clot formation at the rupture site and blocks blood movement or breaks free and plugs an artery downstream. Hence; this can stop blood flow to the area of the heart, causing a heart attack.
• Stroke: Like a heart attack, a stroke arises if a blood clot obstructs the blood supply to the region of the brain.

Diagnosis

To diagnose high cholesterol, a blood test known as a lipid panel or lipid profile is used to assess the levels. This test measures:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides (a kind of fat present in the blood)

Before undergoing the test, the doctor will ask you to fast, and avoid any consumption of food or fluids except water only for about 9 to 12 hours. Other cholesterol diagnostic tests, however, do not involve fasting; hence, it's important to adhere to your provider's instructions.

Treatment

The first defense line against high cholesterol is lifestyle adjustments, like regular exercise and a healthy diet. However, if these changes do not sufficiently lower cholesterol levels, medication may be necessary.

The medication choice or a combination of drugs varies based on factors such as age, personal risks, overall health, and potential side effects. The most common options are:

• Statins: These drugs block a component the liver requires to produce cholesterol, causing the liver to take cholesterol from the bloodstream. Examples of statins are atorvastatin (Lipitor), lovastatin (Altoprev), fluvastatin (Lescol), pitavastatin (Livalo), rosuvastatin (Crestor), pravastatin (Pravachol), and simvastatin (Zocor).
• Cholesterol absorption inhibitors: Cholesterol is absorbed by the small intestine from the diet and released into the bloodstream. These drugs thus help lower blood cholesterol by restricting its absorption. Ezetimibe (Zetia) is an example of a cholesterol absorption inhibitor and can be used in combination with statins.
• Bempedoic acid: This is a new medication that works similarly to statins though it is somewhat unlikely to trigger muscle pain. Bempedoic acid (Nexletol) can be added to a maximum statin dosage to significantly reduce LDL cholesterol. Also, a combination drug comprising bempedoic acid and ezetimibe (Nexlizet) is available.
• Bile-acid-binding resins: The liver creates bile acids, a component essential for digestion using cholesterol. By attaching to bile acids, these drugs, which include cholestyramine (Prevalite), colestipol (Colestid), and colesevelam (Welchol), indirectly reduce cholesterol. This prompts the liver to utilize too much cholesterol to produce more bile acids.
• PCSK9 inhibitors: These assist the liver in absorbing additional LDL cholesterol, lowering the amount flowing in the bloodstream. Evolocumab (Repatha) and alirocumab (Praluent) are particularly useful for people with a genetic disorder causing too high LDL levels or those with a history of coronary disease who cannot tolerate statins or cholesterol drugs. Every few weeks, these medications are administered by injecting under the skin. They are, however, quite expensive.

Prevention

The heart-healthy lifestyle modifications that help reduce cholesterol levels could as well prevent high cholesterol from developing in the first place. These are some measures you could consider:

• Consume a low-salt diet while emphasizing vegetables, fruits, and whole grains.
• Limit animal fats and moderately use healthy fats.
• Cut extra pounds and keep a healthy weight.
• Quit smoking.
• Aim for at least 30 minutes of workout on most days.
• Moderate alcohol intake, if at all.
• Find tactics to reduce and manage stress.

Takeaway

High cholesterol tends to be silent and sneaky. You can have excess lipids in your blood without knowing it for many years, as there are usually no symptoms. The only way to detect high cholesterol is through a simple blood test. This condition can affect individuals of all ages, as well as those who are healthy and active.

Certain health conditions can increase the risk of having high cholesterol and heart disease. Therefore, it's important to know your cholesterol levels and discuss them with your healthcare provider to understand what they mean for your health.