Cholesterol Treatment

What is High Cholesterol?

Cholesterol is a type of fat that is highly abundant in animal products such as red meat including burgers, steak, and sausage.  The Western diet is generally high in foods that contain cholesterol.  Over time, cholesterol and other fat begin accumulating in our blood stream and is known as a condition called hypercholesterolemia.  There is good cholesterol and bad cholesterol in our blood.  Good cholesterol is called HDL and bad cholesterol is named LDL.

Bad cholesterol (LDL) eventually makes its way to arteries all over our body.  This leads to arterial injury, inflammation, and eventually the development of fatty arterial plaques (atheromas).

Fatty plaques reduce blood flow to organs and tissues in our body, which reduces oxygen levels to these areas.  Fatty plaques can also abruptly rupture, leading to complete blockage of arterial blood flow and lack of oxygen delivery to tissues causing tissues to die.  When this occurs in the heart, it is called a heart attack.  This process can also happen in the brain, kidneys, gut, and limbs.

Since high cholesterol (hypercholesterolemia) has serious complications, it is important that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes High Cholesterol?

High cholesterol is caused by diets high in fat and sugar.  Foods that are high in cholesterol include:

  • Red meats (e.g. steak, burgers, sausage)
  • Dairy – Milk, Cheese, Ice cream
  • Eggs

Some people have a genetic predisposition to developing various forms of elevated cholesterol, which is why high cholesterol (hyperlipidemia) tends to run in families.

How common is High Cholesterol?

Hyperlipidemia is a highly prevalent condition in the United States.  It is frequently seen in the elderly population but can also affect adolescents and adults.  This is largely due to the Western diet and lifestyle – physical inactivity and little exercise.  The biggest concern is that hyperlipidemia is a major risk factor for cardiovascular disease, including heart attack and stroke, which are two of the leading causes of death in America.

What are the symptoms and signs of High Cholesterol?

 The symptoms and signs of high cholesterol can range from no symptoms at all, to manifestations of its complications such as heart attack and stroke.  Patients are often asymptomatic in early cases that are mild.  Those with extremely high cholesterol levels for long periods of time may eventually show signs of it on their face.  They often develop fatty plaque-like structures around the eye, which are called cholestomas. 

People with heart attacks usually have chest pain, difficulty breathing, nausea, and sweating.  Individuals with stroke develop sudden one-sided weakness or numbness, confusion, trouble speaking or swallowing, and headaches.  Patients with hypercholesterolemia are also at risk of developing peripheral vascular disease, which causes leg and calf cramps after walking certain distances due to poor circulation.

How is High Cholesterol diagnosed?

Your doctor will test for elevated cholesterol by ordering a fasting lipid panel.  Lipids are fats – a lipid panel tells your doctor which types of fats are elevated, normal, or low.  Remember – HDL is good cholesterol and LDL is bad cholesterol.  A high LDL is worrisome but a low HDL can also be concerning.

HDL is a good fat because it helps get rid of LDL and other bad cholesterol from our arteries, which helps reverse fatty plaque buildup in our arteries.  The fasting lipid panel also evaluates for other types of fat in the blood such as triglycerides – these can also be important in heart disease.  Statins are a class of medication frequently used to decrease cholesterol. They work by decreasing LDL, increasing HDL, and reducing triglycerides.

Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), and screen you for diabetes.  If your doctor is worried about a prior stroke or heart attack, they will probably obtain an EKG (electrocardiogram), chest x-ray, and ultrasound of the heart (echocardiogram).

How is High Cholesterol treated?

High cholesterol is treated with dietary and lifestyle changes, as well as medications.  Your doctor will likely recommend a low-sodium, low-cholesterol diet, rich in fruits and vegetables.  They may also tell you to avoid red meat and encourage intake of lean meats such as poultry and fish.

Your doctor typically evaluates for other cardiovascular risk factors such as older age, smoking history, diabetes, history of stroke or heart attack.  If you smoke, they will advise tobacco cessation.

They may recommend treatment with cholesterol-lowering drugs depending on your cardiovascular risk.  The most common prescription for elevated cholesterol is a class of medications called statins, which include:

Other, less commonly prescribed medications for elevated cholesterol include:

  • Questran (cholestyramine)
  • Colestid (colestipol)
  • Ezetrol (ezetimibe)
  • Lopid (gemfibrozil)
  • Tricor (fenofibrate)
  • Niacin
  • Omega-3 fatty acids

Cholesterol Patient Summary:

  • Cholesterol is a type of fat that is highly abundant in animal products such as red meat and dairy.
  • High cholesterol (hyperlipidemia) is a very prevalent condition in the United States due to the Western diet and lack of exercise. Your primary care doctor typically manages it.
  • Hyperlipidemia is typically caused by genetic factors as well as lifestyle – such as diet and activity level
  • Complications of high cholesterol include heart attack, stroke, and peripheral vascular disease.
  • The condition may not cause symptoms early on but over time individuals may develop fatty skin deposits.
  • The most worrisome symptoms are due to heart attack and stroke, such as sudden chest pain or paralysis
  • Diagnosis usually requires a fasting lipid panel – your doctor will also typically test your kidney and liver function, and screen for diabetes
  • HDL is good cholesterol and LDL is bad cholesterol - A high LDL is worrisome but a low HDL can also be concerning.
  • Treatment typically consists of diet, exercise, and medications.
  • Statins are the first-line medical treatment for hyperlipidemia: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Zocor (simvastatin).
  • Medications less commonly prescribed: Questran (cholestyramine), Colestid (colestipol), Lopid (gemfibrozil), Tricor (fenofibrate), Niacin, Omega-3 fatty acids.

References:

  1. Morris PB, Ballantyne CM2, Birtcher KK3. Review of clinical practice guidelines for the management of LDL-related risk.J Am Coll Cardiol. 2014 Jul 15;64(2):196-206.
  2. Keaney JF Jr1, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med. 2014 Jan 16;370(3):275-8.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.