High Cholesterol

HIGH CHOLESTEROL

Cholesterol is a waxy substance found in blood. The body needs cholesterol to build healthy cells, but high levels of cholesterol can increase the risk of heart disease. With high cholesterol, fatty deposits develop in the blood vessels. Eventually, these deposits grow to make it difficult for enough blood to flow through the arteries. Sometimes, some of the deposits can break suddenly and form a clot that causes a heart attack or stroke.

High cholesterol can be inherited, however it is often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol. One can lower their cholesterol by eating healthily and getting more exercise. Some people also need to take medicine

High cholesterol does not cause symptoms. One can only find out if they have it from a blood test. Too much cholesterol can be bad for one's health. There is 'good' cholesterol and 'bad' cholesterol.

TYPES OF CHOLESTEROL

The difference between 'good' and 'bad' cholesterol;

Good cholesterol otherwise called High-density lipoprotein (HDL), removes cholesterol from the bloodstream. Low-density lipoprotein (LDL) is the 'bad' cholesterol.

If a person's total cholesterol level is high because of a high LDL level, he/she may be at high risk of heart disease or stroke. Conversely, if the total cholesterol level is high only because of a high HDL level, they are probably at a lower risk.

Triglycerides are another type of fat in the blood. Whenever a person eats more calories than the body can use, the extra calories are turned into triglycerides.

Lifestyle changes (e.g. diet and exercise) can improve one's cholesterol levels, lower LDL and triglycerides, and raise HDL.

An individual's ideal cholesterol level will depend on his/her risk for heart disease.

• Total cholesterol level - (less than 200 is best), it will however depend on the HDL and LDL levels.
• LDL cholesterol levels - (less than 130 is best), this will depend on the risk for heart disease.
• HDL cholesterol levels - (60 or higher reduces the risk for heart disease).
• Triglycerides :(less than 150 milligrams per deciliter (mg/dl) is best).

Triglycerides, a different type of lipid

Triglycerides are another type of lipid but they are different from cholesterol. While the body uses cholesterol to build cells and certain hormones, it uses triglycerides as a source of energy.

When one eats more calories than the body can use right away, it converts those excess calories into triglycerides. The triglycerides is stored in the fat cells.

If the individual regularly eats more calories than his/her body can use, the triglyceride levels can go high. This may raise the risk of several health problems, including heart disease and stroke.

A simple blood test can be used to measure triglyceride level, as well as cholesterol levels.

CAUSES OF HIGH CHOLESTEROL

The human liver produces cholesterol, but we also get cholesterol from food. Therefore eating too many foods that are high in cholesterol, saturated fats, and Trans fats may increase an individual's risk of developing high cholesterol. Other lifestyle factors like include inactivity and smoking can also contribute to high cholesterol.

A person's genetics can also affect their chances of developing high cholesterol. Genes are passed down from parents to children. Certain genes instruct the body on how to process cholesterol and fats. In the event that the parents have or had high cholesterol, the person may be at higher risk of having it too.

In very rare cases, high cholesterol is caused by familial hypercholesterolemia. This genetic disorder prevents the body from removing LDL. According to some studies, most adults with this condition have total cholesterol levels above 300 mg/dL and LDL levels above 200 mg/dL.

Being overweight and sedentary also causes high cholesterol. An overweight person, is most likely have a higher level of triglycerides. If one never exercises and is not at all active, it can lower the HDL (good cholesterol).

Cigarette smoking also causes high cholesterol, and lowers the good cholesterol (HDL).

Other health conditions, (e.g. diabetes and hypothyroidism), may also increase the risk of developing high cholesterol and its related complications.

SYMPTOMS OF HIGH CHOLESTEROL

• Dizziness and headaches - With cholesterol building up in the arteries, circulation gets impeded and this disrupts cellular oxygenation. The result is dizziness, loss of balance and strong headaches.
• Swelling and numbness of limbs - Swelling and a feeling of numbness in the limbs is one of the initial symptoms of high cholesterol. This happens because the accumulated lipids prevent good circulation by reducing the delivery of oxygen and nutrients to the muscles.
• Halitosis : Also known as bad breath, it is one of the most common symptoms of high cholesterol. Since cholesterol secretes itself in the liver, too much of it creates serious difficulties with digestion. As a result, dryness and unpleasant odors in the mouth may be experienced.
• Chronic fatigue and weakness - The constant feeling of weakness, fatigue and the desire to sleep at odd hours are usually the result of poor nutrition and excess physical activity. However, what most people do not know is that it can also be a strong sign of high cholesterol.
• Bloating and indigestion - Uncontrolled levels of bad cholesterol (LDL) tend to be a strong trigger for persistent indigestion and bloating. Excessive lipids in the blood and liver affect the body's metabolism and prevents thorough digestion, especially with fatty foods.
• Eyesight problems : Patients with high LDL cholesterol commonly have soft, flat, yellowish lumps in their eyes, irritation, and blurred vision.
• Constipation : Since the build-up of lipids in the arteries affects digestion, bowel motility decreases and the patient experiences episodes of constipation.
• Chest Pains : One very easy symptom to spot is chest pain. Although there are many diseases associated with chest pain, the majority of cases are related to high cholesterol.
• Skin conditions : Another symptom of high cholesterol is back rash. In fact, other skin conditions may occur especially when the body has difficulty regulating the levels of cholesterol. These conditions manifests in the form of red spots, inflammation and an uncomfortable itching sensation that tends to be difficult to control.

