High cholesterol

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Even if you're feeling like Superman, you need to know your cholesterol number

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Blood tests

High-density lipoproteins

High Cholesterol, also known as Hypercholesterolemia (literally: high blood cholesterol), describes the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement. This condition can be a result of numerous diseases and can contribute significantly to various forms of disease, especially cardiovascular disease. The terms "hyperlipidemia" (elevated levels of lipids) and "hyperlipoproteinemia" (elevated levels of lipoproteins) are closely related.

Signs and symptoms

Although elevated cholesterol may not manifest specific symptoms immediately, some forms of hypercholesterolemia result in particular physical manifestations such as xanthoma (thickening of tendons due to cholesterol accumulation), xanthelasma palpabrum (yellowish patches around the eyelids), and arcus senilis (white discoloration of the peripheral cornea).

Persistent high cholesterol can lead to accelerated atherosclerosis which in turn can lead to various cardiovascular diseases:

• Angina pectoris eventually requiring PTCA or CABG
• Myocardial infarction (commonly known as a heart attack)
• Transient ischemic attacks (TIAs)
• Cerebrovascular accidents or Strokes
• Peripheral artery disease (PAOD)

Diagnosis

When assessing cholesterol levels, understanding its subfractions is crucial. These subfractions include LDL, HDL, and VLDL. Historically, due to financial constraints, LDL and VLDL levels were estimated through the Friedewald calculation rather than measured directly.

The traditional methods, like the electrophoretic ones developed in the 1970s, were expensive but with advancements in technology, more affordable and accurate laboratory analyses have been developed.

Classification

For detailed biochemical insights, see hyperlipoproteinemia

Fredrickson classification

Hypercholesterolemia can be categorized based on its appearance on lipoprotein electrophoresis using the Fredrickson classification. In cases where the hypercholesterolemia is inherited (familial hypercholesterolemia), it's common to find a family history of early-onset atherosclerosis and other mentioned signs.

Secondary causes

Numerous secondary causes can lead to elevated cholesterol levels, including:

• Diabetes mellitus and metabolic syndrome
• Kidney-related diseases like nephrotic syndrome
• Hypothyroidism
• Anorexia nervosa
• Zieve's syndrome
• Genetic predisposition or Family history
• Dietary intake, especially foods rich in saturated fats and cholesterol
• Excessive body Weight
• A sedentary lifestyle lacking in physical activity.

Collectively, diet, weight management, and physical activity can have a cumulative positive influence on cholesterol levels.

Dietary influence

Apart from cholesterol acquired from food, one's dietary pattern can influence cholesterol levels in various ways. Notably, the American Heart Association provides a comprehensive list of suitable and unsuitable foods for hypercholesterolemia patients.

Carbohydrates

Recent research suggests that a high intake of carbohydrates, particularly refined ones, can unfavorably alter cholesterol levels. As a result, a diet low in fats, which often implies high carbohydrate consumption, might not always be the healthiest choice.

Trans fats

An emerging consensus among researchers identifies trans fatty acids as a significant dietary risk factor for cardiovascular diseases, more so than saturated fats. Consumers can calculate trans fat content on food labels by deducing the amount of other fats from the total fat content.

Treatment

The treatment approach varies depending on the specific type of hypercholesterolemia. Common treatment modalities include dietary changes, medications like statins, fibrates, nicotinic acid, bile acid sequestrants, and in severe cases, LDL apheresis or liver transplantation. Elevated levels of asymmetric dimethylarginine (ADMA) can complicate treatment as ADMA reduces the production of endothelial nitric oxide, thereby exacerbating the oxidized LDL effect.

Need to treat

In individuals without other risk factors, moderate hypercholesterolemia might not necessitate treatment. However, many medical practitioners, including cardiologists, might advocate for a combined approach involving medications, dietary changes, and lifestyle modifications.

Complications

As stated, chronic high cholesterol can lead to various complications, including myocardial infarction, Stroke, and peripheral artery disease, among others. Early diagnosis, coupled with aggressive and timely management, can potentially prevent these complications.

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