What is high cholesterol?
Cholesterol is a waxy substance present in the bloodstream. It plays a crucial role in maintaining the health of our body’s cells. However, when there is an excessive amount of cholesterol in the blood, it can lead to the formation of fatty deposits within the blood vessels. This condition, known as high cholesterol or hypercholesterolemia, increases the risk of various health issues such as heart attack and stroke.
While a certain level of cholesterol is normal and necessary, an excess of it can have detrimental effects.
There are two distinct types of cholesterol:
- LDL cholesterol (low-density lipoprotein): Referred to as “bad” cholesterol, LDL cholesterol tends to accumulate in the artery walls, elevating the risk of heart attack and stroke.
- HDL cholesterol (high-density lipoprotein): Known as “good” cholesterol, HDL cholesterol aids in removing excess cholesterol from the bloodstream. This helps prevent the formation of blockages in the arteries and provides protection against heart attack and stroke.
Additionally, triglycerides, a type of fat found in the blood, serve as an energy source for the body. Elevated levels of triglycerides can also contribute to the risk of heart attack and stroke.
What causes high cholesterol?
Numerous factors and conditions contribute to the development of high cholesterol, and some of them are within your control while others are not. Certain circumstances may increase the likelihood of having high cholesterol, such as:
- Consuming a diet rich in saturated fat
- Being overweight or obese
- Smoking tobacco
- Excessive alcohol consumption
- Lack of physical exercise
However, it’s essential to note that even if you maintain a healthy diet and lifestyle, high cholesterol can still occur due to factors beyond your control. For instance, individuals with a family history of high cholesterol may have difficulty removing LDL cholesterol from their blood due to genetic variations affecting liver function. Moreover, a condition called familial hypercholesterolemia can lead to high cholesterol from birth.
Cholesterol levels can also be influenced by age, medications being taken, and certain medical conditions, including:
- Chronic kidney disease
It’s important to understand that these factors and conditions can affect cholesterol levels, but they are not the sole determinants. Each person’s cholesterol profile is unique and may require individualized management and treatment.
How is high cholesterol diagnosed?
High cholesterol typically does not display any noticeable symptoms, and its levels are assessed through a blood test. The Centers for Disease Control and Prevention (CDC) suggests that individuals at low risk for cardiovascular disease should undergo cholesterol screening, beginning at the age of 20. This screening is typically ordered by your primary care provider.
For individuals with a normal risk of heart disease, abnormal or high cholesterol is defined by the following criteria:
- Total cholesterol exceeding 200 mg/dL
- LDL cholesterol above 130 mg/dL, with an ideal LDL level being below 100 mg/dL
- HDL cholesterol below 40 mg/dL in men and below 50 mg/dL in women
- Triglycerides exceeding 150 mg/dL
Upon reviewing your cholesterol levels, your healthcare provider will discuss the most appropriate steps to manage and treat your cholesterol effectively.
What medication can be used for high cholesterol?
In some cases, individuals may require medication to lower or prevent high cholesterol. Typically, individuals aged between 40 and 75 years old are more likely to need cholesterol-lowering medication. The most suitable medication for you will depend on several factors, including:
- Your specific cholesterol panel results
- Family history of cholesterol-related issues
- Other existing medical conditions
It’s important to note that even if you are prescribed cholesterol medication, adopting healthy lifestyle changes should still be prioritized.
The following are commonly used types of medications to manage cholesterol and triglyceride levels, either individually or in combination:
1. Statins: Statins are considered the first-line treatment for high cholesterol. They work by inhibiting an enzyme involved in cholesterol production in the body. By doing so, statins effectively reduce the amount of cholesterol produced. They lower LDL cholesterol and increase HDL cholesterol levels. Moreover, statins have been associated with a decreased risk of heart attack and stroke.
Examples of statins include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol)
- Lovastatin (Mevacor, Altoprev)
- Pravastatin (Pravachol)
- Rosuvastatin calcium (Crestor)
- Simvastatin (Zocor)
2. Ezetimibe: Ezetimibe (Zetia) belongs to a class of medications known as cholesterol absorption inhibitors. It works by preventing cholesterol absorption in the intestines. Combining ezetimibe with a statin may provide enhanced protection against heart attack and stroke compared to using a statin alone. Additionally, ezetimibe can be beneficial in lowering LDL cholesterol levels when a statin alone has not been effective.
