Introduction
High cholesterol or hypercholesterolemia refers to elevated levels of cholesterol, a fatty substance produced by the liver and found in certain foods and essential for building cells and producing certain hormones in the blood (Lawes et al., 2004). These elevated levels pertains to that of low-density lipoprotein (LDL) cholesterol, which is commonly referred to as "bad" cholesterol. This condition is usually diagnosed through a blood test called a lipid panel, which measures total cholesterol, LDL, high-density lipoprotein (HDL) or “good” cholesterol, and triglyceride levels (Ibid., 2004).
The optimal cholesterol levels for most adults is a total cholesterol of less than 200 milligrams (mg) per decilitre (dL); LDL cholesterol of less than 100 mg/dL, with below 70 mg/dL being ideal for people with heart disease; and HDL cholesterol of 60mg/dL or higher, with below 40 mg/dL for men and less than 50 mg/dL for women being considered low; and triglycerides of less than 150 mg/dL (Laemmle et al., 1989; Ma, 2004).
Complications
Untreated high cholesterol can result in complications including:
Coronary Artery Disease, which involves the narrowing of the coronary arteries resulting in angina or heart attacks (Liou & Kaptoge, 2020).
Peripheral Artery Disease, where there is reduced blood flow to the limbs, usually the legs, due to narrowed arteries (Wadström et al., 2021).
Atherosclerosis, which refers to plaque build-up leading to reduced blood flow (Fan & Watanabe, 2022).
Stroke, which results from plaque build-up in the arteries that block the arteries which supply blood to the brain (Ibid., 2021).
Prevention
Preventing high cholesterol involves adopting habits or behaviours that ensure a healthy heart, such as the following:
Balanced Diet: Priority should be on foods that are fibre-rich, with good fats, such as omega-3s, and minimal processed foods that are high in trans and saturated fats (Abbate et al., 2020; Sattar et al., 2020).
Frequent Exercise: Exercising and engaging in sports like jogging and swimming (Ibids., 2020).
Frequent Screening: Regular screening is also needed for prevention. It is recommended that adults over the age of 21 should have their cholesterol examined every 4 to 6 years, with individuals who have additional medical disorders or a family history of risk undergoing this screening more frequently (Rosenson, 2021).
Treatment
Medications such as statins, used to lower LDL cholesterol; Ezetimibe, which reduces intestinal cholesterol absorption; Fibrates, which mainly lowers triglycerides and, to a lower degree, increases HDL levels; PCSK9 Inhibitors, which greatly reduce LDL levels by improving the liver’s ability to remove cholesterol from the blood; Bile Acid Sequestrants, which remove cholesterol by binding to bile acids in the intestines; and Niacin (Vitamin B3), which can lower LDL and triglycerides, while increasing HDL, can be used to treat high cholesterol (Illingworth, 2000).
Other than these medications, lifestyle modifications like eating a ‘heart-healthy’ diet, exercise, weight management, and quitting smoking can improve HDL levels and lower the risk of cardiovascular complications (Ibid., 2000).
Conclusion
Cholesterol is essential for health, but they have to be at healthy levels to prevent cardiovascular diseases. Individuals can lower their risk of heart disease, stroke, and other related complications by managing their cholesterol levels and making lifestyle modifications, routine screenings, and prescription medication, when needed.
References
Abbate, M., Gallardo-Alfaro, L., Bibiloni, M. D. M., & Tur, J. A. (2020). Efficacy of Dietary Intervention or in Combination with Exercise on Primary Prevention of Cardiovascular Disease: A systematic review. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, 30(7).
Fan, J., & Watanabe, T. (2022). Atherosclerosis: Known and Unknown. Pathology International, 72(3), 151–160.
Illingworth, D. R. (2000). Management of Hypercholesterolemia. Medical Clinics of North America, 84(1), 23–42.
Laemmle, P., Unger, L., McCray, C., M Chalin, & Glueck, C. J. (1989). Cholesterol Guidelines, Lipoprotein Cholesterol Levels, and Triglyceride Levels: Potential for Misclassification of Coronary Heart Disease Risk. PubMed, 113(3), 325–334.
Lawes, C. M., Vander Hoorn, S., Law, M. R., & Rodgers, A. (2004). High Cholesterol. Comparative Quantification of Health Risks, Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization, 391-496.
Liou, L., & Kaptoge, S. (2020). Association of Small, Dense LDL-cholesterol Concentration and Lipoprotein Particle Characteristics with Coronary Heart Disease: A Systematic Review and Meta-nalysis. PLOS ONE, 15(11).
Ma, H. (2004). Supplement, Ma, Cholesterol and Human Health. Nature and Science, 2(4), 17–21.
Rosenson, R. (2021). Patient Education: High Cholesterol and lLpids (Beyond the Basics). https://savannahendocrinology.com/wp-content/uploads/2024/05/High-cholesterol-and-lipids.pdf
Sattar, N., Gill, J. M. R., & Alazawi, W. (2020). Improving Prevention Strategies for Cardiometabolic Disease. Nature Medicine, 26(3), 320–325.
Wadström, B. N., Wulff, A. B., Pedersen, K. M., Jensen, G. B., & Nordestgaard, B. G. (2021). Elevated Remnant Cholesterol Increases the Risk of Peripheral Artery Disease, Myocardial Infarction, and Ischaemic Stroke: a Cohort-Based Study. European Heart Journal, 43(34), 3258–3269.
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