High cholesterol

Symptoms Of High Cholesterol

High cholesterol often doesn’t show any obvious symptoms. In rare cases where cholesterol levels are extremely high, often due to inherited conditions, it can show up in the body. Symptoms can include: 

• Yellowish bumps on areas like your Achilles tendon or eyelids
• Swollen tendons in the hands
• A pale ring around the colored part of your eye.

Over time, high cholesterol can quietly raise your risk of serious heart problems like chest pain, heart attacks, or strokes. Know your numbers, get a simple blood test to check your cholesterol, and protect your heart health.
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Causes Of High Cholesterol

Before we dive into what causes high cholesterol, let’s first understand what cholesterol is. Cholesterol is a waxy, fat-like substance found in your blood. Your body needs it to build healthy cells, make hormones, and help with digestion. But having too much cholesterol can stick to your blood vessels and raise your risk of heart disease.

There are two main types of cholesterol:

• LDL (Low-density lipoprotein): Also called “bad” cholesterol, because high levels can lead to buildup in your arteries, increasing the risk of heart attack and stroke.

• HDL (High-Density Lipoprotein): It is known as “good” cholesterol because it helps remove LDL from your bloodstream, lowering your risk of heart problems.

Note: There are also triglycerides, a type of fat in the blood. High levels of triglycerides combined with high LDL or low HDL can further increase your risk of heart disease.

What happens in the body during high cholesterol?

Cholesterol travels in your blood attached to proteins called lipoproteins. When you eat foods high in saturated and trans fats, your liver makes more LDL cholesterol. If your body can’t process or remove the extra LDL efficiently, due to poor lifestyle or genetic issues, it starts to build up in the blood.

Excess LDL cholesterol gets deposited in the walls of your arteries. Over time, it combines with other substances to form plaque. This narrows and hardens the arteries (a condition called atherosclerosis), reducing blood flow to the heart, brain, and other parts of the body.

As plaque builds up, it increases the risk of heart attack, stroke, or other cardiovascular problems, especially if a piece of plaque breaks off and causes a blockage.

Risk Factors For High Cholesterol

High cholesterol is typically when LDL cholesterol levels exceed certain thresholds, depending on the presence of risk factors. These include:

Major risk factors 

• Older age (men above 45 years and women above 55 years)
• Sex (men have a greater risk of high total cholesterol than women)
• Race/ ethnicity (Non-Hispanic White, Asian (Indian, Filipino, Japanese, Vietnamese), Hispanic, African American)
• Family history of early heart disease
• Hypertension (High blood pressure)
• Diabetes
• Smoking
• Low HDL levels

Lifestyle factors

• High intake of saturated fats
• Lack of exercise
• Obesity
• Stress
• Overconsumption of alcohol
• Poor-quality sleep

Other medical conditions and drugs 

• Hypothyroidism
• Chronic kidney disease
• Pregnancy
• HIV infection/AIDS
• Lupus erythematosus
• Polycystic ovary syndrome (PCOS)
• Sleep apnea
• Drugs like steroids, cyclosporine, or thiazide diuretics.
  
  

Diagnosis Of High Cholesterol

High cholesterol is usually diagnosed with a blood test called a lipid profile. This test measures the levels of different fats in your blood, like: 

Total cholesterol

• Desirable: < 200
• Borderline high: 200–239
• High: ≥ 240

LDL (Low-density lipoprotein)

• Optimal: < 100
• Near/above optimal: 100–129
• Borderline high: 130–159
• High: 160–189
• Very high: ≥ 190
  
  

HDL (High-density lipoprotein)

• Normal: 40–50 (men), 50–59 (women)
• Low: < 40 (men), < 50 (women) – linked to higher heart disease risk
• High: ≥ 60 – linked to lower-than-average heart disease risk

Triglycerides

• Normal: < 150
• Borderline high: 150–199
• High: 200–499
• Very high: ≥ 500

Note: Lipid testing is recommended for adults starting at age 20, while universal screening is advised for children between 9 and 11 and again at 15 to 17.

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Specialist To Visit

When managing high cholesterol, it’s important to see the right specialist for proper care. Doctors who can diagnose and treat high cholesterol include:

• General physician
• Cardiologist
• Endocrinologist

A general physician diagnoses high cholesterol, recommends lifestyle changes, and prescribes initial medications.

A cardiologist assesses heart risk, manages cholesterol to prevent heart disease and related complications.

An endocrinologist treats cholesterol issues linked to hormonal or metabolic conditions like diabetes or thyroid disorders.

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Prevention Of High Cholesterol

Here are a few tips to keep your cholesterol in range and prevent high cholesterol:

1. Know your numbers

• Lipid testing is recommended for adults starting at age 20

• Regular testing helps you and your doctor spot any problems early and take proactive actions.

2. Eat for your heart

• Limit saturated and trans fats found in red meat, butter, cheese, fried foods, and packaged snacks as they raise bad cholesterol.

• Choose healthy fats like those in nuts, seeds, and olive oil

• Eat high-fibre foods like oats, beans, lentils, fruits, and vegetables

• Prepare meals using fresh ingredients and healthier cooking methods like baking, grilling, or steaming.

