High Cholesterol: Causes, Symptoms, Diagnosis & Treatment

High cholesterol is a condition in which you have too many lipids (fats) in your blood. Also known as hyperlipidemia. This can cause fatty deposits in your blood vessels. Gradually, these deposits grow, making it difficult for enough blood circulation to flow through your arteries. These deposits can break suddenly and form a clot that causes a heart attack or stroke.

Having high cholesterol level can be closely linked with many other medical problems. This means it can cause some serious problems like coronary artery disease. And it can also happen as a result of other diseases, especially ones that trigger inflammation in your body (like lupus). Those with high cholesterol often develop high blood pressure as well.

High level of cholesterol is a very common issue in the United States. According to the Centers for Disease Control and Prevention (CDC), up to 94 million U.S. adults ages 20 and older have what could be considered borderline elevated cholesterol level

Because this disease can often present without any real signs and symptoms, you may not even notice you have it until you visit a healthcare provider.

Cholesterol

Cholesterol is a form of lipid. It’s a waxy substance, fat-like that your liver produces naturally. It’s important for the formation of cell membranes, certain hormones, and vitamin D.

Our body needs just the right level of lipids to function. If you have too many lipids in your bloodstream, your body can’t use everything. The extra ones start to build up in your arteries. When they combine with other substances in your blood, they form plaque (fatty deposits).

This plaque may not cause any problems for years or show symptoms, but with time, the plaque silently begins to get bigger and bigger within your arteries. This is why untreated high level of cholesterol is very dangerous. The extra lipids in your blood help make the plaque bigger without you even knowing it.

Cholesterol can’t dissolve in water, therefore can not travel through the bloodstream on its own. In order to help transport cholesterol, your liver produces lipoproteins.

These lipoproteins are particles that are made from fats and protein. They help carry cholesterol and triglycerides, another type of lipid, through the bloodstream. The two major forms of lipoprotein are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Difference between the Good and Bad Cholesterol

we have several types of lipids in our body. The main ones you’ve probably heard of, are:

• Good cholesterol (HDL)
• Bad cholesterol (LDL).

The good cholesterol known as high-density lipoprotein (HDL). Think of the H as meaning “helpful.” The HDLs carry cholesterol to your liver. The liver keeps your cholesterol levels balanced. It also makes enough cholesterol to support your body’s needs and gets rid of the rest. You must have enough HDLs to be able to carry cholesterol to your liver. If the HDLs level are too low, you’ll have too much cholesterol circulating in your bloodstream.

The bad cholesterol known as low-density lipoprotein (LDL). This is the one that makes plaque form in your arteries. Having too much of bad cholesterol (LDLs) can lead to several heart diseases or conditions over time.

You can also read about symptoms and causes of stroke

Symptoms of high cholesterol

High level of cholesterol is a silent condition. It typically doesn’t show any signs or symptoms. Those people with it doesn’t even realize they have high level of cholesterol until they develop severe complications, that can include heart attack or stroke.

This is why the National Heart, Lung, and Blood Institute (NHLBI) published, a person’s first cholesterol screening should occur between the ages of 9 and 11, and then be repeated every five years after that.

The NHLBI recommends that cholesterol screenings occur every one to two years for men ages 45 to 65 and for women ages 55 to 65. People over 65 should receive cholesterol tests annually.

If your test results aren’t within desirable ranges, your healthcare provider might suggest more-frequent measurements. Your provider might also suggest more-frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as diabetes or high blood pressure.

Causes of high cholesterol

Lifestyle factors, genetics, medical conditions and some medications play a role in causing high level of cholesterol in the blood. These include:

• Smoking. Smoking raises your “bad cholesterol” (LDL).
• Stress. lot of stress triggers hormonal changes that cause your body to produce cholesterol.
• Alcohol. Too much alcohol in your body can raise your total cholesterol.
• Inactivity. Sitting too much instead of being active.
• Diet and Obesity. Eating foods that have a lot of saturated fats or trans fats.
• Gene. Inheriting genes that make your cholesterol levels unhealthy.
• Medications. This include Beta-blockers, Diuretics, Hormonal birth control, Steroids, Antiretrovirals for HIV.
• Medical conditions. This include Chronic kidney disease, Diabetes, Hiv/Aids, Hypothyroidism, Lupus.

