Hypercholesterolemia

HypercholesterolemiaHypercholesterolemia: Description:

The presence of an abnormally large amount of cholesterol in the blood.

Cholesterol is a white, powdery substance that is found in all animal cells and in animal-based foods (not in plants). In spite of its bad press, cholesterol is an essential nutrient necessary for many functions, including:

  • Repairing cell membranes.
  • Manufacturing vitamin D on the skin's surface.
  • Producing hormones, such as estrogen and testosterone.
  • Possibly helping cell connections in the brain that are important for learning and memory.

Regardless of these benefits, when cholesterol levels rise in the blood, they can have dangerous consequences, depending on the type of cholesterol. Although the body acquires some cholesterol through diet, about two-thirds is manufactured in the liver, its production stimulated by saturated fat. Saturated fats are found in animal products, meat, and dairy products.

Types:

  • Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol. High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in your blood, the greater chance you have of getting heart disease.
  • High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol from other parts of your body back to your liver. The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease.

Hypercholesterolemia, or high cholesterol, occurs when there is too much cholesterol in the body. Cholesterol is a soft, waxy, fat-like substance that is a natural component of all the cells of the body. Your body makes all the cholesterol it needs. Any added cholesterol, which comes from the foods you eat, can cause harm.

High cholesterol raises your risk for heart disease, heart attack, and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaque) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs. And blood cells that get caught on the plaque form clots, which can break loose and completely block blood flow through an artery, causing a heart attack or stroke.

The normal range for total blood cholesterol is between 140 and 200 mg per decilitre (mg/dL) of blood (usually just expressed as a number). However, the total number doesn't tell the whole story: There are two types of cholesterol -- HDL (high-density lipoproteins, or "good" cholesterol) and LDL (low-density lipoproteins, or "bad" cholesterol). The amount of HDL relative to LDL is considered a more important indicator of your heart disease risk. There is a third kind of fatty material, triglycerides, found in the blood. They also play a role (generally as triglyceride levels rise, "good" HDL cholesterol falls). When you have high cholesterol, it usually means you have high levels of LDL cholesterol, normal or low levels of HDL cholesterol, and normal or high levels of triglycerides

Evidence points to high cholesterol levels, along with high blood pressure and a family history of the disease, as independent risk factors for AD (Alzheimer's Disease). A major research target for common factors between cholesterol levels and AD has been apolipoprotein E (ApoE). ApoE plays a role in the movement and distribution of cholesterol for repairing nerve cells during development and after injury. People who carry a variant of this gene (ApoE4) are at significantly higher risk for AD.

High cholesterol may pose a risk for Alzheimer's regardless of this genetic factor, however. Some studies report that cholesterol is important within the brain for cell communication and memory.

More Americans have high cholesterol every year. While heredity may be a factor for some people, the main culprits are a lack of exercise and diets high in saturated fats. High cholesterol can be prevented, sometimes with lifestyle changes (diet and exercise) alone. If these do not work, your doctor may recommend medications to bring down your cholesterol levels.

Symptoms hypercholesterolemia:

Hypercholesterolemia has no obvious symptoms until problems have already developed. Heart disease or a heart attack can be the result of hypercholesterolemia, and symptoms include chest pain and calf pain when walking (due to narrowed or blocked arteries).

Most people with high cholesterol don't have any symptoms until cholesterol-related atherosclerosis causes significant narrowing of the arteries leading to their hearts or brains. The result can be heart-related chest pain (angina) or other symptoms of coronary artery disease, as well as symptoms of decreased blood supply to the brain (transient ischemic attacks or stroke).

About one out of every 500 people has an inherited disorder called familial hypercholesterolemia, which can cause extremely high cholesterol levels (above 300 milligrams per deciliter). People with this disorder can develop nodules filled with cholesterol (xanthomas) over various tendons, especially the Achilles tendons of the lower leg. Cholesterol deposits also can occur on the eyelids, where they are called xanthelasmas.

