High Cholesterol

Cholesterol is a fatty substance that circulates in your bloodstream, playing an essential role in cell health. However, excessive cholesterol, particularly the harmful type, can lead to significant health problems. There are two types of cholesterol: LDL and HDL. LDL, or low-density lipoprotein cholesterol, is known as "bad" cholesterol because elevated levels can lead to atherosclerosis, a condition where plaque builds up in your arteries, increasing the risk of heart attacks and strokes. Conversely, HDL, or high-density lipoprotein cholesterol, is considered "good" because it helps remove excess cholesterol from the bloodstream, potentially offering protection against heart attacks and strokes. Despite its "good" label, HDL is complex, and high levels don't necessarily counterbalance high LDL levels. Managing LDL cholesterol is typically prioritized to prevent serious health issues like heart attacks, strokes, and even dementia.

Causes

High cholesterol can stem from several causes and risk factors, some of which are manageable, while others are not. Key contributors include:

• Diets high in saturated fats or cholesterol.

• Obesity or excess body weight.

• Tobacco smoking.

• Sedentary lifestyles without regular exercise.

• Diabetes.

• Liver or kidney disease.

• Hypothyroidism (underactive thyroid).

• Age over 50.

• Menopause.

• Certain medications, like those for high blood pressure or depression.

Genetics also plays a significant role, and familial hypercholesterolemia can lead to high cholesterol levels even with a healthy lifestyle and diet.

Symptoms

High cholesterol is often termed a "silent condition" due to its lack of noticeable symptoms. However, rare signs can appear when cholesterol levels are extremely high:

• Xanthomas: Small, painless yellow nodules on the knees, elbows, and other joints.

• Xanthelasmas: Yellow bumps near the inner corners of the eyes.

• Corneal Arcus: A thin white line around the iris.

Symptoms usually manifest once cholesterol has caused significant arterial blockage, leading to serious health events like angina (chest pain), heart attacks, or strokes. Due to its general lack of symptoms, regular blood tests are crucial for early detection, especially if you have risk factors such as a family history.

Diagnosis

High cholesterol is diagnosed via a blood test called a lipid panel or lipid profile, which evaluates your cholesterol levels. This test measures total cholesterol, LDL, HDL, and triglycerides, often requiring fasting for 9 to 12 hours beforehand, except for water. Cholesterol is measured in milligrams per deciliter (mg/dL), with levels above 200 mg/dL indicating high cholesterol. The CDC recommends starting screenings as early as age 9, with a follow-up between ages 17 and 21. Testing should continue every 4 to 6 years afterward, more frequently for men in their 40s, women in their 50s, and yearly after age 65. Those with elevated levels or risk factors may need more frequent testing. Typically, an LDL level over 160 mg/dL is high. Optimal LDL levels depend on overall health, aiming for under 100 mg/dL if no additional issues are present. For those with heart disease, stroke, peripheral arterial disease, or diabetes, an LDL target is below 70 mg/dL, or below 55 mg/dL for those at especially high risk. Your healthcare provider will discuss the results and necessary actions. Regular cholesterol screening is essential for early identification of high levels to reduce health risks.

Treatments

Managing high cholesterol often involves a combination of medications and lifestyle changes aimed at lowering cholesterol levels. Medications typically start with statins like Atorvastatin and Rosuvastatin, which decrease cholesterol production in the liver. If statins aren't tolerated or additional reduction is needed, alternatives such as Ezetimibe, which blocks cholesterol absorption, bile acid sequestrants, and PCSK9 inhibitors may be used. Bempedoic acid is another option, particularly for those who can't tolerate statins. Alongside medication, lifestyle changes play a crucial role in managing cholesterol. Following a heart-healthy diet, increasing physical activity, quitting smoking, and maintaining a healthy weight are vital. Reducing stress and ensuring adequate sleep can also significantly influence cholesterol management and overall health.

Medications

Medications are often critical in managing high cholesterol, especially if LDL levels are elevated. Here's a summary of common cholesterol-lowering drugs:

• Statins: The first choice for treatment, including atorvastatin (Lipitor) and rosuvastatin (Crestor). They work by blocking cholesterol production in the liver and help lower LDL cholesterol while boosting HDL cholesterol. Mild side effects like muscle pain or increased blood sugar might occur.

• Selective Cholesterol Absorption Inhibitors: Ezetimibe (Zetia) is used to enhance statin effectiveness.

• PCSK9 Inhibitors: Administered via injection, medications like alirocumab (Praluent) and evolocumab (Repatha) complement statins or serve those who can't take them.

• Adenosine Triphosphate-Citrate Lyase Inhibitors: Bempedoic acid (Nexletol) suits those unable to tolerate statins, with combination options available as Nexlizet.

• Bile Acid Sequestrants (Resins): Oldest and generally safe treatments, such as cholestyramine (Questran) and colestipol (Colestid).

It's crucial to maintain open communication with healthcare providers to ensure the treatment plan is tailored to individual needs, choosing the right medication or combination if statins aren't viable.

Prevention

To prevent high cholesterol and encourage heart health, consider these lifestyle changes:

• Eat a balanced diet low in saturated and trans fats; focus on lean meats, whole grains, fruits, and vegetables.

• Incorporate unsaturated fat-rich foods like nuts and olive oil, and high-fiber foods like oats and beans.

• Maintain a healthy weight, as excessive body fat can raise LDL cholesterol.

• Engage in at least 150 minutes of moderate exercise weekly.

• Avoid smoking and limit alcohol to reduce high cholesterol and heart-related issues.