3. PCSK9 inhibitors: PCSK9 inhibitors, such as alirocumab (Praluent) and evolocumab (Repatha), bind to a liver protein and render it inactive. By doing so, they can reduce LDL cholesterol levels and may have a slight effect in raising HDL cholesterol. Combining a PCSK9 inhibitor with a statin may provide even greater protection against heart attack and stroke compared to using a statin alone.
4. Adenosine triphosphate-citrate lyase inhibitors: Adenosine triphosphate-citrate lyase (ACL) inhibitors work by blocking the production of cholesterol in the liver. These are newer agents available for lowering LDL levels, and they are less likely to cause muscle pain as compared to statins.
- Bempedoic acid (Nexletol)
- Bempedoic acid and ezetimibe combination (Nexlizet)
5. Bile acid binders (resins): These medications attach to bile acids in the intestines, leading to a decrease in the overall amount of bile acids in the body. This, in turn, stimulates the liver to utilize cholesterol from the blood to produce new bile acids. Bile acid binders are considered the oldest and safest cholesterol medications, although they may not be as effective as other drugs in preventing heart attacks.
- Cholestyramine (Questran, Prevalite, LoCheolest)
- Colestipol (Colestid)
- Colesevelam hydrochloride (Welchol)
6. Triglyceride-lowering medications: If you have high triglyceride levels, you may require other types of medications either alone or in addition to cholesterol-lowering drugs. These can include:
- Fibrates: fenofibrate, gemfibrozil
- Nicotinic acids: niacin ER
- Omega-3 fatty acids: icosapent ethyl
It’s important to consult with your healthcare provider to determine the most suitable medication for your specific cholesterol profile and overall health condition.
High cholesterol, or hypercholesterolemia, refers to an excessive amount of cholesterol in the blood. While some cholesterol is necessary for the body, an excess can lead to fatty deposits in blood vessels, increasing the risk of heart attack and stroke.
There are two main types:
- LDL cholesterol (low-density lipoprotein): Known as the “bad” cholesterol, it can lead to artery blockages.
- HDL cholesterol (high-density lipoprotein): Referred to as the “good” cholesterol, it helps remove excess cholesterol from the bloodstream.
- Diet rich in saturated fat
- Obesity or being overweight
- Excessive alcohol consumption
- Lack of physical exercise
- Genetic conditions, like familial hypercholesterolemia
- Medical conditions, such as diabetes, hypothyroidism, HIV/AIDS, and chronic kidney disease
Through a blood test. Indicators of high cholesterol include:
- Total cholesterol over 200 mg/dL
- LDL above 130 mg/dL (ideal is below 100 mg/dL)
- HDL below 40 mg/dL in men and 50 mg/dL in women
- Triglycerides over 150 mg/dL
Some common medications include:
- Statins (e.g., Atorvastatin, Simvastatin)
- PCSK9 inhibitors (e.g., alirocumab, evolocumab)
- ACL inhibitors (e.g., Bempedoic acid)
- Bile acid binders (e.g., Cholestyramine, Colestipol)
- Triglyceride-lowering medications (e.g., Fibrates, Nicotinic acids, Omega-3 fatty acids)
Elevated cholesterol levels increase the risk of fatty deposits forming in blood vessels, which can lead to heart attacks and strokes.
Yes. Maintaining a balanced diet, regular exercise, avoiding tobacco, limiting alcohol intake, and maintaining a healthy weight can help manage cholesterol levels.
Yes, some individuals may have genetic predispositions, such as familial hypercholesterolemia, that cause high cholesterol regardless of lifestyle.
The CDC suggests those at low risk for cardiovascular disease to start cholesterol screening at age 20. The frequency thereafter depends on your risk factors and previous test results.
Triglycerides are a type of fat in the blood. High levels can increase the risk of heart attack and stroke, similar to cholesterol.