Cholesterol level makes a statement about the amount of cholesterol contained in the blood. Thus, an elevated cholesterol level or hypercholesterolemia refers to an abnormal or disturbed amount of cholesterol in the blood. Cholesterol is a fatty substance that is important for the structure of the cell membranes surrounding each cell, for quite a few hormones, and for the production of bile acid.
What is elevated cholesterol?
HDL cholesterol (“good cholesterol”), a specific type of cholesterol removes fatty substances from blood vessels. LDL cholesterol (“bad cholesterol”), on the other hand, adds fatty substances to the blood vessels, where they can form harmful deposits. When we speak of elevated cholesterol levels (hypercholesterolemia), we are referring to the harmful LDL cholesterol. The LDL cholesterol level that is still tolerable for an individual depends on whether there are other risk factors that can promote arteriosclerosis. Such risk factors include diabetes, high blood pressure, obesity and smoking. For an intermediate risk profile, an LDL cholesterol level of up to 115 milligrams per deciliter is considered safe. At increased risk, cholesterol levels should not exceed 100 mg/dl. People with coronary artery disease, diabetic mellitus, or at least moderate chronic kidney damage should have cholesterol levels no higher than 70 mg/dl.
Causes
Elevated cholesterol is partly due to genetic predisposition. However, individual lifestyle also has an influence on cholesterol levels: obesity, a diet too rich in fats, and too little physical activity promote the development of elevated cholesterol. More than 50% of people living in the Western hemisphere today have elevated cholesterol levels. In patients who have hypercholesterolemia from birth – exclusively hereditary – (familial hypercholesterolemia), the cholesterol level must be lowered with medication and by adhering to a diet. The predisposition to an elevated cholesterol level is manifested by the fact that the body’s cells are less able, or not able at all, to absorb fatty substances from the blood because they lack a sufficient number of so-called receptors that are ready to absorb fat. LDL cholesterol therefore remains in the blood with adverse health effects.
Symptoms, complaints, and signs
Elevated cholesterol does not usually cause any clear symptoms or complaints. The imbalance in blood lipid levels can only be detected by blood tests. In the long term, however, elevated cholesterol levels can lead to arteriosclerosis. Arteriosclerosis is manifested by pain in the arms and legs, numbness, dizziness and chest tightness, among other symptoms. Some individuals suffer from recurrent heart pain or cardiac arrhythmias. In addition, fainting spells may occur, accompanied by palpitations, sweating and a severe feeling of malaise. If elevated blood lipid levels are not treated, further symptoms may develop over the course of months or years. In addition to the increasing feeling of illness caused by the pain and sensory disturbances in the limbs and the permanently elevated blood pressure, various diseases of the cardiovascular system may develop. Externally, an elevated cholesterol level is not clearly recognizable, but in the long term, changes can occur that indicate a serious disease. These include prominent veins on the arms and neck, excessive perspiration, premature hair loss and noticeably reddened skin on the face and limbs. In most cases, nervousness, inner restlessness and inexplicable panic attacks also set in. If the above symptoms occur in interaction, a medical diagnosis is required.
Diagnosis and course
The effects of elevated cholesterol are not noticeable in the short term. In the long term, however, serious health consequences can occur. Hypercholesterolemia increases the risk of arteriosclerosis, which can then lead to serious coronary artery disease and likewise trigger a heart attack. The risk of blood vessels narrowing due to increasing calcification in the case of elevated cholesterol levels can also affect the legs, for example, in addition to the heart.If a blood vessel responsible for supplying the brain becomes dangerously narrowed, a stroke will result. If the elevated cholesterol level reaches a value of 250 mg/dl, the risk of a heart attack is increased by 100%. At 300 mg/dl, the risk has already quadrupled. Hypercholesterolemia can also be noticeable in the form of yellowish cholesterol deposits, for example on tendons, eyelids and in the skin.
Complications
Too much cholesterol in the blood can cause it to build up on the walls of the arteries. This can accelerate atherosclerosis. Blood vessels are transformed into stiff, calcified tubes that become less able to support blood transport. Consequently, the heart has to pump harder and blood pressure rises. Blood supply decreases where vessels are severely narrowed by deposits. As a result, kidneys, brain cells, heart muscles, muscles in the legs and cells in the eyes may contain too little oxygen. Their functions decline. Further complications can include dementia, pain in the legs when moving or in the heart when straining. In addition, deposits can detach from the walls of the blood vessels. The clots are carried away by the bloodstream and can completely block vessels in other places. If this happens to the heart muscle, it can lead to a life-threatening heart attack. If the brain is affected by a vessel occlusion, a stroke can occur with serious consequences. Affected people can lose many bodily functions and also die from a stroke. Elevated cholesterol levels can also be associated with heart failure and/or cardiac insufficiency. In addition, the kidneys can be affected, for example in the form of kidney weakness or renal insufficiency. Cholesterol can also be deposited in the skin and tendons.
When should you see a doctor?
A visit to the doctor should take place as soon as the person suffers from a sharp increase in weight. If overweight or obese, there is reason for concern and a medical examination should be initiated. If there are sweating episodes, reduced mobility or high blood pressure, a doctor should be consulted. If there are sleep disturbances, changes in heart rhythm, a general feeling of malaise or palpitations, a doctor’s visit is necessary. If bone and joint problems occur, a doctor should be consulted. In case of pain, muscle problems as well as shortness of breath, a doctor is needed. If the affected person suffers from disturbances in blood circulation, there is reason for concern. A doctor should be contacted if there are hormonal problems, mood swings or irritability. If dysfunctions of individual systems occur or there are impairments of attention, a doctor should be consulted. In case of disorders of consciousness, dizziness as well as forgetfulness, a medical examination is necessary. Disturbances of erection as well as vision or hearing are worrisome and must be treated by a physician. A feeling of pressure inside the body, a feeling of illness or general weakness should be presented to a physician. Pain in the arms or legs should be evaluated by a physician. Irritation on the skin, a tingling sensation in the limbs, or numbness in the body should also be investigated and treated.
