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High cholesterol

life science Maturity 11-13 Next article →

High cholesterol, medically known as hypercholesterolemia, is a condition where there are high levels of cholesterol in the blood. It is a specific type of hyperlipidemia, which means having high levels of lipids, or fats, in the blood. It can also be called hyperlipoproteinemia if lipoprotein levels are high, or dyslipidemia if there are any abnormalities in lipid levels.

Cholesterol
Cholesterol

Cholesterol is a vital substance for all animal cells. It is used to build cell membranes, which are the outer walls of cells. It also serves as a precursor, or starting material, for bile acids and steroid hormones.

Because cholesterol cannot dissolve in water, it cannot travel through the blood alone. Instead, it moves within protein particles called lipoproteins. These particles are classified by how dense they are. There are very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), low density lipoproteins (LDL), and high density lipoproteins (HDL). While all these particles carry cholesterol, they have different roles. High levels of non-HDL cholesterol, particularly LDL, are linked to health risks. In contrast, higher levels of HDL are considered protective for the body.

Average non hdl cholesterol levels, World, 2018 (cropped)
Average non hdl cholesterol levels, World, 2018 (cropped)

Several factors can cause cholesterol levels to rise. Environmental factors include diet, weight, stress, and even loneliness. A diet high in sugar or saturated fats can increase total cholesterol and LDL. Trans fats are especially risky because they increase LDL and reduce the protective HDL. Medical conditions can also play a role. These include type 2 diabetes, obesity, an underactive thyroid, and certain other disorders. For some, the cause is strictly genetic. This is seen in familial hypercholesterolemia, which affects about one in 250 individuals. This condition can stem from mutations in genes like APOB, LDLRAP1, or PCSK9.

Xanthelasma palpebrarum
Xanthelasma palpebrarum

Longstanding high cholesterol can lead to a process called atherosclerosis. This is the build-up of fatty plaques inside the arteries, often called the hardening of the arteries. Over many decades, these atheromatous plaques can cause the arteries to narrow progressively. If a small plaque ruptures, it may cause a blood clot to form. This clot can obstruct blood flow entirely. A sudden blockage in a coronary artery can result in a heart attack. A blockage in an artery supplying the brain can cause a stroke. If the narrowing is gradual, it can cause tissue ischemia, which is a restriction in blood supply.

Ischemia can cause many different symptoms depending on where it happens. In the brain, a temporary ischemic attack might cause dizziness, difficulty speaking, or numbness on one side of the body. If the heart does not get enough blood, it may cause chest pain. Ischemia in the eyes can lead to temporary vision loss. In the legs, it might cause pain while walking. In the intestines, it can cause abdominal pain after eating. Some people with high cholesterol also show physical signs like xanthelasma palpebrarum, which are yellowish patches near the eyelids. Other signs include xanthomata, which are yellowish deposits on the tendons or skin.

Doctors use different measurements to diagnose high cholesterol. In the United States, they use milligrams per deciliter (mg/dL). In the United Kingdom and Canada, they use millimoles per liter (mmol/L). For total cholesterol, a level below 200 mg/dL is considered desirable in the U.S. In the UK, the National Health Service recommends a limit of 5 mmol/L for healthy adults. For LDL, a level below 100 mg/dL is most desirable. In the UK, the recommended limit for LDL is 3 mmol/L. These numbers are important, but doctors also consider a person's overall risk factors when interpreting them.

Treating high cholesterol often involves lifestyle changes. Adults are encouraged to avoid trans fats and replace saturated fats with polyunsaturated fats. Other helpful steps include quitting smoking, increasing physical activity, and maintaining a healthy weight. For people with very high levels due to genetics, diet alone is often not enough. These individuals usually require lipid-lowering medications, such as statins. In very severe cases, medical teams may perform LDL apheresis or even surgery to manage the condition.

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File:Xanthelasma palpebrarum.jpg
Xanthelasma palpebrarum.jpg
File:Cholesterol.svg
Cholesterol.svg
File:Average non hdl cholesterol levels, World, 2018 (cropped).svg
Average non hdl cholesterol levels,...
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