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Cholesterol, a waxy substance present in the bloodstream, plays a vital role in constructing healthy cells. However, elevated cholesterol levels can amplify the risk of heart disease. The surplus lipids can accumulate within arteries and interact with other compounds in the blood, leading to the formation of plaque—fatty deposits. Although this plaque may remain asymptomatic, it progressively grows within arteries, eventually impeding sufficient blood flow. In some cases, these deposits can rupture suddenly, causing blood clots that trigger heart attacks or strokes. Detecting high cholesterol requires a blood test.
While hereditary factors can contribute, high cholesterol predominantly arises from unhealthy lifestyle decisions, making it both preventable and manageable. A balanced diet, regular physical activity, and occasional medication can all contribute to lowering high cholesterol levels.
Symptoms
High cholesterol typically lacks noticeable symptoms and becomes apparent when it triggers other health issues. Detection relies on a blood test. According to the National Heart, Lung, and Blood Institute (NHLBI), the first cholesterol screening is recommended between ages 9 and 11, with subsequent tests every five years. For men aged 45 to 65 and women aged 55 to 65, screenings every 1 to 2 years are advised. Individuals over 65 should undergo annual cholesterol tests. Doctors may suggest more frequent tests if results are unfavorable or if risk factors like family history, heart disease, diabetes, or high blood pressure are present.
Causes
Cholesterol travels in your bloodstream attached to proteins, forming lipoproteins. These come in different types:
- Low–density lipoprotein (LDL) carries cholesterol throughout the body and is considered “bad” because it can lead to artery buildup.
- High–density lipoprotein (HDL) is “good” as it collects excess cholesterol and returns it to the liver.
Triglycerides, a blood fat, are also measured in lipid profiles and high levels raise heart disease risk. You can manage cholesterol through exercise, diet, and weight, while genetics also influence how your body handles cholesterol.
Unhealthy cholesterol levels can arise due to medical conditions like:
- Chronic kidney disease
- Diabetes
- HIV/AIDS
- Hypothyroidism
- Lupus
Certain medications for other health issues can also worsen cholesterol levels, including those for:
- Acne
- Cancer
- High blood pressure
- HIV/AIDS
- Irregular heart rhythms
- Organ transplants
Risk factors
Risk factors contributing to the development of unhealthy cholesterol levels includes the following:
- Age: Unhealthy cholesterol levels can affect anyone, but they are more common in people over the age of 40. The liver’s ability to flush LDL cholesterol from the body decreases with age.
- Poor diet: Consuming excessive amounts of saturated fat or trans fats can lead to the emergence of unhealthy cholesterol levels. Saturated fats are frequently found in fatty meat cuts and products made with whole milk. In prepackaged snacks or desserts, trans fats are usually present.
- Smoking or tobacco use: Smoking cigarettes may cause HDL, or “good,” cholesterol, to drop, and increase the “bad” cholesterol.
- Alcohol: Alcohol consumption in excess might raise the total cholesterol level.
- Obesity: A body mass index (BMI) of 30 or higher increases the risk of high cholesterol.
- Lack of exercise: Engaging in exercise assists in raising your body’s levels of HDL, often referred to as the “good,” cholesterol.
- Stress: The body produces cholesterol due to stress that triggers the hormones of the body to change.
Diagnosis
A blood test known as a lipid panel or lipid profile is used to assess cholesterol levels, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, which are a type of blood fat. Typically, a fasting period of nine to twelve hours, involving only water consumption, is advised before the test; however, some tests can be done without fasting based on medical guidance. Cholesterol measurements are reported in milligrams (mg) of cholesterol per deciliter (dL) of blood in the US, and in millimoles per liter (mmol/L) in Canada and many European nations. To interpret the results, general guidelines are used. In the US, children are recommended to undergo one cholesterol screening between ages 9 and 11, followed by testing every five years; more frequent or earlier testing might be advised for children with a family history of early–onset heart disease or personal obesity/diabetes history.
Treatment
When lifestyle changes like exercising and a healthy diet don’t sufficiently lower high cholesterol, doctors may suggest medication. The choice depends on factors like risk, age, and health. Options include:
- Statins: Statins work by inhibiting a necessary liver component involved in cholesterol production. This prompts the liver to eliminate cholesterol from the bloodstream. Various options are available including atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
- Cholesterol absorption inhibitors: The small intestine absorbs dietary cholesterol, releasing it into the bloodstream. Medications like ezetimibe reduce blood cholesterol by restricting the absorption of dietary cholesterol. This approach can be combined with other treatments, such as statins.
- Bempedoic acid: This recent medication functions similarly to statins but has a lower likelihood of inducing muscle pain. Supplementing a maximum statin dose with this compound can effectively reduce LDL levels. Furthermore, there is a combination pill consisting of this compound and another available.
- Bile–acid–binding resins: The liver employs cholesterol to create bile acids essential for digestion. Drugs like cholestyramine, colesevelam, and colestipol indirectly lower cholesterol by binding to bile acids. This spurs the liver to utilize surplus cholesterol for additional bile acid production, consequently reducing blood cholesterol levels.
- PCSK9 inhibitors: These medications enhance the liver’s uptake of LDL cholesterol, thereby reducing the cholesterol present in the bloodstream. They might be prescribed to individuals with a genetic condition causing elevated LDL levels or those with a history of coronary disease who cannot tolerate statins or other cholesterol drugs. Administration involves subcutaneous injections every few weeks, and these treatments tend to be costly.
For high triglycerides, options are:
- Fibrates: Fenofibrate and gemfibrozil decrease VLDL cholesterol and triglycerides.
- Niacin: It limits LDL and VLDL cholesterol but is recommended only if statins can’t be used.
- Omega–3 supplements: These help lower triglycerides, but consult your doctor due to potential interactions.
Medication tolerance varies. Statin side effects include muscle pain, memory issues, and elevated blood sugar. Regular liver function tests might be needed. Children with high cholesterol focus on diet and exercise; some with extreme levels might need statins.
