High Cholesterol Symptoms, Risk Factors and Treatment

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High cholesterol or hyperlipidemia is when you have elevated fats or lipids in your blood, elevated cholesterol, or elevated triglycerides. And we know that high cholesterol is a huge risk factor for cardiovascular diseases, such as heart attacks and strokes. And even if you exercise and even if you have a healthy diet, you may still get high cholesterol. Now, how can that be? Well, you're about to find out, because today I'm going to talk to you about high cholesterol symptoms, risk factors, consequences, and the treatment.  I'll cover the following in detail:


1. Definition of Cholesterol
2. Consequences of  High Cholesterol or Hyperlipidemia
3. Types of Cholesterol: What Do The Blood Work and Numbers Mean?
4. High Cholesterol Risk Factors
5. Symptoms of High Cholesterol
6. Treatment of High Cholesterol


What Is Cholesterol?

What in the world is cholesterol? Well, cholesterol is a waxy, fatty substance that is produced by the liver and many other cells in the body. You see, all the cholesterol you actually need is produced by and made in your body. And cholesterol is not all bad because we actually need it in our bodies. We need cholesterol to make cell membranes and we also need it to make certain hormones, including testosterone and estrogen.  We also need cholesterol to produce vitamin D. So you see, we definitely do need cholesterol.



Consequences of High Cholesterol or Hyperlipidemia

The problem is when we have an excessive amount of cholesterol, we get hyperlipidemia. Because when that happens you start to have a problem. This cholesterol will float around in the blood and pick up other inflammatory cells and it can actually become a plaque or an atheroma in your blood vessels or your arteries.

So then you have these arteries that are blocked by the cholesterol, this fatty waxy material, and certain inflammatory cells and certain calcium deposits. If that happens, you can get a narrowing in these arteries or in these other blood vessels. Once you get this narrowing, that means you're not getting a sufficient blood supply, you're not getting the proper oxygen supply to tissues.

And this cholesterol plaque, or this atheroma, can actually completely occlude or obstruct the blood vessel, it can block the blood vessel. So what happens if you get a blocked blood vessel or artery that is supposed to be sending a blood supply to your heart? Well, you can have a heart attack. If you get a blocked artery that's supposed to be supplying your brain, you can have a stroke.

And if you get blocked arteries that give blood supply to your arms, legs, fingers, or toes, then you can get very poor circulation and have peripheral artery disease. So these are the consequences of having high cholesterol.




Types of Cholesterol: What Do The Blood Work and Numbers Mean?

So now let's talk about the types of cholesterol and what they mean for you. When you go to the doctor and you have him or her to check your cholesterol, they order a lipid panel or a cholesterol panel, and you'll have many different names, numbers, and letters.

So let's breakdown what these things mean.

• Lipid Panel Ranges

On this lipid panel, you will have a total cholesterol number. And this is a sum that includes both your good cholesterol, or the HDL, and the bad cholesterol, the LDL.

Now the rule of thumb is that the total cholesterol should be less than 200 milligrams per deciliter, but you must consult your physician to find out what your total cholesterol means for you. Because if you have an exceedingly high good cholesterol then you may also have a high total cholesterol, but that could be driven by your good numbers.

In other words, it is possible for you to have a total cholesterol that seems high but it's not as bad as one may think because you have a great 'good cholesterol'. The bottom line: the total cholesterol is not so discriminate because it has good cholesterol and bad cholesterol.

•  LDL: Bad Cholesterol

Now, the bad cholesterol is the LDL or the low-density lipoprotein. And just focus on that number "L." You want the LDL to be low, because it's bad. And having a high LDL is something that will actually increase your risk for cardiovascular disease.

Your target LDL really will be individualized because it depends on your other risk factors for cardiovascular disease. So again, you'll need to consult your physician, talk about your risk factors, and then find out your target of an LDL.

• HDL Cholesterol

On that lab work, you will also likely have an HDL, or the good cholesterol, high-density lipoproteins. Focus on the letter H.

You want the HDL to be high because it's good. As a general rule, we say that an HDL of greater than 60 milligrams per deciliter is excellent. But if you have an HDL that is less than 40, that is sub-optimal.  But again, make sure you consult your physician and find out the target HDL for you.

• Non-HDL Cholesterol

Another type of cholesterol you may see on your lipid profile, on your cholesterol blood work, is the non-HDL. And you get this number by taking the total cholesterol and subtracting out the good cholesterol, you subtract out the HDL.

The non-HDL includes numbers like the LDL, but also other types of cholesterol such as the very low-density lipoprotein, or VLDL, the intermediate-density lipoprotein, or IDL. It includes lipoprotein.  And so you have more cholesterol than just the LDL and the HDL we discussed, and the non HDL will include those numbers.

• Triglycerides

Finally, you have triglycerides. And triglycerides when they are excessive are also bad news, as far as being a risk factor for cardiovascular disease. Rule of thumb, triglycerides should be less than one 50 milligrams per deciliter. Again, you must consult your physician, I cannot stress this enough, to find out your specific goals for cholesterol.




High Cholesterol Risk Factors

Now let's talk about the risk factors for high cholesterol. Who is at risk? And what even causes one to have high cholesterol? Remember I stated at the beginning of this article that in some cases, even if you exercise, even if you have a healthy diet, you may still be predisposed to high cholesterol. So let's talk about that here.

First off, the risk factors. Cigarette smoking is a risk factor for high cholesterol. So if you are smoking cigarettes then yes, you are at increased risk for having hyperlipidemia. Also certain chronic diseases. If you have diabetes mellitus, that is a risk factor for high cholesterol.

High blood pressure or hypertension is a risk factor. The kidneys, if you have chronic kidney disease, that's a risk factor. Obesity is also a risk factor. Another risk factor for high cholesterol is if you have a strong family history. In fact, there is a genetic disease called FH, familial hypercholesterolemia.

FH is a genetic disease that causes a mutation in one or more of the genes that code for the LDL catabolism. And so if you have FH, familial hypercholesterolemia, then you will have extremely elevated levels of LDL. What does that do? That puts you at a very high risk for atherosclerotic disease, cardiovascular disease, even at a young age.

Some people with FH, especially, the homozygous type, will actually get this atherosclerotic disease as children. So having a family history and that genetic component, especially if it is familial hypercholesterolemia, will put you at risk.

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So when I was saying that in some patients, even if they diet, even if they exercise, they'll still have high cholesterol, I'm talking about the patients with FH. This is why it is extremely important that number one, you know your family history. If you have a lot of young relatives who have died of heart disease or have had heart attacks or strokes at very young ages, you definitely want to go get checked to make sure that you don't have familial hypercholesterolemia.

And in these patients, even if they do everything right, if they do the diet and if they do exercise, they typically will have to take medications. Another risk factor for high cholesterol can be diet, a diet that's very high in animal fats, saturated fats, and trans fats.


high cholesterol symptoms risk factors and treatment

High Cholesterol Symptoms

So what are the symptoms of high cholesterol? How will you know if you have it? Well, honestly, there really are no overt symptoms of high cholesterol in and of itself. And by the time you get a symptom of high cholesterol, it may actually be the narrowing of an artery leading to a heart attack or a stroke, at which point it's too late.

So the key is prevention and screening. You want to consult your physician and you want to get screened for high cholesterol early on before you ever even have a symptom. There is something called Arcus senilis, which is when you get a collection of cholesterol on the cornea or on the eye.

And then there's another sign called xanthelasma (pronounced ZAN-thuh-LAZ-muh), which is some cholesterol deposits that are located on tendons or under the skin. But again, you don't want to wait till things get to that point.  You want to be screened for your cholesterol level early on before you even have a chance to get any signs or symptoms.


Treatment for High Cholesterol

Lifestyle Changes

Finally, what is the treatment for high cholesterol? Now, there are some things that you can do in your lifestyle. You can stop smoking, for one, and that will take away a huge risk factor for high cholesterol. And then you want to try to avoid certain diseases, the chronic diseases that can cause high cholesterol or can predispose you to high cholesterol, or certainly if you have these diseases, you want to manage them well with your physician, including diabetes, kidney disease, and hypertension. You want to manage these things very well in order to try to prevent having high cholesterol.

And then there's diet. You want to have a diet that is low in saturated fats, low in trans fats. You don't want to have a whole lot of animal fats in your diet. And there are some thoughts that certain foods can help to lower cholesterol, such as apples, lentils, some chia seeds, and oats. Again, before making any diet changes or diet plans, you want to consult your physician and a nutritionist.

Medication for High Cholesterol

If you do all of the diets, it is possible, especially if you have a genetic predisposition and then certainly if you have familial hypercholesterolemia, even if you do everything right, it's possible that you may still have high cholesterol. In that case, you may need medications. Some of the medications that are used in treating hypercholesterolemia or high cholesterol include statins, such as atorvastatin. Also bile acid sequestrants. Zitia, is another treatment, a medication to treat high cholesterol. And nicotinic acid or niacin can also be used.


Understanding high cholesterol symptoms, risk factors, and treatment. The key is to understand that high cholesterol is a risk factor for cardiovascular disease. It can cause heart attacks and strokes. It can also cause poor circulation. So what you want to do is be aware of it because knowledge is power. You want to consult your physician and make sure that you are screened to see if you have high cholesterol. And if you do, you want to treat it.

Dr. Frita - Frita McRae Fisher, M.D.
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  1. Henry Killingsworth on August 25, 2023 at 2:14 pm

    It was informative when you mentioned that cholesterol can cause your blood vessels to become blocked. I am worried that I might have high cholesterol because I have gained a lot of weight recently. It might be a good idea for me to go to a doctor so that I can get my blood tested.

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