Dr Aidin Rawshani

High blood cholesterol levels (high blood lipids): causes, treatments, risks


The body uses cholesterol for many different functions, such as producing hormones (e.g vitamin D) and components for cell membranes. It takes only a small amount of cholesterol in the blood to meet the needs of the body. If a person has too much cholesterol in the blood, the excess can be deposited within the walls of the blood vessels (arteries), including the coronary arteries, the carotid arteries (which supply blood to the brain and head) and the arteries supplying blood to the legs and intestines.

Cholesterol deposits within the artery wall build up to create atherosclerotic plaques that cause narrowing and blockage of the artery. Narrowing of the artery implies that less blood can flow through the artery, which leads to signs and symptoms of reduced blood perfusion in the organ supplied by the artery. Atherosclerotic plaques in the coronary arteries cause angina pectoris (chest pain).

High cholesterol (hyperlipidemia) is a condition with elevated levels of certain bad fats, or lipids, in the blood. This condition is usually caused by lifestyle factors, such as poor nutrition and physical inactivity, combined with heredity (genes). In addition, there are certain medicines that can cause high cholesterol.

In healthcare, high cholesterol is diagnosed if you consistently have high levels of bad cholesterol in your blood, especially LDL cholesterol, this can be detected with a routine test called lipid panel. To treat high cholesterol, your doctor can recommend healthy lifestyle changes, such as proper nutrition, increased exercise, smoking cessation and striving for a healthy weight. Your doctor may also prescribe medicines, such as statins, to lower and control your high blood cholesterol. High cholesterol that remains untreated can lead to the build-up of plaques in the blood vessels, called atherosclerosis. The build-up of plaques increases the risk of heart attack, stroke and peripheral artery disease (vascular disease of the lower leg).

Causes of high cholesterol

The risk of developing elevated cholesterol levels in the blood is divided into two different categories, namely modifiable and non-modifiable risk factors. The probability that you develop high cholesterol during your lifetime rises with increasing age, heredity (genetics) and ethnicity, these are considered non-modifiable factors.

However, there are several avoidable factors that contribute to the development of high cholesterol, such as obesity and overweight, stress, smoking, poor eating habits, low physical activity and high blood sugar levels.

Aging and lipids

As the human body ages, our metabolism and various biochemical processes change inside our cells. An example is your liver that gets worse at getting rid of the bad cholesterol, LDL cholesterol (LDL cholesterol), as effective as when you were young. If the body gets worse by eliminating LDL cholesterol, then the cholesterol levels in the blood rise. Various age-related changes increase the risk of developing high cholesterol. High age is probably the strongest risk factor for high cholesterol.

Family history and heredity (genes)

Some people can develop high cholesterol due to mutations or changes in their genes. These mutations make it harder for the body to get rid of LDL cholesterol from the blood or break it down in the liver. Familiar hypercholesterolemia is a hereditary form of high cholesterol in the blood, this condition is strongly associated with cardiovascular disease.

Genetic studies have shown that family members tend to have similar levels of LDL cholesterol, known as bad cholesterol, or HDL cholesterol, known as good cholesterol. Read more about current research to better understand how genetic differences can affect how the body absorbs cholesterol from the foods that we eat, how much cholesterol the liver produces and removes, and how we react to treatment against high cholesterol.

Lifestyle factors

Bad diets are a common cause of high cholesterol in the blood, consuming large amounts of saturated fat or trans fats, can cause an increase in bad cholesterol (LDL cholesterol). Lack of physical activity, such as spending a changing part of the day in front of the TV or computer, is associated with lower Levels of good cholesterol (HDL cholesterol). Smoking leads to a decrease in HDL cholesterol, especially in women, and increases the level of LDL cholesterol in the blood.

Other medical conditions that may cause high cholesterol (hyperlipidemia)

The following medical conditions can cause high cholesterol

  • Chronic Kidney Disease
  • HIV
  • Impaired thyroid function (hypothyroidism)
  • Obesity and Obesity
  • Polycystic Ovarian Syndrome (PCOS)
  • Inflammatory diseases such as psoriasis, pemphigus, histiocytosis, lupus erythematosus, and rheumatoid arthritis
  • Drugs that can lead to high cholesterol in the blood
  • Examples of drugs that can cause high cholesterol

Various diuretic treatments used for high blood pressure (thiazides) Immunosuppressants, such as cyclosporine used to treat inflammatory diseases, psoriasis or to prevent rejection after a transplant Steroids used to treat inflammatory diseases such as lupus and psoriatic retinoids such as retinol for the treatment of acne Antiretroviral drugs used to treat Hivantiarrhythmic drugs such as amiodarone, used in the treatment of irregular heart rhythm.

