Quick Stats:

People of all ages can suffer from high cholesterol, and it is estimated that 38% of all Americans have unhealthy levels.

• In 2015–2016, more than 12% of adults age 20 and older had total cholesterol higher than 240 mg/dL, and more than 18% had high-density lipoprotein (HDL, or “good”) cholesterol levels less than 40 mg/dL.
• 93 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. Nearly 29 million adult Americans have total cholesterol levels higher than 240 mg/dL.
• 7% of U.S. children and adolescents ages 6 to 19 have high total cholesterol.

What is High Cholesterol?

High cholesterol, or hypercholesterolemia, as it is medically known, is prevalent amongst Americans. In fact, the Centers for Disease Control and Prevention (CDC) reports that up to 38% may have unhealthy levels of cholesterol. But what is cholesterol, and what does high cholesterol mean?

Cholesterol is a waxy substance, produced in the liver and occurring naturally in the blood. Cholesterol is important to form the structure of every cell in the body as well as helping to make hormones, vitamin D and enzymes that help with digestion. All the cholesterol we need is made by our bodies, however about a quarter of cholesterol comes from the foods we eat, such as eggs, meat, cheese, and dairy products. Fatty deposits can develop in the blood vessels when these levels get too high. As these deposits increase, it can become difficult for your blood to flow through your arteries.

Whilst we need ‘good’ cholesterol to maintain good health, too much ‘bad’ cholesterol can lead to heart disease. High-density lipoprotein, or HDL, is good cholesterol. HDL helps to carry bad cholesterol back to the liver, cleaning the blood as it does so. Low-density lipoprotein or LDL is bad cholesterol. This type of cholesterol clogs the arteries and causes them to narrow and harden. If the build-up breaks off, they can form a clot that leads to a heart attack or stroke.

What are the symptoms of high cholesterol?

There are no symptoms of high cholesterol, the only way to detect it is for your doctor to perform a blood test.

What causes high cholesterol?

High cholesterol can be passed down genetically, but usually, lifestyle contributes to elevated cholesterol levels.

What are the contributing risk factors?

Many lifestyle factors can contribute to elevated levels of cholesterol:

• Poor Diet: Foods that have a high saturated fat content, such as animal & dairy products, or foods with a high trans-fat content such as fried foods, vegetable oils, and margarine, and some commercially produced cookies and popcorns will increase cholesterol.
• Obesity: You will be at a greater risk of high cholesterol if you have a BMI over 30.
• Sedentary lifestyle: Exercise helps to increase your levels of HDL (good cholesterol) and lower the levels of LDL (bad cholesterol).
• Smoking: It is thought that smoking lowers the levels of HDL, as well as causing damage to the blood vessels allowing them to gather fatty deposits more easily.
• Age: whilst anyone of any age can suffer from high cholesterol, as you age, your body chemistry changes, and it becomes harder for your liver to remove LDL from the blood.
• Diabetes: High blood sugar levels can cause damage to the lining of the arteries, as well as contributing to LDL cholesterol.

Levels of cholesterol:

When should I see a doctor?

If you are concerned that you may have high cholesterol, or be at risk, you should ask your doctor if you need a cholesterol test. Children and young adults are usually tested once between the ages of 9 and 11, and once again between the ages of 17 and 19. As adults, further tests are usually performed once every five years for those without risk factors of heart disease. For those with family history of high cholesterol or those whose test results show high levels of cholesterol, your doctor may recommend more frequent testing.

I’ve had my cholesterol test, but what do the numbers mean?

Cholesterol levels are measured in milligrams per deciliter (mg/dL).

When your doctor orders your blood cholesterol levels to be checked, they will analyze your results based on your HDL, LDL, and total cholesterol numbers, and discuss the results with you.

The doctor will calculate your cholesterol ratio by dividing your total cholesterol number by your HDL cholesterol number. The lower the ratio, the lower the risk of heart disease.

An optimal ratio is 3.5 to 1, and it is recommended to keep your ratio below 5 to 1.

Complications from high cholesterol:

The build-up of cholesterol and fatty deposits, called plaque, on the walls of your blood vessels, causes them to narrow and harden. This narrowing of the arteries is called atherosclerosis and leads to reducing the blood flow through the arteries, causing further complications.

• Heart attack: If the plaque in your arteries causes them to rupture, a blood clot can develop at the site. This blood clot can break free causing a blockage in the artery further along. If the blood flow to the heart stops, it will cause a heart attack.
• Stroke: As with a heart attack, a stroke could happen if a blood clot stops the flow of blood to the brain.
• Chest pain: If the cholesterol levels in the arteries that supply the heart with blood (coronary arteries) are high, you may experience chest pain (angina) a symptom of coronary artery disease.

Treatment & Management:

Your doctor will discuss with you the best course of action concerning your treatment. Before deciding on suitable treatment, your doctor will take into account your cholesterol ratio, your entire cholesterol profile, and risk factors such as age, family history, if you smoke or if you suffer from one of the following conditions:

• diabetes,
• high blood pressure,
• coronary artery disease,
• metabolic syndrome.

How can I prevent or treat high cholesterol at home?

To prevent high cholesterol, lifestyle changes can be made. These tips will help you maintain a healthy cholesterol level:

• Eat a well-balanced, low-fat diet.
• Eat a diet focused on fruit & vegetables.
• Keep your body weight in a healthy range.
• Limit your cholesterol intake
• Exercise daily for at least 30 minutes – forms of exercise such as swimming, cycling, or brisk walking are all beneficial.

What drugs are used to treat high cholesterol:

There are several types of lipid-lowering drugs. Some drugs work by reducing LDL cholesterol, and some are stronger than others. You may experience side effects with all drugs.

Statins

Statins, also known as HMG-CoA reductase inhibitors are the most effective drugs in lowering LDL cholesterol and are therefore likely to be the first drugs your doctor will prescribe in your treatment. Statins block the substance that your liver needs to make cholesterol, and can also help your body reabsorb cholesterol from built-up deposits in your artery walls. This has the potential to reverse coronary heart disease.

Common statins are:

• Atorvastatin, (Lipitor)
• Fluvastatin (Lescol XL)
• Lovastatin (Altoprev)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Some statins are available in combination form for ease of administration:

• Caduet (amlodipine and atorvastatin)
• Roszet (ezetimibe and rosuvastatin)
• Vytorin (ezetimibe and simvastatin)

Cholesterol absorption inhibitors

Cholesterol absorption inhibitors help to reduce the amount of dietary cholesterol that is absorbed through the intestines.

• Ezetimibe (Zetia) reduces the absorption of both naturally produced and dietary cholesterol.

Bile-acid-binding resins

These medications lower cholesterol indirectly by binding the cholesterol to bile acids. This in turn makes your liver use the excess cholesterol to produce more bile acid to aid digestion.

• Cholestyramine (Prevalite)
• Colesevelam (Welchol)
• Colestipol (Colestid)

PCSK9 inhibitors

PCSK9 inhibitors (proprotein convertase subtilisin/kexin type 9 inhibitors) help to dramatically reduce cholesterol levels. They are a newer class of injectable medication, that helps your liver absorb more LDL cholesterol, and therefore lowers the amount circulating in your blood. These could be used for people who have genetic factors that cause very high levels of LDL or for patients with an intolerance to statins and other cholesterol medications.

• Alirocumab (Praluent)
• Evolocumab (Repatha)

Tolerance of medications varies from person to person. Common side-effects of statins are muscle pain and muscle damage, elevated blood-sugar levels, reversible memory loss, and confusion. Use ModRN Health to check the possible side effects for each drug.