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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health High Cholesterol

High Cholesterol

Publisher
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High cholesterol is the presence of high cholesterol in the blood. It?s not a disease but a metabolic disorder secondary to many diseases. It contributes coronary heart disease, hypertension, and stroke.

 

Causes

  • Hereditary- familial hypercholesterolemia
  • Obesity
  • Diet rich in fat, junk and oily foods
  • Sedentary life styles
  • Alcohol
  • Smoking
  • Old age
  • Mental stress and tension

Other secondary causes

  • Diabetes mellitus and metabolic syndrome
  • Nephrotic syndrome
  • Hypothyroidism
  • Anorexia nervosa
  • Zieve’s syndrome
  • Antiretroviral drugs- protease inhibitors and NRTI’S

Signs and symptoms

  • High cholesterol typically has no noticeable symptoms. It is usually found by lipid profile testing.
  • Yellowish patches around eyelids- Xanthelesma palpabrum
  • Cholesterol deposits around cornea and whitish edges of cornea- arcus senalis
  • Xanthoma- deposition of cholesterol in patches on the skin or in tendons

Complications

  • Atherosclerosis
  • Angina
  • Stroke and other cerbrovascular disorders
  • Peripheral vascular disease
  • Premature death
  • Pancreatitis
  • Erectile dysfunction

Tests and diagnosis

Fasting lipid profile

Cholesterol type

Normal

Borderline high

High

Total cholesterol

<200 (mg/dl)

200- 239 (mg/dl)

>240 (mg/dl)

Low-density lipoprotein

<130 (mg/dl)

130- 159 (mg/dl)

>160 (mg/dl)

Triglycerides

<150 (mg/dl)

150- 199 (mg/dl)

>200 (mg/dl)

 

 

HDL levels

HDL cholesterol levels

HDL cholesterol category

<40 mg/dl

Major risk factor for heart disease

40- 59 mg/dl

The higher, the better

>60 mg/dl

Protective against heart

 

 

Other tests

  • ECG
  • 2D- Echo

 

Treatment

Diet

Diet low in fat, moderate in carbohydrates, and rich in proteins, vitamins and minerals

  • Total fat- Less than 30% of calories
  • Saturated fat- Less than 7% of calories
  • Polyunsaturated fat- Less than or equal to 10% of calories
  • Monounsaturated fat- Approximately 10-15% of calories
  • Carbohydrates (complex) - 50-60% of calories

Exercise

Although exercise has little effect on LDL- cholesterol, aerobic exercise may improve insulin sensitivity, HDL- cholesterol, and triglyceride levels and may thus reduce your heart risk.

Medications  

Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients with known coronary artery disease and type II diabetes.

  • Statins (most prominently Rosuvastatin, Atorvastatin, Simvastatin, or Pravastatin) are the first line drugs used for primary prevention against macrovascular complications with type 2 diabetes and other cardiovascular risk factors.
  • Cholesterol absorption inhibitors (ezetimibe)
  • Fibrates (Gemfibrozil, Bezafibrate, Fenofibrate)
  • Vitamin B3 (niacin)
  • Bile acid sequestrants (Cholestyramine)
  • LDL apheresis and in hereditary severe cases liver transplantation