You can also read about risk factors and complications diabetes

Risk factors of high cholesterol

Any age, gender, and ethnicities can develop high cholesterol level. Those people at higher risk are those who:

• consume a lot of saturated and trans fats, like those found in fast food
• have limited physical activity
• are living with obesity
• smoke tobacco products
• have diabetes, kidney disease, or hypothyroidism
• have a family history of high cholesterol

Complications of high cholesterol

Having high level of cholesterol can lead to a dangerous accumulation of cholesterol (lipids) and other plague deposits on the walls of your arteries (atherosclerosis). These plaques can reduce the blood flow through your arteries, which can cause the following complications:

• Angina or Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you might have chest pain (angina) and other symptoms of coronary artery disease.
• Heart attack. If plaques tear or rupture, a blood clot can form at the plaque-rupture site, blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you’ll have a heart attack.
• Stroke. Similar to a heart attack, a stroke occurs when a blood clot blocks blood flow to part of your brain.
• High blood pressure
• Peripheral vascular disease
• Chronic kidney disease

You can also read about Prevention and diagnosis of heart failure

Prevention of high cholesterol

Changes in your lifestyle can keep you from getting high level of cholesterol. Things you can do include:

• Eat healthy foods.
• Cut back on eating fatty meats.
• Don’t buy snacks that have “trans fat” on the label.
• Stay active instead of sitting too much.
• Keep your stress level down.
• Get the right amount of sleep.
• Stay at a healthy weight.
• Stop smoking.

How to lower your cholesterol level

The same heart-healthy lifestyle changes that can help prevent having high cholesterol, also can help lower it, if you are diagnosed with bad cholesterol level.

Also your healthcare provider may prescribe medications or other forms of treatments to help lower your cholesterol levels. In some cases, they may refer you to a specialist for more care.

Diets

In order to achieve and maintain healthy cholesterol levels, your healthcare provider may recommend changes to your diet.

He or she may suggest:

• eat a wide variety of high fiber foods, such as fruits, vegetables, and whole grains
• choose lean sources of protein, such as chicken, fish, and legumes
• opt for baked, broiled, steamed, grilled, and roasted foods instead of fried foods
• avoid fast food and sugary, pre-packaged options when possible
• limit your intake of foods that are high in cholesterol, saturated fats, and trans fats

Foods to beware of include:

• red meat, organ meats, egg yolks, and high fat dairy products
• deep-fried foods, such as potato chips, onion rings, and fried chicken
• certain baked goods, such as some cookies and muffins
• processed foods made with cocoa butter or palm oil

Consuming fish and other foods that contain omega-3 fatty acids can also help lower your LDL levels. For example, salmon, mackerel, and herring are rich sources of omega-3s. Walnuts, almonds, ground flaxseeds, and avocados also contain omega-3s.

Diagnosis of high cholesterol

After a physical examination and medical history, a blood test is used to check cholesterol levels, called a lipid panel or lipid profile, this typically is done to show the results of:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides (a different type of lipid in blood)

Being diagnosed with high cholesterol doesn’t automatically mean you will be put on medicinal treatment. If your healthcare provider does prescribe you medication, different factors may influence the type of medication they recommend for you.

Knowing this, most healthcare professionals use generalized measurements to decide on the best treatment plans. This depends on the following chart, which categorize high cholesterol level based on desirable, borderline high and high cholesterol.

Other tests to diagnose high level of cholesterol or hyperlipidemia include:

• Lipoprotein (a).
• Apolipoprotein B.
• Coronary calcium scan.
• High sensitivity C-reactive protein (hs-CRP).

Learn more about: Cholesterol test

Treatment of high cholesterol

As stated before, lifestyle changes such as exercising and eating a healthy diet are the first line of treatments for lowering and also preventing high cholesterol level. But, if you’ve tried all these home remedies and lifestyle changes and your cholesterol level still remain high, your healthcare provider might suggest medications, such as:

• Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
• Statins. Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
• Bempedoic acid. This newer drug works in much the same way as statins but is less likely to cause muscle pain. Adding bempedoic acid (Nexletol) to a maximum statin dosage can help lower LDLsignificantly. A combination pill containing both bempedoic acid and ezetimibe (Nexlizet) also is available.
• PCSK9 inhibitors. These drugs can help the liver absorb more LDL cholesterol, which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used 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. They are injected under the skin every few weeks and are expensive.
• Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.

If you also have high triglycerides, your provider might recommend:

• Fibrates
• Niacin
• Omega-3 fatty acid supplements

Tolerance of medications varies from person to person, and depending on the cholesterol levels. The common side effects of statins are:

• muscle pains
• Sometimes muscle damage
• reversible memory loss
• confusion
• elevated blood sugar

When you decide to take cholesterol medications, your healthcare provider might recommend liver function tests to monitor the medication’s effect on your liver.

Diets and lifestyle changes are the best first line of treatment for children age 2 and older who have high level of cholesterol or who have obesity. Those of age 10 and older who have extremely high cholesterol levels might be prescribed cholesterol-lowering medication, such as statins. Before taking any cholesterol medications or using any preventive measures for your high cholesterol level, make sure to consult your doctor first for guidelines and the best treatment options for you.

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