HIGH CHOLESTEROL (HYPERLIPIDAEMIA)

The Humble Guide to High Cholesterol

High Cholesterol (Hyperlipidaemia)

High cholesterol is a prevalent and potentially serious health condition that affects millions of individuals worldwide. Understanding cholesterol, its types, causes, and the impact it has on your health is essential for effective management and prevention. In this comprehensive guide, we will delve into the world of high cholesterol, providing you with the knowledge and insights needed to comprehend, manage, and take steps towards a healthier, cholesterol-balanced life.

1. What is High Cholesterol?

High cholesterol, medically referred to as hyperlipidaemia, is a condition characterized by an elevated level of cholesterol in the blood. Cholesterol is a fatty substance crucial for various bodily functions, but an excess of it in the blood can lead to health concerns, particularly in relation to heart and vascular health.

2. How is High Cholesterol Measured?

High cholesterol levels are determined through blood tests, specifically a cholesterol blood panel. This panel typically includes measurements of:

LDL (Low-Density Lipoprotein) cholesterol: Often termed "bad" cholesterol.
HDL (High-Density Lipoprotein) cholesterol: Often termed "good" cholesterol.
Total cholesterol levels.
Triglycerides, another type of blood fat.

3. What Causes High Cholesterol?

High cholesterol can result from various factors including:

Dietary choices: Consuming excessive saturated and trans fats.
Genetics: A family history of high cholesterol.
Sedentary lifestyle: Lack of physical activity.
Obesity: Excess body weight.
Age: Cholesterol levels tend to rise with age.
Certain medical conditions: Diabetes, hypothyroidism, and kidney disease.
Medications: Some medications can raise cholesterol levels.

4. What Are the Symptoms of High Cholesterol?

High cholesterol typically doesn't cause noticeable symptoms on its own. It is often referred to as a "silent" condition because the adverse effects manifest over time. The primary concern is the increased risk of heart disease and stroke.

5. What Are Complications of High Cholesterol?

Complications associated with high cholesterol include:

Atherosclerosis: Buildup of cholesterol in arterial walls, leading to narrowed arteries.
Coronary artery disease: Reduced blood flow to the heart.
Stroke: Impaired blood flow to the brain.
Peripheral artery disease: Reduced circulation to limbs.
Heart attack: Sudden blockage of coronary arteries.

6. When Should I See a Doctor for High Cholesterol?

It's advisable to consult a doctor for high cholesterol if:

You have risk factors like a family history of high cholesterol or heart disease.
You're over the age of 40 (or younger with risk factors) and haven't had cholesterol screening.
You've received high cholesterol test results.
You have other risk factors like diabetes or high blood pressure.

7. Lifestyle Modifications for High Cholesterol

Dietary Changes:

Adopt a heart-healthy diet, such as the Mediterranean diet or DASH (Dietary Approaches to Stop Hypertension) diet.

Limit saturated and trans fats, found in red meat and processed foods, and opt for healthier fats like monounsaturated and polyunsaturated fats found in olive oil, nuts, and fatty fish.

Increase soluble fiber intake from sources like oats, beans, and fruits to help lower LDL (bad) cholesterol levels.

Reduce dietary cholesterol by consuming lean proteins and limiting egg yolks and organ meats.

Regular Exercise:

Engage in at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.

Aim for muscle-strengthening activities on two or more days per week.

Weight Management:

Achieve and maintain a healthy body weight through a combination of diet and exercise.

Weight loss can help lower LDL cholesterol and improve overall cardiovascular health.

Smoking Cessation:

Quit smoking, as smoking not only raises LDL cholesterol but also damages blood vessels and increases the risk of heart disease.

Limit Alcohol Consumption:

If you consume alcohol, do so in moderation. Limit alcohol intake to one drink per day for women and up to two drinks per day for men.

Stress Management:

Practice stress-reduction techniques such as meditation, deep breathing exercises, yoga, or mindfulness to manage chronic stress, which can affect cholesterol levels.

8. What Medications Are Useful for High Cholesterol?

Statins:

Statin medications, such as atorvastatin, simvastatin, and rosuvastatin, are often prescribed as the first-line treatment for high cholesterol.

Statins lower LDL cholesterol levels and reduce the risk of cardiovascular events.

Common side effects may include muscle aches and liver enzyme elevation, which should be monitored by a healthcare provider.

Ezetimibe:

Ezetimibe is used alone or in combination with statins to further lower LDL cholesterol levels.

It works by reducing the absorption of cholesterol in the small intestine.

PCSK9 Inhibitors:

PCSK9 inhibitors, such as evolocumab and alirocumab, are injectable medications used when statins and ezetimibe are ineffective or not tolerated.

They lower LDL cholesterol by enhancing the liver's ability to remove LDL from the blood.

Fibrates:

Fibrates, such as fenofibrate and gemfibrozil, primarily lower triglyceride levels and can raise HDL (good) cholesterol.

They may be used when high triglycerides are a significant concern.

Monitoring and Follow-Up:

Regular monitoring of cholesterol levels is essential to assess the effectiveness of treatment and adjust medications as needed.

Follow-up appointments with a healthcare provider are necessary to review progress, discuss any side effects, and make necessary adjustments to the treatment plan.

Additionally, monitoring other cardiovascular risk factors like blood pressure, blood sugar, and smoking status is crucial for comprehensive heart disease prevention.

Patient Education:

Patients should understand the importance of medication adherence and lifestyle modifications in managing high cholesterol.

