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Hypercholesterolaemia (High Cholesterol)

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 6 minutes read

Hypercholesterolemia, commonly known as high cholesterol, is a condition characterised by elevated levels of cholesterol in the blood. This condition is a significant risk factor for cardiovascular diseases, including heart attacks and strokes. Understanding the causes, symptoms, risk factors, and dietary management of hypercholesterolemia is essential for maintaining heart health and preventing associated complications.

Causes of hypercholesterolemia

Hypercholesterolemia can arise from a combination of genetic and lifestyle factors. Some primary causes include:

  1. Dietary Intake - Consuming foods high in saturated and trans fats, such as red meat, processed foods, and fried foods, can contribute to elevated cholesterol levels.

  2. Genetic Factors - Genetic conditions like familial hypercholesterolemia can lead to high cholesterol levels due to inherited mutations that affect the body's ability to remove cholesterol from the blood.

  3. Obesity - Excess body weight, particularly abdominal obesity, can increase cholesterol levels and contribute to the development of hypercholesterolemia.

  4. Physical Inactivity - Lack of regular physical activity can lead to imbalances in cholesterol metabolism, contributing to high cholesterol levels.

  5. Smoking - Tobacco smoke contains chemicals that can damage blood vessels and promote the accumulation of cholesterol plaques, leading to increased cholesterol levels.

Risk Factors for Hypercholesterolemia

Several factors can increase the risk of developing hypercholesterolemia:

  1. Unhealthy Diet - Consuming a diet high in saturated fats, trans fats, and cholesterol can raise blood cholesterol levels.

  2. Obesity - Being overweight or obese can lead to elevated cholesterol levels and increase the risk of developing hypercholesterolemia.

  3. Lack of Physical Activity - Sedentary lifestyle habits can contribute to imbalances in cholesterol metabolism and increase the risk of high cholesterol.

  4. Genetics - A family history of hypercholesterolemia or early-onset heart disease can increase the likelihood of developing high cholesterol levels.

  5. Age and Gender - Cholesterol levels tend to rise with age, and men typically have higher cholesterol levels than premenopausal women. However, after menopause, women's cholesterol levels tend to increase.

Symptoms of Hypercholesterolemia:

Hypercholesterolemia typically does not cause noticeable symptoms until it leads to complications such as heart disease or stroke. However, in some cases, individuals may experience:

  1. Xanthomas: These are yellowish deposits of cholesterol that can develop under the skin, particularly around the eyes, elbows, knees, and tendons.

  2. Xanthelasma: These are cholesterol deposits that appear as yellowish patches on the eyelids.

  3. Arcus senilis: This is a grayish-white ring that forms around the cornea of the eye and is associated with high cholesterol levels in older adults.

  4. Coronary Artery Disease Symptoms: These may include chest pain, shortness of breath, and fatigue, especially during physical exertion.

What will my doctor do?

The doctor will likely take your cholesterol blood test alongside a few other routine blood tests too. Your doctor may take your blood pressure, calculate your BMI score and take into account your demographics, this will allow them to calculate your risk of developing cardiovascular disease in the next 10 years (Qrisk score).

Your doctor will use a QRisk score to calculate your risk of developing heart disease in the next 10 years. If your cholesterol level is raised, your Qrisk is above 10% or you are not improving your levels with lifestyle changes alone, then your doctor may recommend a cholesterol-lowering medication.

Statins are common medications that work by reducing the amount of cholesterol in your body. These medications are often well tolerated but in some, they can cause muscular aches and pains and affect your liver. Your doctor will guide you on how to start this medication appropriately.

Other medicines that can lower cholesterol include bile acid sequestrants, fibrates and ezetimibe – which can be used in combination with a statin, or on its own. Bempedoic acid can be used in people who don't respond to other cholesterol-lowering medication and is also available in combination with ezetimibe. A new treatment called inclisiran turns off the gene PCSK9 and increases the liver's ability to remove harmful cholesterol from the blood. However, this is only recommended if you have had a heart attack, stroke or other cardiovascular event and your LDL cholesterol remains high (above 2.6 mmol/L) on maximum treatment with other lipid-lowering therapies, including statins (or you can't take other treatments).

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How to interpret the blood test?

There are usually 4 different measures for the cholesterol level. Total cholesterol is the overall amount of cholesterol in your blood. This should be 5 or below. HDL (good cholesterol) - this reduces your risk of a heart attack or stroke. This should be 1 or above. LDL (bad cholesterol) - this increases your risk of heart problems or stroke and should be 3 or below. Triglycerides are similar to bad cholesterol and should be 2.3 or below.

Optimising your cholesterol blood results reduces your risk of developing heart attacks or stroke.

How to lower your cholesterol?

If your cholesterol level is raised, the first and most crucial step is to address your diet. It is important to reduce the amount of microwaveable, junk, processed, and takeaway foods that you consume. It is important to increase your good fats and nutrient-dense healthy foods., such as advised to exercise regularly by taking 150 minutes of moderate exercise or 75 minutes of intense activity a week and to stop smoking and drink less than 14 units of alcohol a week to reduce your risk of suffering from the disease.

Foods to Avoid

To manage hypercholesterolemia effectively, it's essential to limit or avoid foods high in saturated fats, trans fats, and cholesterol:

  1. Processed Meats - Avoid or minimise the consumption of processed meats such as sausages, bacon, and deli meats, which are high in saturated fats and cholesterol.

  2. Fried Foods - Foods fried in unhealthy oils and fats should be avoided, as they can significantly increase cholesterol levels.

  3. Butter and Margarine - High-fat dairy products like butter and margarine are rich in saturated fats and should be limited in the diet.

  4. Fast Food and Junk Food - Food items like burgers, fries, and fried chicken are typically high in unhealthy fats and should be consumed sparingly.

  5. Sugary Snacks and Desserts - Foods high in added sugars, such as pastries, cakes, cookies, and sugary beverages, can contribute to weight gain and worsen cholesterol levels.

Foods to Eat

Including heart-healthy foods in your diet can help lower cholesterol levels and reduce the risk of heart disease:

  1. Fruits and Vegetables - Aim to incorporate a variety of fruits and vegetables into your meals. They are rich in fiber, antioxidants, and other nutrients that support heart health.

  2. Whole Grains - Choose whole grains such as oats, barley, brown rice, and whole wheat bread, which are high in fiber and can help lower cholesterol levels.

  3. Lean Proteins - Opt for lean protein sources such as skinless poultry, fish, legumes, and tofu, which are lower in saturated fats than red meat.

  4. Healthy Fats - Include sources of unsaturated fats in your diet, such as olive oil, avocado, nuts, and seeds, which can help improve cholesterol levels when consumed in moderation.

  5. Fatty Fish - Incorporate fatty fish like salmon, mackerel, and trout into your diet regularly, as they are rich in omega-3 fatty acids, which have been shown to lower triglyceride levels and reduce the risk of heart disease.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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