Understanding High Blood Cholesterol

Introduction

High blood cholesterol, or hypercholesterolemia, is a common but serious condition that increases the risk of cardiovascular diseases, including heart attacks and strokes. Cholesterol is a fatty substance found in the blood, essential for cell membranes, hormone production, and vitamin D synthesis. However, too much cholesterol can build up in arteries, leading to atherosclerosis (hardening and narrowing of the arteries).

Types of Cholesterol

• Low-Density Lipoprotein (LDL) – "Bad" Cholesterol: High levels contribute to plaque formation in arteries.
• High-Density Lipoprotein (HDL) – "Good" Cholesterol: Helps remove excess cholesterol from the bloodstream.
• Triglycerides: Another type of fat in the blood, which, when elevated, increases cardiovascular risks.

Causes of High Cholesterol

1. Unhealthy Diet - High intake of saturated fats, trans fats, and processed foods.
2. Lack of Physical Activity - A sedentary lifestyle reduces HDL and increases LDL.
3. Genetics - Familial hypercholesterolemia (FH) is a genetic condition that elevates cholesterol levels from birth.
4. Obesity - Excess weight is linked to high LDL and triglyceride levels.
5. Medical Conditions - Diabetes, hypothyroidism, and kidney disease can worsen cholesterol levels.
6. Smoking and Alcohol - Both negatively affect lipid metabolism.

Health Risks

• Atherosclerosis - Arteries become narrow and stiff.
• Heart Attack - Plaque rupture can lead to sudden artery blockage.
• Stroke - Blocked arteries in the brain increase stroke risk.
• Peripheral Artery Disease (PAD) - Cholesterol buildup in leg arteries causes pain and circulation problems.

Diagnosis and Monitoring

Doctors measure cholesterol levels using a lipid panel, which includes: - Total cholesterol - LDL cholesterol - HDL cholesterol - Triglycerides

Regular screening is recommended based on age, family history, and cardiovascular risk factors.

Treatment and Management

Lifestyle Changes (First-Line Approach)

• Diet: Follow a heart-healthy diet like the Mediterranean or DASH diet. Avoid processed foods.
• Exercise: At least 150 minutes of moderate aerobic activity per week.
• Weight Management: Reducing body weight can improve lipid profiles.
• Quit Smoking: Improves HDL and reduces cardiovascular risk.

Medications (If Necessary)

• Statins: Most effective in lowering LDL.
• Ezetimibe: Reduces cholesterol absorption from food.
• PCSK9 Inhibitors: Powerful injectables for high-risk patients.
• Fibrates and Niacin: Mainly target triglycerides.

Conclusion

Managing cholesterol effectively requires a combination of healthy lifestyle choices and, in some cases, medications. Regular check-ups and adherence to medical advice are vital in preventing cardiovascular diseases.

Source recommendations

1. American Heart Association Guidelines on Cholesterol Management

1. https://www.heart.org/en/health-topics/cholesterol
2. https://professional.heart.org/en/
3. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia
4. https://www.ahajournals.org/doi/10.1161/cir.0000000000000625
5. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean

2. European Society of Cardiology Guidelines on Dyslipidemia

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Dyslipidaemias-Management-of
2. https://academic.oup.com/eurheartj/article/41/1/111/5556353
3. https://www.escardio.org/static-file/Escardio/Guidelines/publications/DYSLIPguidelines-dyslipidemias-FT.pdf
4. https://pubmed.ncbi.nlm.nih.gov/37739143/
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines