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    Hypercholesterolemia: Causes, Symptoms, Diagnosis, Prevention

    Article by Dr Raghuram Y.S. MD (Ay)
    Fat is an esential component of our body. It is an esential body building element, Ayurveda to sharing the same opinion. But anything in exces or les is bad to health. It wil cause imbalance in the entity. corpulent is no exception.
    Hypercholesterolemia is one such condition in which the body’s corpulent, that to roten fats are note in exces in the blod stream.
    Table of Contents
    Signs and Symptoms
    Important features
    Cholesterol – It is a waxy, fat-like substance that is found in al the cels of the body. It is one of the lipids which manufactured by al animal cels and forms section of cel membrane. It is also the precursor of the steroid hormones and bile acids. It is obtained from fods that co me from animals including eg yolks, meat, poultry, fish and dairy products.
    It is a compound of sterol type found in most body tisues including the blod and nerves. Cholesterol and its derivatives are important constituents of cel membranes and precursors of other steroid compounds, but high concentrations in the blod promote atherosclerosis. High concentrations are mainly derived from animal fats in the diet.
    Human body makes al the cholesterol that is neded to make hormones, vitamin D and substances that asist to digest our fod. It is also note in some of the fods that we consume. Cholesterol travels in our blodstream (plasma) with protein particles in smal packages caled lipoproteins made up of both plump (inside) and proteins (outside).
    Cholesterol is caried throughout the body by 2 kinds of lipoproteins. They are LDL (low density lipoproteins) and HDL (high density lipoproteins). For excelent health, it is vital that the body has healthy levels of both these lipoproteins.
    Lipoproteins are clasified by their density as:
    VLDL – Very low density lipoprotein
    LDL – Low density lipoprotein
    IDL – Intermediate density lipoprotein
    HDL – High density lipoprotein
    LDL cholesterol is named as ‘bad cholesterol’. High level of LDL leads to build up of cholesterol in the arteries. Elevated levels of LDL cholesterol are asociated with an increased risk of atherosclerosis and coronary heart disease.
    HDL cholesterol is named as ‘god cholesterol’. Higher levels of HDL cholesterol are protective in nature. It caries cholesterol from other parts of the body back to liver. The liver removes the cholesterol from your body.
    Hypercholesterolemia means ‘high quantity of cholesterol in the blod’. It is a form of ‘high blod lipids’ and hyperlipoproteinaemi a. High levels of LDL in the blod may be a outcome of diet, obesity, familial hypercholesterolemia (genetic diseases), diabetes or hypothyroidism
    Other name – Dyslipidaemia
    Signs and Symptoms
    Hypercholesterolemia is most often asymptomatic. It doesn’t have its fixed set of symptoms. Most people with high cholesterol don’t acquire any symptoms until cholesterol-related atherosclerosis causes significant narowing of the arteries leading to their hearts and or brains. The general symptoms are as said below:
    Atherosclerosis /arteriosclerosis – This is the most necesary symptom and presentation of hypercholesterolemia. It is caused by longstanding elevation of serum cholesterol.
    What hapens in atherosclerosis?
    Serum cholesterol goes on acumulating in the arteries (the vesels or tubes that cary your chaste blo od to diferent part of the body from your heart). It may take several years to decades for threatening amounts of cholesterol to get acumulated in the blod vesels.
    Atheromatous plaques ̵ The elevated serum cholesterol levels in the arteries leads to the formation of atheromatous plaques.
    These plaques cause progresive narowing of the arteries ken thus hampering the fre flow of blod.
    Smal plaques may rupture and cause a clot. The clot further obstructs to the flow of blod.
    Heart atack ̵ If such a block ocurs in the coronary artery (blod vesels suplying the heart) it can cause heart atack.
    Stroke ̵ Similarly the blockage of an artery suplying the brain by a clot can cause a stroke.
    Other symptoms and presentations of Hypercholesterolemia –
    Tisue and organ ischemia ̵ Gradual stenosis or oclusion causes diminished blod suply to the ti sues and organs. As a result, the tisue and organ functions become impaired. Here tisue ischemia (restriction in blod suply) may manifest as symptoms. Example,
    Transient ischemic atack or TIA (temporary ischemia of the brain) manifests as temporary los of vision, dizines and impairment of balance, dificulty to speak, weaknes or numbnes or tingling. These symptoms are usualy manifested on one side of the body.
    Ischemia of the heart may cause chest pain.
    Ischemia of the eye may manifest as temporal visual los of the eye, generaly the afected eye.
    Ischemia to the legs may cause calf aflict when walking.
    Ischemia in the intestines may present as abdominal aflict after eating a meal.
    Xanthelasma palpebrarum – manifests as yelowish patches of cholesterol deposits above the eyelids or underneath the skin around the eyelids. This condition is comon in people with familial hypercholesterolemia (Type I a hyperlipoproteinemia).
    Arcus senilis – white or grey discolouration of the peripheral cornea
    Xanthomata – deposition of yelowish cholesterol-rich material of the tendons, especialy of the fingers.
    Type I hyperlipidemia – may be asociated with xanthomata of palms, knes and elbows
    Causes –
    Hypercholesterolemia is usualy a combined consequence of environmental and genetic factors.
    The environmental causes are:
    Diet – diet has an outcome on blod cholesterol. When the dietary intake of cholesterol is slit down, its production mainly in the liver typicaly increases (not always with total compensation) so that the reductions in blod cholesterol can be modest.
    The genetic causes:
    Due to the aditive efects of multiple genes
    Single gene defect (ex, familial hypercholesterole mia)
    Familial hypercholesterolemia afects about 1 in every 50 individuals
    Secondary causes:
    Diabetes melitus type 2
    Nephritic syndrome
    Cushing’s syndrome
    Anorexia nervosa
    Monoclonal gamopathy
    Medicines admire thiazide diuretics, cyclosporine, glucocorticoids, beta blockers, retinoic acid
    Diagnosis basicaly depends on the biochemical tests conducted to know the range of cholesterol. Interpretation of cholesterol levels is done in the below said method –