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2. Keep moving

• Aim for at least 150 minutes of physical activity per week

• Start with walking, swimming, cycling, or pick something you enjoy

• Try brisk walking that gets your heart rate up

3. Stay fit 

• Being overweight or obese can increase bad cholesterol and lower good cholesterol 

• Losing just 5% to 10% of your body weight can improve your cholesterol levels

• Even small weight loss helps reduce the risk of heart disease.

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4. Quit smoking

• Smoking raises bad cholesterol and increases the risk of heart disease and cancer

• Use tips and tools to manage cravings and stay on track.

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5. Cut back on alcohol

• Limit alcohol, or better, abstain from it.

• Take a few alcohol-free days each week

• Avoid binge drinking and ask your doctor if you need help cutting down.
  
  

Treatment Of High Cholesterol

Managing high cholesterol often requires a combination of prescribed medications and healthy lifestyle changes for effective, long-term control. The lifestyle modifications are outlined in the prevention and home care section. Medication options include:

1. Medications

Statins: They lower cholesterol made by the liver and help prevent heart disease. Common examples include: 

• Atorvastatin
• Rosuvastatin
• Simvastatin

Bile acid sequestrants: These block cholesterol absorption in the gut and help the liver remove more cholesterol from the blood. Commonly used drugs are:

• Cholestyramine
• Colesevelam

Niacin (Nicotinic acid derivatives): This class of drugs lowers bad cholesterol and triglycerides while increasing good cholesterol (HDL). For example: 

• Vitamin B3

Fibrates: they mainly lower high triglyceride levels and slightly raise good cholesterol (HDL). Common drugs include:

• Fenofibrate
• Gemfibrozil

Ezetimibe: It reduces cholesterol absorption in the intestines, often used with statins. 

Bempedoic acid: This is a newer drug that helps lower bad cholesterol, especially for those who can’t tolerate statins. 

Omega-3 fatty acids: Can help lower triglycerides and slightly raise good cholesterol (HDL).

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Future directions

Here are some newer drugs that are still under research and not widely available yet: 

• Lomitapide: A special pill that helps people with a rare cholesterol disorder (HoFH) lower their LDL by up to 60%, but it may cause stomach issues and affect the liver.

• Lerodalcibep: An experimental monthly injection that uses gene-targeting tech to sharply reduce bad cholesterol, now in advanced clinical trials.

• PCSK9 vaccine: A future vaccine being studied to help the body make long-lasting antibodies that naturally lower bad cholesterol, potentially with fewer doses.

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Home-care For High Cholesterol

Managing cholesterol starts with simple lifestyle changes—especially what you eat, which plays a key role in keeping your cholesterol in check. 

Eat more of these:

• Oily fish (like salmon, mackerel)
• Oils like mustard oil, groundnut (peanut) oil, olive oil, and rice bran oil 
• Whole grains (brown rice, oats, barley)
• Fruits and vegetables
• Nuts and seeds like almonds, walnuts, flaxseeds, and chia seeds.

Eat less of these:

• Fatty meats like mutton, chicken with skin, and processed meats like sausages
• Butter
• Hard cheeses (like cheddar), cream
• Cakes, biscuits, namkeens
• Foods with coconut oil or palm oil

The following natural options can support cholesterol management, but they should never be used as a substitute for your prescribed treatment. Always consult your doctor first before adding these to your diet:

• Red yeast rice: It may lower cholesterol like statins, but safety and quality vary widely.

• Soy protein: Found in tofu, soy milk, etc, may slightly improve cholesterol levels.

• Garlic (Lehsun): It may have a modest cholesterol-lowering effect, but there is mixed evidence.

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• Psyllium husk: A natural soluble fiber that helps lower LDL (bad) cholesterol by promoting its removal from the body.

• Fenugreek (Methi): Rich in soluble fiber, fenugreek seeds can help reduce cholesterol levels and improve heart health.
  
  

Complications Of High Cholesterol

High cholesterol can cause the arteries to narrow, leading to serious complications like:

• Coronary heart disease: High cholesterol can clog the arteries that supply the heart, reducing blood flow and leading to heart disease.

• Heart attack: If plaque fully blocks blood flow to the heart, it can cause a heart attack.

• Stroke: Cholesterol buildup in brain arteries can block blood flow and trigger a stroke, either from a clot or a blocked vessel.

• Peripheral artery disease (PAD): Cholesterol can clog leg arteries, causing pain when walking and, if untreated, may lead to serious complications like gangrene (when body tissue dies due to a lack of blood flow).

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Living With High Cholesterol

Living with high cholesterol means making daily choices that protect your heart and overall health. Key tips for managing high cholesterol include:

1. Eat heart-healthy foods

• Choose more fruits, vegetables, whole grains, nuts, and oily fish like salmon.
• Cut back on saturated fats (like butter, fatty meats) and avoid trans fats (found in some baked or fried foods).

2. Stay active

• Aim for at least 30 minutes of moderate exercise like walking, cycling, or swimming on most days.

3. Stick to your medications

• Take medications as prescribed by your doctor regularly.

4. Avoid smoking and limit alcohol

• Both can raise cholesterol and harm your heart.

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5. Get regular check-ups

• Monitor your cholesterol levels regularly. This can help your doctor adjust your treatment plan as needed to keep your heart healthy.

6. Manage stress

• Chronic stress may indirectly affect your cholesterol. Try relaxation techniques like meditation, yoga, or deep breathing.