Causes and Risk factors hypercholesterolemia:

The primary cause of hypercholesterolemia is an unhealthy lifestyle. Lack of exercise and a diet that is high in saturated fat and cholesterol increase the amount of LDL in the bloodstream. Such a lifestyle may lead to obesity, which in itself causes the overproduction of cholesterol. Those who drink alcohol and/or smoke cigarettes excessively further increase their risk of this condition.

Certain diseases, such as kidney disorder, liver disease, and diabetes, prevent the body from processing cholesterol efficiently, hence raising total cholesterol levels. Additionally, those with a family history of heart disease tend to have a higher probability of developing hypercholesterolemia. Although rare, hypercholesterolemia can result from a hereditary condition known as lipid disorder. In this case, a genetic defect in the liver cells causes the production of excessive LDL cholesterol from birth.

Risk Factors:

Men: Heart disease is the major cause of death in men. On average, men develop high cholesterol 10 - 15 years earlier than women do and have a greater risk of dying of heart disease at a younger age.

Women: Women ages 20 - 34, and those beyond menopause (around age 55), have higher cholesterol levels than men. Some evidence suggests that lower HDL levels may be a more significant risk in women than in men, especially when combined with high triglyceride levels.

Children and Adolescents: Children who have abnormal cholesterol levels are at increased risk of developing heart disease later in life. However, it is difficult to distinguish “normal” cholesterol levels in children. Changes in cholesterol levels occur between the ages of 8 - 18 and vary between genders and population groups. Cholesterol levels tend to naturally rise sharply until puberty, decrease sharply, and then rise again.

Children who are overweight are at higher risk for high triglycerides and low HDL, which may be directly related to later unhealthy cholesterol levels. Childhood LDL levels and body-mass index (BMI) are strongly associated with cardiovascular risk during adulthood. Overweight and obese children who have high cholesterol should also get tested for high blood pressure, diabetes, and other conditions associated with metabolic syndrome.

As in adults, the primary source of unhealthy cholesterol levels in children comes from diets high in unhealthy fats: Saturated fats (found mainly in animal and dairy products) and trans fatty acids (found in commercial food products).

Young and Middle-Aged Adults Hypercholesterolemia: The strongest evidence of unhealthy cholesterol levels and heart disease is in adults over age 45. However, while total cholesterol levels are decreasing among older adults, they are increasing in those ages 25 - 34 years. Research strongly suggests that the younger a person is when unhealthy cholesterol levels develop, the greater the chance for serious heart and blood vessel problems in the future. Young men without cholesterol problems have been found to have a higher life expectancy, by up to 8 years. Other studies have suggested similar risks from unhealthy cholesterol in young women as well.

Elderly Adults: About 85% of people who die from coronary artery disease are over the age of 65. Because high cholesterol is an important risk factor for heart disease, experts strongly recommend statin or other lipid-lowering therapy for elderly people with high cholesterol levels. Surveys indicate that total cholesterol levels have been declining in older people over the last few decades. Many experts believe this is due in part to increased use of statin drugs.

Genetic Factors and Family History Hypercholesterolemia: Genetics play a major role in determining a person's blood cholesterol levels. Children from families with a history of premature heart disease should be tested for cholesterol levels after they are 2 years old. Genes may influence whether a person has low HDL levels, high LDL levels, high triglycerides, or high levels of other lipoproteins, such as lipoprotein (a). Several studies have found a genetic mutation affecting neuropeptide Y in people with high total cholesterol and LDL levels. Neuropeptide Y is a compound in the brain that regulates appetite. Researchers have identified a gene called APOAV (apolipoprotein AV), which may help detect patients at risk for elevated levels of triglycerides.