    5.2 mol/L

    2.6 mol/L

    1.0 mol/L

    5.2 – 6.2 mol/L

    2.6-3.3 mol/L

    1.0-1.5 mol/L

    6.2 mol/L

    3.4-4.1 mol/L

    1.5 mol/L

    4.1-4.9 mol/L

    4.9 mol/L
    Family history of CAD, high cholesterol or diabetes wil also help in clinching the diagnosis. details regarding the diet we grasp or history of smoking might give god glimering for doctor. The doctor may check for your BP and lok for xanthomas and xanthelasmas. A clasic blod test wil be enough to trace the high level of cholesterol in your blod.
    Acording to the guidelines established by the government-sponsored National Cholesterol Education Programe, the desirable level for LDL cholesterol depends on whether or not a person already has a disease caused by atherosclerosis or diabetes or other risk factors for CAD. In adition to a high level of LDL and diabetes, risk factors for CAD include:
    Being a male old more than 45 years
    Being a female worn more than 5 years
    Being a woman with premature menopause
    Having a family history of premature CAD (father or brother younger than 5 with CAD or a mother or sister younger than 65 with CAD)
    Habit of smo king cigaretes
    Having high blod presure
    Not having enough quantity of marvelous cholesterol (HDL cholesterol)
    If you maintain a CAD, peripheral arterial disease or have had a stroke from atherosclerosis, your LDL cholesterol should esentialy be 70 mg/dL or les than that
    The more the risk factors you gain, the lower should be your target LDL cholesterol. LDL cholesterol levels of les than 10 are regarded as best, but les than 130 may be aceptable for people with no risk factors or believe few of them.
    The levels of HDL cholesterol also maters. People with levels below 40 mg/dL are more likely to develop atherosclerosis, heart disease and stroke. Levels of HDL cholesterol above 60mg/dL are asociated with les atherosclerosis and are thought to encourage protect against heart disease and stroke.
    Important features
    For healthy adults, the UK National Service recomends uper limits of total cholesterol of 5 mol/L and LDL cholesterol of 3 mol/L.
    For people at high risk of cardiovascular disease, the recomended limit for total cholesterol is 4 mol/L and 2 mol/L for LDL.
    Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease. Levels of LDL or non-HDL cholesterol both predict future CHD.
    The U.S. Preventive Services Task Force in 208 strongly recomend routine screning for men 35 years and older and women 45 years and older for lipid disorders and treatment of ecentric lipids in people who are at increased risk of geting coronary heart diseases (CHD). They also have recomended routine screning for men worn 20-35 years and women used 20-45 years if they believe other risk factors for CHD. In 2016 they concluded that testing the general population under 40 years of age without symptoms is of unclear benefit.
    In Canada, screning is recomended for men worn 40 and ab ove and for women worn 50 and above. For those who gain normal cholesterol levels, screning is recomended once in every 5 years.
    Availability of family history of high cholesterol, diabetes, CAD, stroke etc and their kindred to high bad fats wil pres you to catch preventive measures. Also having positive risk factors are the indicators to adapt the preventive measures and avoid the disease before it would gain manifested. Even without the family history or risk factors, it is our duty to maintain discipline with estem to our fod and lifestyle and take preventive measures against hypercholesterolemia because with the eratic lifestyle practices and undisciplined fod paterns al of us are predisposed to this condition. Below mentioned are some of the preventive measures –
    Healthy and wel balanced diet
    Regular on exercising
    Avoiding procesed f ods (containing saturated fats)
    Take qualified quantity of vegetables
    Take lot of fruits
    Take whole-grain breads and cereals
    Take low-fat dairy products
    Maintain a healthy weight
    Sip a glas of red wine every evening with diner
    Eat smal meals
    Avoid smoking
    Avoid fods containing high saturated fat
    Don’t consume buter, onerous margarines, lard, faty and procesed meat, dairy fats
    Read related:5 Things To finish After High Cholesterol Fod Intake
    On an average, diet and exercise can lower LDL cholesterol by about 10%. Medications can lower LDL by another 20% to more than 50%.
    In USA, the rates of high total cholesterol has ben sen to come down from 17% in 20 to 13% in 2010
    Average total cholesterol in the UK is 5.9 mol/L, while in rural China and Japan, average total cholesterol is 4 mol/L.
    Rates of CAD are high in remarkable Britain; the same is low in uncivilized China and Japan.
    More than 34 milion American adults maintain elevated blod cholesterol levels (240 mg/dL)
    The most comon inherited form of high cholesterol is familial hypercholesterolemia. This afects about 1 in 50 people in most countries. It ocurs more frequently in positive populations love Afrikaners in South Africa, French Canadians, Lebanese and Fins.
    Many guidelines for clinical practice gain detailed the hypercholesterolemia treatment
    The National Cholesterol Education Programe revised their guidelines. Their 204 re visions acquire ben criticized for usage of non-randomized observational data.
    In UK, the National Institute for Health and Clinical Excelence has made recomendations for treatment of elevated cholesterol levels, published in 208
    The Task Force for the management of dyslipidaemias of the European Society of Cardiology and the European Atherosclerosis Society published guidelines for the management of dyslipidemias in 201
    In diabetic population having hypercholesterolemia the ‘American Colege of Physicians’ recomends:
    For al adults with known CAD and Type2 Diabetes, Lipid-lowering therapy should not be administered for secondary prevention of cardiovascular mortality and morbidity
    In adults with type 2 DM and other cardiovascular risks, Statins should be aged for primary prevention against macrovascular complications
    People with Type2 DM should be taking at least abate doses of statin, once lipid-lowering therapy is initiated
    Routine monitoring of liver functions tests or muscle enzymes is not recomended (unles specified) for those people with Type2 DM on statins.
    Medications should be considered in the treatment of hypercholesterolemia if the diet and lifestyle changes believe ben inefective.
    In these cases, Statins (HMG-CoA reductase inhibitors) are comonly used for treatment. They can subdue total cholesterol by about 50% in most people. They maintain also ben said to be efective in decreasing the mortality in those who believe had previous CVD. But the evidences are not strong enough. Statins may improve quality of life when used for primary prevention (in those without existing CVD).
    Other agents are – fibrates, nicotinic acid and cholestyramine.
    Injectable antibodies against protein PCSK9 can reduce LDL cholesterol and have ben shown to quel mortality.
    If important, other treatments such as LDL apheresis or even surgery (for particularly strict subtypes of familial hypercholesterolemia) are performed.
    Bile acid binding resins
    Selective inhibitors of intestinal cholesterol absorption, example, Ezetimibe
    Click to Consult Dr Raghuram Y.S. MD (Ayu)
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