Control cholesterol levels

Your doctors will order routine blood tests to control blood cholesterol levels. The timing and frequency of these blood tests depend on age and risk factors, family history for high cholesterol in the blood or other cardiovascular diseases such as myocardial infarction or stroke.

Doctors use lipid samples to check if you have healthy cholesterol levels in your blood. A lipid panel measures the concentration of total cholesterol, HDL cholesterol and non-HDL cholesterol in the blood. Non-HDL cholesterol includes LDL cholesterol and is calculated by subtracting your HDL cholesterol levels from your total cholesterol levels.

Normal cholesterol levels

If you are 19 years old or younger, your total cholesterol level should be lower than 4.2 mmol/L, non-HDL cholesterol should be lower than 3.1 mmol/L, LDL cholesterol should be lower than 2.5 mmol/L, and HDL cholesterol should be higher than 1.1 mmol/L.

If you are 20 years of age or older, your total cholesterol should be between 3.2 and 5.1 mmol/L, your non-HDL cholesterol should be lower than 3.3 mmol/L, LDL cholesterol should be lower than 2.5 mmol/L, and HDL cholesterol should be 1.0 mmol/L or higher.

People with high cholesterol need to check the levels of cholesterol in the blood regularly, the frequency of these checks depends on your age, risk factors, heredity and cardiovascular diseases such as varicose veins, heart attack or stroke.

Lifestyle changes that prevent the development of high cholesterol

Cholesterol is an important component for many organs of our body and cells need cholesterol to function normally, on the contrary, high levels of cholesterol increase the risk of cardiovascular disease.

To prevent high cholesterol or if you have certain risk factors that may contribute to the development of high cholesterol or other cardiovascular risk factors, your doctor may recommend that you adopt a healthy lifestyle, such as eating healthy foods, being physically active, achieving a healthy weight, stopping smoking and cope with stress.

Symptoms and complications of high cholesterol in the blood

High cholesterol does not cause specific symptoms. However, people who have very high cholesterol levels in the blood may develop cholesterol-rich coatings in different areas of the skin, usually under the eyes, a condition called xantelasma in medical language. Undiagnosed or untreated hyperlipidemia (high cholesterol) can lead to serious complications such as heart attack, stroke and heart failure.

High cholesterol levels cause the build-up of fatty plaques in all blood vessels of the body, this is called atherosclerosis or varicose veins thickening.

Common complications resulting from high cholesterol

Carotid artery disease (carotid artery disease) Angina (ischemic heart disease, including angina or myocardial infarction) Peripheral artery disease (lower leg vascular disease) Stroke

How to diagnose high cholesterol

In order for doctors to diagnose high cholesterol, you need to undergo a physical medical examination, ask about the medical history and family history, repeatedly check what your cholesterol levels are in the blood. Your doctor may also order several other tests to see if you suffer from other medical conditions that may cause high cholesterol.

Your doctor will ask about your eating habits, exercise habits, family history and other risk factors for high cholesterol, as well as if you have a history of vascular disease (e.g. heart attack or stroke). Your doctor may ask if you have any other signs or symptoms. This information can help your doctor determine if you have complications or other conditions that may cause high cholesterol.

During your physical examination, your doctor will check signs of very high cholesterol, such as xantelasma, or signs of other diseases that may be caused by high cholesterol.

Your doctor may order some of the following tests to determine if other medical conditions caused high cholesterol

Blood tests to control thyroid hormones (T3, T4, TSH), this can help exclude hypothyroidism as a cause of high cholesterol levels. Testosterone sampling to exclude Polycystic Ovary Syndrome (PCOS). Skin biopsy to exclude inflammatory diseases, such as psoriasis, which can affect cholesterol levels.

Treatment of high cholesterol (hyperlipidemia)

High cholesterol is treated with lifestyle changes and medicines to control or lower your cholesterol in your blood. Lipoprotein apheresis is a procedure that can be used to treat familial hypercholesterolemia.

To help you lower or control elevated blood cholesterol levels, your doctor may recommend that you adopt the following healthy lifestyle changes:

Healthy eating. Dietary recommendations include diet that limits the amount of saturated fat and trans fats that you eat. It is also recommended that you consume more fish with high levels of omega-3 fatty acids and vegetable oils that can help lower the level of cholesterol in the blood and the risk of cardiovascular disease. DASH is a diet plan that can help you lower your bad LDL cholesterol. A healthy diet also includes whole grains, fruits and vegetables rather than refined carbohydrates such as sugar. Talk to your doctor about other nutritional changes that you can implement.