WHEN TO SEE A DOCTOR

Normally the doctor will decide when a patient should have a cholesterol test. Children and young adults with no risk factors for heart disease are usually tested one time between the ages 9 and 11 and again between the ages 17 and 19. Repeat testing for adults with no risk factors for heart disease is usually done at five year interval.

If the test results aren't within desirable ranges, the doctor might recommend more-frequent tests. The doctor might also suggest even more frequent tests if the patient has a family history of high cholesterol, heart disease or indeed other risk factors, such as smoking, diabetes or high blood pressure.

RISK FACTORS

Factors that can increase the risk of bad cholesterol may include:

• Diabetes - Higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lower HDL cholesterol can be attributed to high blood sugar (diabetes).
• Lack of exercise - Exercise helps boost the body's good cholesterol (HDL), at the same time, it increases the size of the particles that make up bad cholesterol (LDL), and this renders it less harmful.
• Obesity - A body mass index (BMI) of 30 or greater puts one at risk of high cholesterol.
• Poor diet - Saturated fat (found in animal products), and Trans fats (found in some commercially baked cookies, crackers etc.) can raise cholesterol levels. High cholesterol foods, (red meat and full-fat dairy products) tends to increase cholesterol.
• Smoking - Smoking damages the walls of the blood vessels and makes them prone to the accumulation of fatty deposits. Smoking might also lower level of good cholesterol (HDL).
• Age : The body's chemistry changes as we age, this increases the risk of high cholesterol. (E.g. as we age, the liver becomes less able to remove LDL cholesterol hence the accumulation).

Complications of high cholesterol

Development of atherosclerosis

A dangerous accumulation of cholesterol and other deposits on arterial walls (atherosclerosis) occurs out of High cholesterol. This reduces blood flow through the arteries, which can result in complications, such as:

• Stroke - Similar to a heart attack, a stroke occurs when a blood clot blocks blood flow to parts of the brain.
• Chest pain - If the coronary arteries (arteries that supply the heart with blood) are affected by the high cholesterol level, it might result in chest pain (angina) as well as other symptoms of coronary artery disease.
• Heart attack - If plaques tear or rupture, a blood clot can form at the rupture site. This will block the flow of blood or if it breaks free, it may plug an artery downstream thus effectively impeding blood flow. If blood flow to part of the heart stops, the patient will have a heart attack.

DIAGNOSIS

There is no way to tell if one has high cholesterol without having it checked. A simple blood test called a lipid panel or lipid profile will reveal the cholesterol level.

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides — a type of fat in the blood

For the most accurate measurements, patients must not eat or drink anything other than water for nine to twelve (9 : 12) hours before the blood sample is taken.

Men of age 35 and older and women age 45 and older should have their cholesterol levels checked.

People (both Men and women) 20 years and older who have risk factors for heart disease should have their cholesterol levels checked.

Teens who may be taking certain medicines or have a strong family history of high cholesterol must be checked as well.

TREATMENT

Exercising and eating a healthy diet are the first line of defense against high cholesterol. But the doctor might recommend medication, if a person adopts these important lifestyle changes and cholesterol levels remain high.

Personal risk factors, age, health and possible side effects of the drug will determine the choice of medication or combination of medications.

Common choices include:

• Cholesterol absorption inhibitors - The small intestine absorbs the cholesterol from food and releases it into the bloodstream. Ezetimibe (Zetia) is a drug that helps to reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used in combination with a statin drug.
• Statins - They block a substance which the liver needs to make cholesterol. This causes the liver to remove cholesterol from the blood. Statins can also potentially reverse coronary artery disease by helping the body re-absorb cholesterol from built-up deposits on arterial walls. Choices include atorvastatin (Lipitor), fluvastatin (Lescol XL) to mention but a few.
• Bile-acid-binding resins : The liver uses cholesterol to make bile acids, a substance needed for digestion. Colesevelam (Welchol), colestipol (Colestid) and cholestyramine (Prevalite) are medications that lower cholesterol indirectly by binding to bile acids. This prompts the liver to use the excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood.

Injectable medications - A newer class of drugs, known as PCSK9 inhibitors, can lower the amount of cholesterol circulating in the blood by helping the liver absorb more LDL cholesterol. Alirocumab (Praluent) and evolocumab (Repatha) might be recommended for people who have a genetic condition that causes very high levels of LDL, or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.