Other medical conditions and risk factors strongly associated with unhealthy cholesterol levels include:

  • Polycystic ovarian syndrome: Women with this disorder, particularly those who are obese, appear to be at increased risk for high triglyceride and low HDL levels. This risk may be due to higher levels of the male hormone testosterone in these women.
  • Kidney disease.
  • Certain medications such as specific antiseizure drugs, corticosteroids, and isotretinoin (Accutane)

Uncontrollable risk factors include:

  • Gender: After menopause, a woman's LDL-cholesterol level ("bad" cholesterol) goes up, as does her risk for heart disease.
  • Age: Your risk increases as you get older. Men aged 45 years or older and women aged 55 years or older are at increased risk of high cholesterol.
  • Family history: Your risk increases if a father or brother was affected by early heart disease (before age 55) or a mother or sister was affected by early heart disease (before age 65).

Controllable risk factors include:

  • Diet: The saturated fat and cholesterol in the food you eat raise total and LDL-cholesterol levels.
  • Weight: Being overweight can make your LDL-cholesterol level go up and your HDL level goes down.
  • Physical activity/exercise: Increased physical activity helps to lower LDL- cholesterol and raise HDL-cholesterol (the "good" cholesterol) levels. It also helps you lose weight.

Diagnosis:

Hypercholesterolemia is diagnosed by checking levels of cholesterol in your blood. It is best to have a blood test called a lipid profile to measure your cholesterol levels. Most people will need to "fast" (not eat or drink anything) for 9 to 12 hours before taking the test.

The lipoprotein profile will give information about your:

1. Total cholesterol.

2. LDL (bad) cholesterol: the main source of cholesterol buildup and blockage in the arteries.

3. HDL (good) cholesterol: the good cholesterol that helps keep cholesterol from building up in arteries.

4. Triglycerides: another form of fat in your blood.

If it is not possible to get a lipid profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

Home Tests on hypercholesterolemia: Tests are available for home use and in public locations, such as shopping malls and pharmacies. For example, the CholesTrak Test can be taken at home with results in 10 minutes, but it measures only total cholesterol. The BioSafe Cholesterol Panel Test is also a home test, but it needs to be sent to a laboratory. This test, however, is very accurate and provides a full lipid profile.

Treatment:

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, there are two main ways to lower your cholesterol:

Therapeutic Lifestyle Changes (TLC): Includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.

The TLC Diet: This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarine) can also be added to the TLC diet to boost its LDL-lowering power.

Weight Management: Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).

Physical Activity: Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

Drug Treatment: If cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including Statins, bile acid sequestrants, nicotinic acid, fabric acids, and cholesterol absorption inhibitors. Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Cholesterol absorption inhibitors lower LDL and can be used alone or in combination with statin drugs.

Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.

Changes in lifestyle -- better diet, more exercise -- are the most effective means of both preventing and, in less severe cases, treating high LDL cholesterol levels. In addition to lifestyle changes, specific cholesterol-lowering medications are often prescribed.

Losing Weight: Being overweight increases risk of high cholesterol and heart disease. Even a 5-10-pound weight loss can lower LDL twice as much as diet alone. Weight lose often results in lower triglyceride levels and increased HDL, too. To maintain a healthy diet, you should aim for a gradual, weekly weight loss of 1/2 to 1 pound.

Getting Exercise: Regular exercise both reduces the risk of death from heart disease and helps lower LDL cholesterol levels, especially when combined with a healthy diet. Thirty minutes of moderate exercise five times per week can help you lose weight or maintain a proper weight, reduce LDL and triglyceride levels, and increase levels of HDL. Exercise may also lower blood pressure. Talk with your doctor before starting a new exercise plan.

Medicine and medications:

Statins are a common class of drugs prescribed for hypercholesterolemia and include Pravastatin, Fluvastatin, Simvastatin, Atorvastatin, and Lovastatin. Gemfibrozil, Cholestyramine, and Niacin are other medications that help lower blood cholesterol levels. Depending on the gravity of the condition, doctors may prescribe one or more of these medications.

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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