High Cholesterol: Prevention, Treatment and Research

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Cholesterol is a natural component in everyone’s blood, and supports normal function of cell membranes, hormone levels and more. However, having too much, is considered hyperlipidemia, hypercholesterolemia or high blood cholesterol — a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.

Here’s what happens in your body when you have high cholesterol: The waxy cholesterol builds up in artery walls and contributes to plaque, a hard deposit that narrows and clogs the arteries. (You may hear this referred to as atherosclerosis, or “hardening of the arteries.”)

When plaque builds up, it becomes harder for the heart to circulate blood and oxygen, which can cause chest pain or shortness of breath with increased exertion (angina). If a blood clot forms at the site of a disrupted plaque in a narrowed artery, it can block blood flow to the brain (a stroke) or to the heart (a heart attack).

There are actually several different types of cholesterol, one of which is high density lipoprotein (HDL) cholesterol. High levels of some kinds of cholesterol, including low density lipoprotein (LDL) cholesterol, can be harmful to your heart and blood vessels.

Prevention

To keep blood cholesterol numbers in a desirable range, it helps to follow these practices:

• Know your numbers. Adults over age 20 should have their cholesterol measured at least every five years. That gives you and your doctor a chance to intervene early if your numbers start to rise.
• Stick to a healthy diet. Saturated fats, trans fats and dietary cholesterol can all raise cholesterol levels. Foods thought to keep cholesterol low include monounsaturated fats (such as nuts and olive oil), polyunsaturated fats (such as fish and canola oil) and water-soluble fiber (such as oats, beans and lentils). Get practical ideas to on eating for cardiovascular health.
• Exercise and manage your weight. Along with a healthy diet, staying fit and maintaining a normal weight for your height lower your cardiovascular risks by minimizing the odds of other contributing health problems like obesity and diabetes. If you’re overweight, losing as little as 5 to 10 percent of your weight can significantly lower your risk of cardiovascular disease. Learn how implementing an exercise routine helps your heart in The ABCs of Moving More for Heart Health.

Treatment

Only one in three people who have high LDL cholesterol have the condition under control. The main goal of treatment is to lower, or control, your LDL level to minimize your personal risk for heart attack or cardiovascular disease, based on your cholesterol numbers and other risk factors, such as a history of cardiovascular disease.

Lifestyle changes are recommended for anyone with high cholesterol. These include:

Diet upgrades. First on the treatment menu is a heart-healthy diet. “I find that my patients generally love the Mediterranean diet,” says Johns Hopkins Ciccarone Center cardiologist Michael Blaha, M.D., M.P.H. “It tastes great, it’s satiating, and there’s excellent evidence that it reduces cholesterol and cardiovascular risk.”

Highlights of the Mediterranean diet include reducing saturated fat (found in animal products, butter, whole and 2% dairy products, coconut oil and palm oil) and trans fats (found in fried foods and baked goods). Eat mostly polyunsaturated or monounsaturated fats (found in fish, avocadoes, olive oil, nuts, and canola and soybean oil). Alcohol can raise triglycerides, so you may be advised to cut back.

Regular exercise. Aim for at least 30 minutes of exercise a day, most days. The American Heart Association recommends 40 minutes of moderate to vigorous exercise three to four times per week.

Weight management. This step is especially important for those who are overweight and who have high triglyceride levels or too-big waistlines (above 40 inches for men or 35 inches for women).

Medications. In addition to lifestyle changes, some people are prescribed drugs designed to lower cholesterol. Here are some of those medications:

• Statin medications slow the liver’s production of cholesterol and can help remove cholesterol circulating in the blood.
• Selective cholesterol absorption inhibitors (like ezetimibe) prevent the absorption of cholesterol from the intestine and help removal in the liver.
• PCSK9 inhibitors may be available for patients with high cholesterol in certain circumstances.
• Resins (bile acid sequestrants) bind to bile, a digestive acid, which causes the liver to produce more bile and thus use up more cholesterol.
• Fibrates lower triglycerides (rather than LDL levels).
• Niacin (nicotinic acid) is a B vitamin that affects the production of fats in the liver.
• Omega-3 fatty acid medications derived from fish oils also work to lower high triglyceride levels.

