High Cholesterol

A waxy substance found in the blood required to build healthy cells is called cholesterol. However, if it reaches high amounts it may cause certain health problems (such as heart disease). Moreover, when cholesterol levels become high, some people may develop fatty build-up in the blood vessels. Therefore, these deposits may prevent the blood flow through the arteries, which also may cause health problems. In some cases, fatty deposits may suddenly break, which makes a blood clot that may lead to a stroke or myocardial infarction.

While high cholesterol can pass from parents to children (inherited), in most cases, it is an outcome of unhealthy lifestyle choices. In any case, it is easily treatable with dietary changes, regular exercise, and medicines (sometimes).

Symptoms

This health problem does not have symptoms and to check cholesterol levels is enough to do a blood test.

The first cholesterol checkup should be done between 9 and 11 years old and then every 5 years according to the National Heart, Lung, and Blood Institute (NHLBI). It also recommends to check cholesterol levels every 1-2 years in men between 45 to 65 years old and women between 55 and 65 years old.

If your cholesterol levels are not in normal ranges, physicians may advise more frequent measurements. Regular cholesterol checkups also are recommended if you have a family history of high cholesterol, heart disease, or other risk factors (including hypertension, diabetes, and others).

Causes

This substance travels through the bloodstream attached to proteins. This combination is called lipoprotein. However, doctors classify cholesterol into two types depending on the protein type it is attached. For example:

  • LDL (low-density lipoprotein) – This type is also known as β€œbad” cholesterol that carries it throughout the body. This type of cholesterol may build up in the arteries’ walls narrowing them.
  • HDL (high-density lipoprotein) – Also known as β€œgood” cholesterol. It helps transport excess cholesterol back to the liver.

During cholesterol measurement, doctors will check your triglyceride levels (a type of fat in the blood). If you have high triglyceride levels it also may elevate your risk of heart disease.

Furthermore, if you have high cholesterol levels due to inactivity, obesity, and an unhealthy diet it may cause an increase in triglyceride levels too. However, you can treat this health problem easily compared to people who have a genetic factor that elevates cholesterol levels.

Check below some diseases that also may increase unhealthy cholesterol levels:

In addition, certain medications also may increase cholesterol levels. For example, medicines used to treat:

  • Acne
  • Cancer
  • High blood pressure (hypertension)
  • HIV/AIDS
  • Irregular heart rhythms (arrhythmias)
  • Medicines used to prevent organ transplant rejection

Risk Factors

Anyone can develop high cholesterol levels and the following factors may elevate your risk. For example:

  • Poor diet – Those who eat high amounts of saturated or trans-fat may have increased levels of cholesterol. Trans fats are usually found in packaged desserts and snacks.
  • Obesity – An increased risk of developing high cholesterol have people with a body mass index (BMI) of 30 or higher.
  • Lack of physical exercise – Regular exercise helps boost HDL cholesterol.
  • Smoking – People who use tobacco products are more prone to develop high cholesterol levels.
  • Alcohol – Misuse of alcoholic beverages may increase your total cholesterol level.
  • Age – While high cholesterol commonly occurs in people over 40 years old, it may develop in children as well.

Complications

People with high cholesterol may develop atherosclerosis (fatty deposits in the walls of the arteries). Thus, fatty deposits usually reduce blood flow in the arteries, which may lead to certain complications. Examples include:

  • Chest pain – In case coronary arteries (that supply the heart with blood) are affected, it may lead to chest pain (angina) and other coronary artery disease symptoms.
  • Myocardial infarction – Sometimes, plaques may break and make a blood clot. Therefore, it blocks the blood flow and may lead to a heart attack.
  • Stroke – This complication occurs similar to myocardial infarction when a blood clot prevents blood flow to a brain part.

How to Prevent High Cholesterol?

In most cases, the following tips help to prevent or reduce high cholesterol levels. For example:

  • Adopt a low-salt diet that includes fresh fruits, vegetables, and whole grains
  • Try to limit the amount of animal fats you are eating
  • Lose extra weight
  • Stop smoking or never start
  • Regular exercise (aim for at least 30 minutes of physical exercise daily)
  • Limit or avoid alcoholic drinks
  • Reduce stress

Diagnosis

Healthcare professionals usually identify high cholesterol by performing a lipid panel or profile, which shows:

  • Total cholesterol
  • LDL and HDL cholesterol
  • Triglycerides

Before tests, it is advised to fast, meaning consuming no liquids or food. However, you can drink water for 9 to 12 hours before the test. Consult with your healthcare professional before some cholesterol tests do not require fasting.