MEDICATIONS FOR HIGH TRIGLYCERIDES

If the patient also has high triglycerides, the doctor might prescribe:

• Omega-3 fatty acid supplements - These supplements can help lower triglyceride levels. They are available by prescription or over-the-counter. Patients should seek their doctors' approval before acquiring it over the counter. Omega-3 fatty acid supplements could affect other medications.
• Fibrates - These medications reduce the liver's production of very-low-density lipoprotein (VLDL) cholesterol and rather speed -up the removal of triglycerides from the blood. (e.g. Fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid) VLDL cholesterol contains mostly triglycerides).
• Niacin : With this medication, the liver's ability to produce LDL and VLDL cholesterol Niacin is limited. Niacin however does not provide benefits over statins. It has also been linked to liver damage and strokes, subsequently, most doctors now recommend it only for people who for some reason cannot take statins.

TOLERANCE

Tolerance of medications varies between individuals. Commonly, the side effects of statins are muscle pains and muscle damage, reversible memory loss and confusion, and elevated blood sugar. The doctor might recommend liver function tests to monitor the medication's effect on the patient's liver if he/she opts to take medication for cholesterol.

CHILDREN AND CHOLESTEROL TREATMENT

For children age 2 and older who have high cholesterol or who are obese, diet and exercise are the best initial treatment. Children age 10 and older who have extremely high cholesterol levels might be prescribed cholesterol-lowering drugs, such as statins

PREVENTION OF HIGH CHOLESTEROL

Making healthy food choices and exercising are two ways to reduce the risk of developing high cholesterol.

• People should endeavor to eat healthier fats, (lean meats, avocados, nuts, and low-fat dairy items) and resort to fewer foods with saturated fats (e.g. red meat and most dairy products).
• Foods that contain trans-fat (e.g. fried and packaged foods) must be avoided, instead look for foods that are rich in omega-3 fatty acids (salmon, herring, walnuts, almonds and some egg brands).
• Engage in simple exercises like riding a bike to work, going for a walk, joining a yoga class etc. the ultimate aim is to get 30 minutes of activity every day.

The genetic risk factors for high levels of cholesterol cannot be controlled. Lifestyle factors however, can be managed at a personal level.

To lower the risk of developing high cholesterol:

• Exercise regularly.
• Do not smoke.
• It is advisable to eat nutritious foods that are low in cholesterol and animal fats, and rather high in fiber.
• Avoid heavy alcohol consumption.
• Maintain a healthy weight.

The doctor's recommendations for routine cholesterol screening must also be followed. The doctor will most likely encourage the patient to get his/her cholesterol levels tested on a regular basis if he/she is found to be at risk of high cholesterol or coronary heart disease.

LOWERING CHOLESTEROL THROUGH DIET

To help achieve and maintain healthy cholesterol levels, our doctors may recommend dietary changes.

For example, they may advise the patient to:

• Avoid the consumption of fast and junk food.
• Eat fruits, green leafy vegetables, and whole grains (high-fiber foods).
• Limit the intake of foods that are high in cholesterol, saturated fats, and Trans fats
• Choose chicken, fish, and legumes (e.g. Lean sources of protein).
• Instead of fried foods, settle for broiled, grilled, baked, steamed, and roasted foods.

The following are foods that are high in cholesterol, saturated fats, or Trans fats:

• Fish and other foods that contain omega-3 fatty acids, (e.g. salmon, mackerel, and herring are rich sources of omega-3s may also help lower LDL levels Red meat, egg yolks, and high-fat dairy products.
• Processed foods (made for example, with cocoa butter, palm oil, or coconut oil)
• Deep fried foods, (e.g. potato chips, onion rings, and fried chicken).
• Certain baked foods, (e.g. some muffins and cookies).

FOODS TO AVOID

Dietary cholesterol such as meat, eggs, and dairy is found in animal products. To help treat high cholesterol, the doctor may encourage the limitation of high-cholesterol foods such as the under listed;

• Eggs (especially the yolks)
• High-fat dairy products, (e.g. cheese, milk, ice cream, and butter)
• Fatty portions of red meat
• Liver and other organ meats

Doctors may recommend, that patients eat some of the above foods in moderation.

Lifestyle and home remedies

Lifestyle changes are essential to improving cholesterol levels. To bring the cholesterol numbers down, the following may be prudent to;

• Don't smoke - If the patient is already a smoker, he/she must find a way to quit.
• Mono-unsaturated fat : This is a healthier option (found in olive and canola oils). Other sources of healthy fat are avocados, nuts and oily fish
• Lose extra pounds : The loss of even 5 to 10 pounds can help lower cholesterol levels.
• Eat a heart-healthy diet : The focus should be on plant-based foods, (e.g. fruits, vegetables and whole grains). Saturated fats, (found in red meat), full-fat dairy products, and Trans fats (found in many processed foods) must be limited.
• Exercise regularly - With the doctor's input, work up to at least 30 minutes of moderate intensity exercise five times a week or engage in vigorous exercise five times a week.