Lowering Your Cholesterol

Working to lower your cholesterol can be a long-term effort, and changing your health habits is key, Blaha says. To increase your odds of success:

• Don’t count on medications alone. You have to make lifestyle changes as well, according to Blaha.
• Start small. Modifying your diet and lifestyle in minor ways will make it easier to incorporate those changes into your life over the long haul. For example, rather than embarking on a drastic calorie-cutting diet, start by swapping out high-cholesterol and high-fat foods you love for healthier choices. For instance, buy skim milk instead of whole. Substitute olive oil for butter when you cook. Purchase foods with “no trans fats” on the labels.
• Know your cholesterol-lowering drugs. Some of these medications interact with grapefruit and pomegranate (and their juices). Pay close attention to your doctor’s guidelines about cholesterol drugs, and never stop taking them without consulting your physician. Be sure to report medication side effects to your doctor.

Research

New guidelines for LDL levels and addressing cardiovascular disease risk

New guidelines for assessing your heart disease give you and your doctor powerful tools for estimating your cardiovascular disease risk and lowering your LDL cholesterol levels. Working with your health care team, you can create a plan with a customized combination of lifestyle changes, medications and continued monitoring.

A cost-effective test can detect the early risk factors for heart disease

Using computerized tomography (CT), a coronary artery calcium scan can detect calcium and plaque in the walls of your heart’s arteries. The test is relatively inexpensive and can reveal early warning signs of heart disease so you can take action to lower your risk.

PSCK9 inhibitors can lower your LDL cholesterol: a lot

PSCK9 inhibitors may be a good choice for people with an inherited form of high cholesterol. These new drugs can lower dangerous LDL levels by half or more. The drugs’ costs are high, but the health care industry is working with manufacturers and pharmacists to bring the price down and make PSCK9 inhibitors available to more people.

Older Adults and High Cholesterol: What You Need to Know

Older Adults and High Cholesterol: What You Need to Know | Johns Hopkins Medicine

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High cholesterol is well known as a risk factor for heart disease. Surprisingly, though, some research has shown that high cholesterol does not increase the risk of dying from heart disease in elderly people.

Negative Impact of High Cholesterol

Studying cholesterol in older adults is trickier than it sounds, Martin says. Many people who have high cholesterol die from complications of heart disease before reaching an advanced age. Those who live into their 70s or 80s despite high cholesterol might have other factors that increased their longevity. That bias could skew the research results.

“If someone has made it to that age and hasn’t had problems from their cholesterol, they may have gotten lucky with genes or other protective factors,” he says. But that doesn’t mean high cholesterol is harmless — or that their luck won’t run out.

In addition, high cholesterol is one of many factors that work together to contribute to cardiovascular disease, along with elements such as  high blood pressure, diabetes, smoking and inactivity. Cholesterol might not always be the single most important factor, Martin says, but it’s a piece of the puzzle that patients and doctors should not ignore.

Treatment Gets Personal

There’s no one-size-fits-all approach for managing high cholesterol in older adults. “There’s not just one number we follow, but rather we consider the full picture,” says Martin.

For instance, he says, clinicians have to consider the other prescription drugs a patient is taking. Older adults often take many medications, and some medications might interact negatively with statin drugs typically prescribed to lower cholesterol.

Medical guidelines suggest that in treating patients over age 75, clinicians should pay extra attention to the potential for negative drug interactions.

Those guidelines are just a starting point, however. In some patients, other health problems might take priority. In those cases, the side effects of the statins might outweigh the benefits. In others who have fewer competing health risks and want to make cardiovascular disease treatment a priority, it might make sense to treat high cholesterol more aggressively. “It requires extra care and discussion to figure out the best decision for each patient, in partnership with the patient and his or her family,” Martin says.

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Related Topics

Cholesterol – VLDL (VLDL Cholesterol, VLDL Cholesterol)

Synonyms : Very low density lipoprotein cholesterol;

Very Low Density Lipoprotein; VLDL; Very low density lipoproteins.

Brief characteristics of the analyte Cholesterol – VLDL

Atherogenic marker.

Very low density lipoproteins – a heterogeneous group of particles with a diameter of 30-80 nm (smaller than chylomicrons, but larger than other lipoproteins). It is the main vehicle for the transport of exogenous lipids in plasma. Hyperlipemia due to VLDL, like chylomicrons, gives the plasma a cloudy appearance, which is noted as the presence of chilos, but unlike lipemia due to chylomicrons, turbidity due to VLDL does not separate in the form of a layer when plasma is stored for 12-18 hours at a temperature +4°С. The heterogeneity of the sizes of VLDL is determined by the difference in the content of both proteins and lipids in them. Larger particles contain relatively more non-polar triglycerides and fewer phospholipids and cholesterol than smaller ones.