Furthermore, in the U.S. levels of cholesterol are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood while in Canada and most European countries are measured in millimoles per liter (mmol/L). Check below some test outcomes based on the general guidelines:

  • Desirable – below 200mg/dL or 5.2 mmol/L
  • Moderate – 200-239 mg/dL or 5.2-6.2 mmol/L
  • High – more than 240 mg/dL or 6.2 mmol/L

LDL Cholesterol Results

  • Less than 70 mg/dL or 1.8 mmol/L is considered a normal level, especially for people with a history of heart disease (including angina, stents, coronary bypass, myocardial infarctions, coronary artery disease, and others)
  • Below 100 mg/dL or 2.6 mmol/L is an optimal level for people with an elevated risk of coronary artery disease or diabetes.
  • 100-129 mg/dL or 2.6-3.3 mmol/L is considered a high level of LDL, especially for those who suffer from coronary artery disease.
  • 130-159 mg/dL or 3.4-4.1 mmol/L this LDL level is considered normal for people without heart disease or diabetes and increased for those with coronary artery disease.
  • 160-189 mg/dL or 4.1-4.9 mmol/L is a high level for healthy people and very high if you suffer from coronary artery disease.
  • More than 190 mg/dL or 4.9 mmol/L this LDL level is considered very high and mostly indicates a genetic disorder.

HDL Cholesterol Results

  • If results show an HDL level below 40 mg/dL or 1.0 mmol/L for men and lower than 50 mg/dL or 1.3 mmol/L for women it is considered too low.
  • HDL level of 40-59 mg/dL or 1.0-1.5 mmol/L for males and 50-59 mg/dL or 1.3-1.5 mmol/L for females is considered quite well.
  • An HDL level higher than 60 mg/dL or 1.5 mmol/L for both men and women is considered best.

Triglycerides

  • Those who have below 150 mg/dL or 1.7 mmol/L of triglycerides are considered good
  • Moderate – 150-199 mg/dL or 1.7-2.2 mmol/L
  • High – 200-499 mg/dL or 2.3-5.6 mmol/L
  • Very high – more than 500 mg/dL or 5.6 mmol/L

Treatment

In most cases, you can treat this health problem with certain lifestyle changes. These include dietary changes, regular exercise, and others. However, if cholesterol levels still are high, your doctor may recommend some medicines.

Healthcare professionals usually prescribe different medicines for patients because it depends on several factors including risk factors, age, other health problems, potential medicine adverse reactions, and others. Check below the most common medicines recommended for people with high cholesterol:

  • Statins – This group of medicines is used to block a substance that produces cholesterol. As a result, the liver can remove cholesterol from the blood. These include Fluvastatin, Atorvastatin, Lovastatin, Rosuvastatin, Simvastatin, Pravastatin, and others.
  • Cholesterol absorption inhibitors – In normal circumstances, the small bowel absorbs cholesterol from food and releases it into the bloodstream. These medications help to limit the absorption of cholesterol from your diet. In most cases, doctors prescribe Ezetimibe and it can be used along with statins.
  • Bempedoic acid – This is a new medicine that works similarly to statins but has fewer adverse reactions. Usually, people who use this medicine notice a significant decrease in LDL cholesterol levels.
  • Bile-acid-binding resins – Normally, the liver uses cholesterol to produce bile acids needed for digestion. These medications are used to reduce cholesterol by binding the bile acids. These include Cholestyramine, Colesevelam, and Colestipol.
  • PCSK9 inhibitors – This group of medicines is usually used to reduce LDL cholesterol in people with a genetic disorder, who have an intolerance to statins, or with heart disease. These include Evolocumab and Alirocumab. In addition, PCSK9 inhibitors are usually injected under the skin and are expensive.

High Triglycerides Medicines

If tests show you have high triglyceride levels, doctors may recommend additional medicines. These include:

  • Fibrates – These include Gemfibrozil and Fenofibrate to reduce the production of VLDL (very low-density lipoprotein) and improve the removal speed of triglycerides from the blood.
  • Niacin – This medication is used to reduce the liver’s ability to make LDL and VLDL cholesterol. However, Niacin may cause serious adverse reactions including liver damage, strokes, and others. Discuss with your healthcare professional before using this medicine.
  • Omega-3 fatty acid supplements – These supplements are available either by prescription or over-the-counter (OTC). In any case, you should consult with your doctor before using them.

Frequently Asked Questions

What are the most common causes of high cholesterol?

Usually, high cholesterol is present in people who smoke, drink alcohol in high amounts, do not exercise, and eat fatty food. However, in such cases, you can easily lower cholesterol levels with some dietary changes and lifestyle choices. If you are concerned about cholesterol levels, discuss it with your doctor.

What are the most common signs of high cholesterol?

These include:

  • Hypertension (high blood pressure)
  • Numbness
  • Breathing problems
  • Angina (chest pain)
  • Fatigue
  • Speaking problems
  • Nausea

If you experience any of the previous high cholesterol signs, do not hesitate to see a doctor.

What are foods that people with high cholesterol should include in their diet?

  • Apples
  • Buckwheat
  • Dark chocolate
  • Chia seeds
  • Berries
  • Beans
  • Avocados
  • Almonds

If you have additional questions, ask your healthcare professional.

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