To be physically active. There are many health benefits of being physically active and getting the recommended amount of physical activity every week. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and increase HDL cholesterol. Before you start any training program, ask your doctor what level of physical activity is right for you.

Aim for a healthy weight. If you have high cholesterol and are overweight, you can improve your health by aiming for a healthy weight. Research has shown that adults with overweight and obesity can reduce LDL cholesterol and increase HDL cholesterol by losing only 3 percent to 5 percent of their body weight. Achieving 5 percent to 10 percent weight loss in 6 months is recommended.

Manage stress. Research has shown that chronic stress can increase LDL cholesterol levels and reduce HDL cholesterol levels. Quitting smoking is extremely important for people with high cholesterol levels.

If you cannot lower or control your cholesterol levels along with lifestyle changes, your doctor may prescribe medicine.

Drug options in the treatment of hyperlipidemia

Statins inhibit cholesterol synthesis in the liver by blocking the protein HMG-CoA reductase from making cholesterol. Liver cells try to compensate for the low cholesterol by synthesizing more LDL receptors on the cell surface to increase LDL uptake from the blood. Statins are the most common drug used to treat high cholesterol. PCSK9 inhibitors lower LDL cholesterol by reducing the destruction of the LDL receptor in the liver, which helps to remove and clear LDL cholesterol from the blood. Bile acid sequestrants block the reabsorption of bile acids and increase the conversion of cholesterol into bile acids. This treatment can lower cholesterol levels in the blood. Ezetimibe blocks diet cholesterol from being absorbed in the intestines. Lomitapid blocks the liver from releasing VLDL cholesterol into the blood. It is used only in patients who have familial hypercholesterolemia. The mipomersen reduces the levels of non-HDL cholesterol in the blood. It is used only in patients who have familial hypercholesterolemia. Niacin (nicotinic acid) poorly reduces LDL cholesterol and triglycerides and raises HDL cholesterol.

If your doctor prescribes medicines as part of your treatment plan, be sure to continue your healthy lifestyle changes. The combination of medicines and healthy lifestyle changes helps to lower and control your blood cholesterol levels. Talk to your doctor about any side effects to determine which medicine is best for you.

Some patients with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower the level of cholesterol in the blood. Lipoprotein apheresis is a dialysis-like process in which LDL cholesterol is removed from the blood using a filtration machine, while the rest of the blood is returned to the patient.

If you have been diagnosed with high cholesterol, it is important to continue treatment. Follow-up care may vary depending on your cholesterol levels, your risk of heart and vascular complications such as heart attack or stroke, and your response to treatment.

Elevated triglycerides

Triglycerides are a kind of fat that is used to store energy and when consuming energy in the muscles. Elevated triglyceridemia (triglyceridemia) in the blood is a type of lipid disorder or dyslipidemia that contributes to an increased risk of cardiovascular disease and diabetes. This condition can occur on its own, associated with other lipid disorders such as high cholesterol, low HDL cholesterol or as part of the metabolic syndrome.

Triglycerides can also rise as a result of certain medical conditions, heredity (genetics) contributes to triglycerides levels in the blood, lifestyle habits and some medicines can lead to high triglycerides.

Medical conditions that may increase triglyceride levels in the blood include thyroid disease, diabetes, liver and kidney disease as well as overweight and obesity. Sometimes some mutations in our genome can cause high levels of triglyceride in the blood. Being physically inactive, eating foods high in fat and carbohydrates (sugar) or drinking too much alcohol can increase triglycerides in the blood. Some medicines used to treat breast cancer, high blood pressure, HIV and other conditions may also increase triglyceride levels in the blood.

High triglycerides usually do not cause symptoms, but untreated or uncontrolled high levels of triglycerides in the blood may increase the risk of serious complications such as coronary heart disease and stroke. Very high triglycerides can increase the risk of acute pancreatitis, which is inflammation of the pancreas, the condition causes severe pain in the abdomen.

Your doctor can diagnose you with high triglycerides in your blood if your blood triglyceride levels in fasting are 1.7 mmol/L or higher. Normal levels of triglyceride in fasting are less than 0.8 mmol/L for children under 10 years of age and less than 1.0 mmol/L for all individuals older than 10 years.

If you are diagnosed with high triglycerides in your blood, your doctor may first recommend that you adopt healthy lifestyle changes, such as healthy eating, which includes restriction of alcohol, added sugar and foods high in saturated fat or trans fat, regular physical activity, quit smoking and aim for a healthy body weight. Your doctor may also prescribe medicines such as Fibrates, Omega-3 fatty acids, nicotinic acid or statins to control or lower levels of triglycerides in your blood.

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