Cholesterol
  • Sep 16, 2016

Cholesterol is a waxy, fat-like substance that body needs. But, when too much in your blood, it can build up on the walls of arteries. This can lead to heart disease and stroke.
High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.
Cholesterol is carried through blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. Different types of cholesterol, based on what type of cholesterol the lipoprotein carries are:

  • Low-density lipoprotein (LDL). LDL, or "bad," cholesterol transports cholesterol particles throughout body. LDL cholesterol builds up in the walls of arteries, making them hard and narrow.
  • High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to the liver.
Risk Factors
About one in every six adult has high cholesterol. Anyone, including children, can develop it.
Several factors that are beyond control can increase the risk. These include age, sex, and heredity. But, there are some risk factors that can be changed. Examples include the following:-
  • Unhealthy diet. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, can raise cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase total cholesterol.
  • Obesity. Having a body mass index (BMI) of 30 or greater puts at risk of high cholesterol.
  • Large waist circumference. Risk increases in men with a waist circumference of at least 40 inches (102 centimeters) or women with a waist circumference of at least 35 inches (89 centimeters).
  • Lack of exercise. Exercise helps boost body's HDL, or "good," cholesterol while increasing the size of the particles that make up LDL, or "bad," cholesterol, which makes it less harmful.
  • Smoking. Cigarette smoking damages the walls of blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower level of HDL, or "good," cholesterol.
  • Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of arteries.
Complications
  • High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits (plaques) can reduce blood flow through arteries, which can cause complications, such as:
  • Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.
  • Heart attack. If plaques tear or rupture, a blood clot may form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of heart stops, you'll have a heart attack.
  • Stroke. Similar to a heart attack, if blood flow to part of brain is blocked by a blood clot, a stroke occurs.
What are the Signs and Symptoms?
High cholesterol itself does not have symptoms. A blood test is the only way to detect high cholesterol. Many people do not know that their cholesterol level is high. That’s why it’s important to schedule regular visits with doctor. Be sure to ask about having cholesterol tested.

How is High Cholesterol Diagnosed?
 Recommendations for the age of first screening vary. Most adults should get their cholesterol levels checked every five years. More frequent tests are needed in case of a family history of high cholesterol, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.
If total cholesterol is 200 mg/dL* or more, or if HDL (good cholesterol) is less than 40 mg/dL, one will need to have a lipoprotein profile blood test done.

What Levels of Cholesterol are Healthy?
 Desirable Levels
Total cholesterolLess than 200 mg/dL
LDL (“bad” cholesterol)Less than 100 mg/dL
HDL (“good” cholesterol)40 mg/dL or higher
TriglyceridesLess than 150 mg/dL
* Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

How is it Treated?
Lowering high cholesterol levels is important for people at all ages, with and without heart disease. In case of high cholesterol, one needs to eat a healthy diet, exercise regularly, quit smoking, and may need to take medication.
The specific choice of medication or combination of medications depends on various factors, including individual risk factors, age, current health and possible side effects. Common choices include:
  • Statins. Statins block a substance liver needs to make cholesterol. This causes liver to remove cholesterol from blood. Statins may also help body reabsorb cholesterol from built-up deposits on artery walls, potentially reversing coronary artery disease. Choices include atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin
  • Bile-acid-binding resins.  Liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine, colesevelam and colestipol  lower cholesterol indirectly by binding to bile acids. This prompts liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in blood.
  • Cholesterol absorption inhibitors. Small intestine absorbs the cholesterol from diet and releases it into bloodstream. The drug ezetimibe helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used in combination with a statin drug.
  • Injectable medications. A new class of drugs can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in blood. Alirocumab and evolocumab may be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.
Medications for high triglycerides
  • Fibrates. The medications fenofibrate and gemfibrozil decrease triglycerides by reducing liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from blood. VLDL cholesterol contains mostly triglycerides.
  • Niacin. Niacin decreases triglycerides by limiting liver's ability to produce LDL and VLDL cholesterol. But niacin doesn't provide any additional benefit than using statins alone.
  • Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower triglycerides.
  • Tolerance varies. Tolerance of medications varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. While taking cholesterol medication, it is recommended to have liver function tests to monitor the medication's effect on liver.
Can it be Prevented?
Several steps can be taken to maintain a normal cholesterol level:
  • Eat a healthy diet. A high amount of saturated fat and cholesterol in food can increase blood cholesterol.
  • Maintain a healthy weight. Being overweight can increase cholesterol level. Losing weight can help lower LDL (bad) cholesterol and total cholesterol level, and raise HDL (good) cholesterol level.
  • Exercise regularly. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol. Try to be physically active for 2 hours and 30 minutes (150 minutes) each week.
 


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