Hypercholesterolemia refers to an abnormal increase of cholesterol in the blood. This condition can lead to various health problems such as cardiovascular diseases, heart attacks, and strokes. Cholesterol is a waxy substance produced by the liver and is also present in the food we consume. There are two types of cholesterol: Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL). LDL, also known as ‘bad cholesterol’ is harmful to our health as it can clog the arteries and increase the risk of heart diseases. HDL, on the other hand, is referred to as ‘good cholesterol’ as it removes the excess cholesterol from the blood and reduces the risk of heart diseases.
Types of Hypercholesterolemia
There are two main types
of hypercholesterolemia: Primary hypercholesterolemia and secondary
hypercholesterolemia.
Primary hypercholesterolemia is an inherited condition
that is caused by a genetic mutation leading to an increased production of
cholesterol in the liver. This type of hypercholesterolemia is most common and
is usually seen in people who have a family history of heart diseases.
Secondary hypercholesterolemia, on the other hand, is
caused by underlying medical conditions such as diabetes, kidney disease,
hypothyroidism, and other metabolic disorders.
Causes of Hypercholesterolemia
Hypercholesterolemia is primarily caused by lifestyle
factors such as a high-fat diet, sedentary lifestyle, and smoking. Other
factors that can contribute to hypercholesterolemia are genetics, age, and
gender. Men have a higher risk of developing hypercholesterolemia compared to
women.
Diagnosis of Hypercholesterolemia
Hypercholesterolemia is diagnosed through a simple blood
test called lipid profile. This test measures the levels of LDL, HDL, and total
cholesterol in the blood. A normal cholesterol level is considered to be below
200 mg/dL. A lipid profile is usually recommended for people over the age of
20, and those who have a family history of heart diseases or other risk
factors.
Investigation of Hypercholesterolemia
If the lipid profile results show elevated cholesterol
levels, further investigations may be required to determine the underlying
cause of hypercholesterolemia. This may include a detailed medical history,
physical examination, and additional blood tests to check for other medical
conditions.
The American Heart Association (AHA) updated their
guidelines for hypercholesterolemia in 2022 to help healthcare professionals
and patients better understand the diagnosis, treatment, and management of this
condition. The AHA guidelines
emphasis on three main areas:
Assessment of cardiovascular
risk: The AHA recommends that healthcare providers use the American College of
Cardiology/AHA Pooled Cohort Equations to determine a patient's 10-year risk
for developing cardiovascular disease (CVD). The guidelines also state that
non-fasting lipid profiles should be used for routine screening.
Lifestyle modifications: The
AHA emphasizes the importance of lifestyle modifications in reducing
cardiovascular risk. These include maintaining a healthy diet that is low in
saturated and Trans fats, engaging in regular physical activity, and avoiding
tobacco use.
Medical therapy: The AHA
guidelines recommend the use of statins as first-line therapy for patients with
hypercholesterolemia. Statins are effective in reducing LDL cholesterol levels
and have been shown to reduce the risk of CVD events. Other lipid-lowering
agents, such as ezetimibe and bile acid sequestrants, can also be used in
combination with statins to further lower cholesterol levels.
The AHA guidelines also state that healthcare providers should consider personalizing treatment plans based on a patient's individual risk factors and CVD risk. They should also monitor patients regularly to ensure that the treatment plan is effective and make adjustments as needed.
Treatment of Hypercholesterolemia
Hypercholesterolemia can be treated through lifestyle
changes such as following a healthy diet, regular physical activity, and
quitting smoking. In addition to lifestyle changes, medications such as
statins, bile acid sequestrants, and niacin can also be prescribed to lower
cholesterol levels. The use of medicine for hypercholesterolemia aims to lower
low-density lipoprotein (LDL) cholesterol levels, which is considered the
"bad" cholesterol, and decrease the risk of cardiovascular diseases
such as heart attacks and strokes.
The following are some of the commonly used medications for hypercholesterolemia:
Statins: Statins are the
most commonly prescribed medications for hypercholesterolemia. They work by
blocking the liver's ability to produce cholesterol and are highly effective in
reducing LDL cholesterol levels. Examples of statins include atorvastatin
(Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).
Bile Acid Sequestrants: Bile
acid sequestrants are another type of lipid-lowering medication. They work by
binding to bile acids in the intestines and preventing their reabsorption into
the bloodstream. This leads to a reduction in the amount of bile acids in the
blood, which, in turn, reduces the production of LDL cholesterol. Examples of
bile acid sequestrants include cholestyramine (Questran) and colesevelam
(WelChol).
Niacin: Niacin, also known
as vitamin B3, is a type of lipid-lowering medication that increases the
production of high-density lipoprotein (HDL) cholesterol, which is considered
the "good" cholesterol. Niacin can also lower the levels of LDL
cholesterol and triglycerides, another type of blood fat.
Ezetimibe: Ezetimibe is a medication that blocks the absorption of cholesterol from the gut into the bloodstream. By reducing the amount of cholesterol in the blood, ezetimibe can help to lower LDL cholesterol levels.
It's important to note that the use of medication for hypercholesterolemia should be
guided by a healthcare provider. The type and dose of medication may vary
depending on individual risk factors and the patient's medical history. In some
cases, multiple medications may be required to achieve optimal cholesterol
control.
In conclusion, hypercholesterolemia is a common condition
that can lead to various health problems. It is important to get regular lipid
profile tests to monitor cholesterol levels and take appropriate measures to
keep them under control. Lifestyle changes, medications, and proper medical
care can help to manage hypercholesterolemia and reduce the risk of heart
diseases.
Diabetes Specialist
MBBS, MSc (Diabetes & Endocrinology)
CCD-BMJ-AKU-RCP (London)
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