Definition

Cholesterol is a lipid component with a waxy consistency and plays a crucial role in the synthesis of fats, cellular maintenance, hormone production, and the absorption of certain vitamins. Elevated levels of cholesterol can lead to complications. Hypercholesterolemia is a condition characterized by elevated levels of low-density lipoprotein (LDL) or "bad" cholesterol in the body's fat tissue. This can lead to the accumulation of fat in the blood vessels, a condition known as atherosclerosis, which in turn increases the risk of a heart attack or stroke.

LDL, or low-density lipoprotein, is an unhealthy type of fat that poses a significant risk to health. It promotes the calcification and buildup of cholesterol in the blood vessels, increasing the risk of stroke or heart attack. Inflammation of the plaque can lead to the formation of blood clots in its vicinity. The occurrence of a stroke or heart attack is dependent on the location of the blockage.

Cardiovascular diseases are the primary cause of mortality globally, with atherosclerosis being the predominant underlying factor.

If you want to know more about atherosclerosis, you can read it here: Atherosclerosis - Definition, Cause, Symptom, And Treatment

Causes

There are two types of hypercholesterolemia, each of which results from distinct causes:

• Familial hypercholesterol

This medical condition is an uncommon genetic disorder, with a prevalence of 1 in 250 individuals. This disorder is attributed to a genetic abnormality that is accountable for eliminating LDL cholesterol from the bloodstream. Having this mutation can lead to elevated LDL levels in your bloodstream, which can be potentially hazardous. Individuals afflicted with this syndrome may experience the premature onset of heart blood vessel abnormalities, which are a prevalent form of heart disease.

• Acquired hypercholesterol

This condition is a commonly occurring one. An unhealthy diet results from consuming excessive amounts of sugar and high quantities of saturated and trans fats, which can be found in foods such as red meat, coconut oil, hydrogenated oil, fast food, and fried food.

Risk factor

Elevated cholesterol increases the risk due to some contributing factors. Certain factors are immutable, while others are susceptible to modification. Several risk factors associated with hypercholesterolemia include:

• Hereditary predisposition to elevated cholesterol levels
• Excessive intake of sugar and lipids, particularly saturated or trans fats, in one's diet.
• Diabetes
• Elderly
• Tobacco consumption
• Obesity
• Insufficient exercise
• Hypothyroidism
• Administration of medications such as amiodarone, rosiglitazone, cyclosporine, or hydrochlorothiazide.

Symptoms

Hypercholesterolemia might be asymptomatic in certain conditions. Numerous people may remain unaware of this problem until they experience a heart attack, stroke, or other severe symptoms. Consequently, it is necessary to schedule frequent cholesterol screenings.

Untreated hypercholesterolemia in individuals with a familial predisposition can lead to the manifestation of several symptoms, including:

• Chest pain or angina pectoris
• Xanthoma refers to the buildup of adipose tissue under the skin.
• Xanthelasma refers to the occurrence of yellowish deposits that include cholesterol on the eyelids.
• Corneal arcus is a crescent-shaped deposit of fatty substances that forms around the eye's cornea. It can seem white, blue, or gray in color.

Read more: Xanthelasma - Definition, Cause, Symptom, And Treatment

Diagnosis

It is generally advisable to conduct regular checks to monitor the status of your cholesterol levels. The CDC advises that healthy adults get standard cholesterol screenings every 5 years. However, individuals with greater risk factors for hypercholesterolemia are advised to have more frequent screenings, often every 2 to 6 months.

The diagnosis of hypercholesterolemia can be confirmed with a comprehensive medical history assessment, physical examination, and further diagnostic tests.

Anamnesis

In doctor-patient interviews, the doctor will inquire about:

• Current symptoms
• Medical history
• Medical history of the family
• Routine activities

Physical examinations

The doctor will assess the patient's blood pressure, respiratory rate, pulse, and body temperature throughout the physical examination. The doctor will then conduct a comprehensive head-to-toe examination to validate the symptoms.

Additional examinations

The doctor will recommend a comprehensive lipid profile blood test. Before obtaining a blood sample, it is necessary to abstain from consuming any food or drink for a specific duration. A lipid panel analysis quantifies total cholesterol levels, including LDL cholesterol, HDL cholesterol (known as good cholesterol), and triglycerides. If your low-density lipoprotein (LDL) or overall LDL level is elevated, your doctor may diagnose you with hypercholesterolemia.

If your total cholesterol test results are above 200 mg/dL or your HDL value falls below 40, the doctor will advise you to undergo a 12-hour fasting examination. The LDL limit ranges from 130 mg/dL to 159 mg/dL, with a high range of 160 mg/dL to 189 mg/dL.

Once your doctor has eliminated other potential causes of hypercholesterolemia, they will advise you to complete a genetic test. If you possess a hereditary disorder known as hypercholesterolemia, the physician will perform a genetic analysis of your family. Administration of cholesterol-lowering medicine necessitates concurrent liver function testing.

Management

The objective of managing hypercholesterolemia is to decrease the low-density lipoprotein (LDL) level to mitigate the risk of cardiovascular complications. As the doctor recommends, the initial approach to treating hypercholesterolemia typically involves lifestyle modifications, such as dietary changes, increased physical activity, and smoking cessation.

Several strategies to consider are engaging in regular exercise, maintaining healthy body weight, consuming foods that are low in saturated fat, managing stress levels, taking medication to lower cholesterol, refraining from using tobacco products, controlling sugar and blood pressure levels, reducing alcohol consumption, and incorporating vegetables, fruits, and whole grains into your diet.

Lifestyle modifications can be hard, so ask for help. Controlling your diet and exercise can lower your cholesterol. Your doctor may prescribe cholesterol-lowering medicine. Statins, which prevent the liver from making cholesterol, are widely recommended for hypercholesterolemia.

Read more: Low Density Lipoprotein (LDL) - Indications, Contraindications, Results And Suggestions

Complications

Uncontrolled hypercholesterolemia can lead to the accumulation of plaque within the blood vessels. Hypercholesterolemia can lead to several consequences, including heart disorders and cardiovascular diseases such as heart attacks, strokes, blood vessel disorders, sudden heart attacks, microvascular disorders, and peripheral arterial disorders.

Prevention

Genetic hypercholesterolemia is unpreventable. There are numerous ways to maintain cholesterol levels within the normal range, including:

• Eat more fiber and less sugar, saturated fat, and trans fat.
• Lower your salt intake and eat more fruits, veggies, and whole grains.
• Maintain healthy weight
• Exercise regularly.
• Limit alcohol consumption
• Check cholesterol regularly.
• Avoid stress
• Stop smoking.

When to see a doctor?

Schedule routine checkups and consult the doctor. The physician will inquire whether the prescribed cholesterol medication has been efficacious, whether the patient has experienced any adverse effects from cholesterol-lowering medications, and whether the patient has adhered to the doctor's instructions.

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