Treatment and therapy
Before beginning therapy for elevated cholesterol, it must first be determined whether other risk factors that promote arteriosclerosis are present, such as obesity, a diet too high in fat, smoking, lack of exercise, high blood pressure, or diabetes. This overall picture determines the target value to which the cholesterol level must be reduced. A first measure is to change the diet to a low-cholesterol and high-fiber diet. It is also important to lower elevated cholesterol levels through physical activity. Other diseases, such as diabetes, which promote hypercholesterolemia, are treated in parallel. In the case of elevated cholesterol levels, so-called cholesterol absorption inhibitors prevent the cholesterol in food from being absorbed into the body by the small intestine. Nicotinic acid suppresses the release of fatty acid from adipose tissues, which causes a reduction in elevated cholesterol levels. At the same time, HDL cholesterol is increased. So-called exchanger resins prevent bile acid released from the liver into the intestine from re-entering the body.This causes the liver to replace the now missing bile acid with the help of the cholesterol in the blood, so that the hypercholesterolemia is reduced. Herbal agents such as garlic are used as a supplement to combat elevated cholesterol levels. If hypercholesterolemia is diagnosed, regular examinations of blood lipid levels are recommended.
Outlook and prognosis
The prognosis of elevated cholesterol must be evaluated according to individual circumstances. For many affected individuals, a change in lifestyle and optimization of food intake is sufficient. Sufficient exercise, sporting activities and the avoidance of excess weight are necessary to bring about an alleviation of the symptoms. If possible, food should not contain excessive animal fats and harmful substances such as nicotine and alcohol should be avoided. If no other diseases are present, a good prognosis is given with the measures described. If an underlying disease is present, the prognosis depends on the time of diagnosis as well as the treatment options for the disease. In the case of a chronic or a congenital disorder, a cure is not to be expected. In the case of diabetes or a metabolic disorder, lifelong therapy is required in most cases. Control examinations must be carried out at regular intervals. The cholesterol level is measured and the dose of medication is adjusted to the current values. Although most patients do not recover, the drugs provide significant relief from the symptoms. The affected person can have a good quality of life and live with the disease despite the elevated cholesterol level. Without treatment, there is a risk of calcification of the arteries. A life-threatening condition may develop as blood vessels slowly become clogged.
Prevention
To prevent elevated cholesterol levels, attention should be paid to a healthy lifestyle. This includes a diet with a low-fat mixed diet. Fish and poultry contain only a small amount of saturated fatty acids. A high-fiber diet (e.g., bread, fruits and vegetables) is also preferable. Olive oil and sunflower oil have a positive effect on elevated cholesterol levels. Even red wine enjoyed in moderation is said to lower hypercholesterolemia and increases positive HDL cholesterol. High-fat dairy products, butter, cream, egg yolks, nuts and sweets, on the other hand, should be avoided. Exercise in the form of regular endurance training is recommended. Smoking should be avoided, as it multiplies the risk of heart attack.
Aftercare
A slightly elevated cholesterol level does not necessarily have to become the subject of follow-up care. Nevertheless, those affected must keep an eye on it – especially in connection with obesity, type 2 diabetes and high blood pressure. Hypercholesterolemia should be monitored in any case. It can be indicated by so-called xanthomas. Since the organism produces cholesterol itself, an elevated cholesterol level does not necessarily indicate excessive consumption of eggs and meat products. In the follow-up, diet is usually not necessary – unless it is for weight loss. In addition, the patient may be more at risk for all the consequences of atherosclerosis. Appropriate preventive examinations are advisable. However, hypercholesterolemia requires close monitoring and follow-up in transplant patients. It is a fact that practically all immunosuppressants lead to hypercholesterolemia. Here, however, follow-up primarily involves the graft and immune functions. Only in the second instance do cholesterol levels become important. In the aftercare of hypercholesterolemia, weight loss and plenty of exercise, as well as dietary adjustments, are the most commonly pursued approaches. Alcohol and nicotine consumption should be avoided. Drug treatment with CSE inhibitors (cholesterol synthesis enzyme inhibitors), so-called statins, anion exchangers such as colestyramine, fibrates or nicotinic acid is only undertaken in cases of persistently high cholesterol levels. If necessary, blood purification is performed in those affected.
What you can do yourself
In many cases, a change in lifestyle already contributes significantly to lowering elevated cholesterol levels. In the diet, emphasis should be placed on a low-fat and high-fiber diet with plenty of fresh vegetables and fruits, as well as whole grain products.It is better to avoid fatty meat altogether; poultry and fish are good alternatives to hearty home cooking. For preparation, it is recommended to use vegetable fats that are rich in polyunsaturated fatty acids, such as olive, sunflower or walnut oil. Many vegetable oils, as well as salmon, herring and mackerel, are high in omega-3 fatty acids, which can help lower “bad” LDL cholesterol. To reduce obesity, the consumption of sugar and alcohol should also be limited: However, moderate consumption of red wine (maximum one to two glasses per day) can increase the amount of HDL cholesterol in the blood and inhibit the harmful effects of LDL cholesterol. Regular exercise, preferably in the fresh air, can also help to lower blood lipid levels: practicing an endurance sport such as running, swimming or cycling also has a positive effect on fitness and body weight. Smoking, in conjunction with hypercholesterolemia, increases the risk of heart attack and other cardiovascular diseases; nicotine consumption should therefore be completely avoided.