Educate patients about potential side effects of cholesterol-lowering medications and the importance of reporting them to their healthcare provider.

Encourage patients to actively participate in their care, ask questions, and seek clarification on any concerns or doubts.

Individualized Treatment:

High cholesterol management should be tailored to each patient's specific needs, taking into account their overall cardiovascular risk, age, gender, and other medical conditions.

Collaborate closely with healthcare providers to create personalized treatment plans.

9. High Cholesterol Clinical Treatment Guidelines

American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (2019):

Primary prevention (Patient without established cardiovascular diseases):

Recommend the use of the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator to assess 10-year cardiovascular risk.

20-75 years and LDL-C ≥4.9 mmol/L:

Use high-intensity statin without risk assessment.

Type 2 Diabetes and age 40-75 years:

Use moderate-intensity statin and risk estimate to consider high-intensity statins.

Risk-enhancers:

≥10 years for T2DM

≥20 years for type 1 DM

≥30 mcg albumin/mg creatinine

eGFR <60 ml/min/1.73 m²

Retinopathy

Neuropathy

Peripheral vascular disease ABI <0.9

In those with multiple ASCVD risk factors, consider high-intensity statin with aim of lowering LDL-C by 1.3 mmol/L or more.

Age >75 years:

Clinical assessment and risk discussion.

Age 40-75 years and LDL-C ≥1.81 mmol/L and <4.92 mmol/L without diabetes:

Use the risk estimator that best fits the patient and risk-enhancing factors to decide intensity of statin.

Risk 5% to <7.5% (borderline risk): Risk discussion: if risk-enhancing factors are present, discuss moderate-intensity statin.

Risk ≥7.5-20% (intermediate risk): Risk discussion: use moderate-intensity statins and increase to high-intensity with risk enhancers.

Risk ≥20% (high risk): Risk discussion to initiate high-intensity statin to reduce LDL-C by ≥1.3 mmol/L.

Both moderate- and high-intensity statin therapy reduce ASCVD risk, but a greater reduction in LDL-C is associated with a greater reduction in ASCVD outcomes.

European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines (2019):

Risk stratify individuals using SCORE (Systematic COronary Risk Evaluation)

Very-high:

Achieve ≥50% LDL-C reduction from baseline

Aim LDL-C <1.4 mmol/L (<55 mg/dL).

High risk:

Achieve ≥50% LDL-C reduction from baseline

Aim LDL-C <1.8 mmol/L

Moderate risk:

Aim LDL-C <2.6 mmol/L

Low risk:

Aim LDL-C <3.0 mmol/L

10. High Cholesterol Monitoring Parameters and Adherence

When you are on cholesterol-lowering medication, it's important to monitor various parameters to assess the effectiveness of the medication, manage potential side effects, and ensure overall cardiovascular health. Monitoring parameters when on cholesterol medication may include:

Cholesterol Levels:

Continue to monitor your cholesterol levels regularly to assess the medication's impact. This includes tracking total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Liver Function Tests:

Some cholesterol-lowering medications, particularly statins, can affect liver enzymes. Regular liver function tests, including measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), can help detect any liver-related issues.

If you experience symptoms like unexplained fatigue, abdominal pain, or yellowing of the skin or eyes while on medication, inform your healthcare provider promptly.

Muscle Symptoms:

Statins, in particular, are associated with muscle-related side effects, such as muscle pain or weakness (myopathy).

If you experience persistent muscle symptoms, report them to your healthcare provider. They may order a creatine kinase (CK) blood test to assess muscle damage.

Kidney Function:

Some cholesterol medications may affect kidney function in rare cases.

Regular monitoring of kidney function through tests like serum creatinine and estimated glomerular filtration rate (eGFR) may be recommended.

Blood Pressure:

High cholesterol often coexists with other cardiovascular risk factors, such as high blood pressure.

Monitoring blood pressure and ensuring it remains within a healthy range is crucial for overall cardiovascular health.

Weight and Diet:

Maintain a healthy weight and adhere to a heart-healthy diet as recommended by your healthcare provider or a registered dietitian.

Monitoring your weight and dietary habits can help manage cholesterol levels and overall health.

Lifestyle Habits:

Continue to follow a heart-healthy lifestyle, which includes regular physical activity, not smoking, and limiting alcohol intake.

Lifestyle habits play a significant role in cholesterol management and overall cardiovascular health.

Adherence to Medication:

Ensure you take your cholesterol medication as prescribed. Missing doses or discontinuing medication without consulting your healthcare provider can affect its effectiveness.

11. Cost-Effectiveness of High Cholesterol Treatment

Lifestyle changes at population policy level have proven to be more cost-effective than individual lifestyle and drug interventions, especially when directed at high-risk populations.

Legislation supporting healthier habits, such as reducing salt intake and enforcing smoking bans, has been effective in preventing cardiovascular disease.

Individual-level interventions, such as improving diet, increasing physical activity, and smoking cessation, have the potential to be cost-effective. However, their effectiveness is limited by suboptimal adherence, and strategies to improve adherence, including the use of electronic device reminders are being explored.

There is strong evidence supporting the cost-effectiveness of using low-cost statins to lower blood cholesterol levels.

Disclaimer:
The information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The content is not intended to be a comprehensive source of information and should not be relied upon as such. Reliance on any information provided in this article is solely at your own risk. The authors and the publisher do not endorse or recommend any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned in the article. Any reliance on the information in this article is solely at the reader's own risk.

Book an Appointment

Make An Appointment With Us At Your Convenience For A Seamless Experience

Book Now