The main site of VLDL synthesis is the liver, a small amount of them enters the plasma from the intestines. The main role of these particles is the transport of triglycerides from the liver to peripheral tissues. VLDL, in addition, serve as the main precursor of low-density lipoprotein (LDL). The plasma half-life of VLDL is 6-12 hours.

Tissue enzyme lipoprotein lipase plays an important role in triglyceride metabolism and plasma clearance from VLDL.

What is the purpose of determining the level of cholesterol – VLDL in the blood

The determination of VLDL in blood serum in combination with other lipids is used to additionally assess cardiorisks. Elevated VLDL cholesterol levels are associated with an increased risk of atherosclerotic changes.

The specificity of the analyte studied in the “Cholesterol – VLDL” test

Very low density lipoproteins are classified as highly atherogenic lipoproteins involved in the mechanism of atherosclerotic plaque formation: increased absorption of VLDL by macrophages causes a pronounced accumulation of cholesterol in them and the formation of foam cells.

It has been proven that the development of atherosclerosis is accelerated by an increased concentration of VLDL in diabetes mellitus and kidney disease.

More details about the laboratory assessment of lipid metabolism parameters can be found here.

Rules for preparing for a blood test to determine the level of cholesterol – VLDL

Strictly on an empty stomach after a night fasting period of 12 to 14 hours. On the eve of the study, it is necessary to exclude increased psycho-emotional and physical activity (sports training), alcohol intake.

In what cases is a blood test for cholesterol – VLDL

• Diagnostics of lipid metabolism disorders.

• Evaluation of atherogenic changes in the blood and the risk of developing pathology of the coronary vessels.

Interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.

Interpretation of the results of determining the level of cholesterol – VLDL in blood serum

Units of measurement : mmol / l.

Alternate units : mg/100 ml.

Unit conversion : mg/dL x 0.0259 => mmol/L.

Reference values ​​: level >0.8 mmol/l indicates increased risk

Increased values

Basic literature

1. Medical laboratory diagnostics. Programs and algorithms. / Ed. Karpishchenko A. I. – St. Petersburg: Intermedica, 2001. – 304 p.

2. Panin L. E. Lipoprotein metabolism and atherosclerosis. Bulletin of the SO RAMS, 2006, No. 2 (1220), p. 15 -22. Mesko D. (Ed.).

3. Differential diagnosis by laboratory medicine. – Springer, 2002, p.132-6.

Cholesterol: good or bad? – Unimed Medical Center in Zaporozhye

Cholesterol is one of the main characters of articles about healthy and proper nutrition. Thousands of texts have been written about its harm, as well as its benefits. At the same time, many are sure that cholesterol is still bad. In any case, this is what we are trying to convince the labels of hundreds of products, decorated with a catchy inscription “No cholesterol”.

So what is more in cholesterol – good or bad? Let’s try to figure it out.

Cholesterol is a lipid, that is, fat. 80% of cholesterol the human body produces on its own, this cholesterol is called endogenous. The remaining 20% ​​we get from food – exogenous cholesterol. And now, what, as a rule, the authors of articles turn a blind eye to – horror stories about the dangers of cholesterol: it is very important for a person, because it is a building material for body cells and participates in metabolic processes. Thanks to him, hydrocarbons do not crystallize in the membranes. With the participation of cholesterol, estrogen and androgen are formed. The conversion of sunlight into vitamin D also occurs with the participation of cholesterol. And this is only a small part of the functions that it performs in the human body.

But an increase in cholesterol levels is fraught with serious diseases and pathologies. Its excess, which occurs due to the consumption of cooking fats, margarine, sausages, fatty meat and sour-milk products, leads to the formation of so-called plaques in the vessels and arteries, which lead to the development of pathologies such as atherosclerosis, heart attack, stroke, and even myocardial infarction.

Just a couple of decades ago, the same atherosclerosis was diagnosed only in the elderly. In recent years, this disease has become much younger.

In addition to malnutrition, hypodynamia can lead to an increase in cholesterol levels, caused by the fact that modern people are becoming less and less active and spend most of their time in a sitting position. Other causes include being overweight, smoking, and drinking too much alcohol. Increase cholesterol and diseases of the kidneys, liver, diabetes, dysfunction of the thyroid gland, hypertension. Very often, high cholesterol is caused by a genetic predisposition.

There are no clear signs of elevated cholesterol levels. But the symptoms exist in diseases, the development of which provokes high cholesterol:

• narrowing of the coronary arteries of the heart;
• occurrence of pain in the legs during physical exertion;
• the appearance of xanthoma – yellow spots on the skin.

To maintain the balance of cholesterol in the blood, you need to eat right.