Cardio-metabolic Area

Hypercholesterolemia
Arterial Hypertension
Diabetes Mellitus

Cholesterol is an organic compound belonging to the family of lipids. It performs various biological functions in the body, which are important and essential to build healthy cells, for the production of certain hormones, vitamin D and bile salts. In spite of its essential biologic function, when cholesterol circulates in the blood in concentrations that are higher than normal (hypercholesterolemia), it becomes a hazard for health, increasing the risk of developing cardiovascular diseases.

Hypercholesterolemia can lead to the formation of pathological fat deposits in blood vessels. This may affect the smooth flow of blood in vessels that supply both the heart and the brain, thus causing a risk of either acute or chronic ischemic attacks or causing strokes.

Hypercholesterolemia, which can be hereditary, is often the result of unhealthy life choices and, as such, it can be prevented and treated. A healthy diet, regular physical exercise and, associated pharmaceutical treatment upon indication of a medical professional may result in significant long-term reduction or prevention of the disease.

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Symptoms

Hypercholesterolemia has no symptoms. A blood test is the only way to detect hypercholesterolemia.

Your doctor should prescribe a basic cholesterol test when you are 20, an then check your cholesterol levels every five years. If test results are not within the desirable limits, your doctor may recommend that you check them more often. Your doctor may also suggest more frequent checkups if you have a family history of hypercholesterolemia, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.

Causes

Cholesterol is carried through the blood, where it binds to specific proteins. This combination of proteins and cholesterol is called a lipoprotein. Types of cholesterol differ based on the type of lipoprotein that forms when cholesterol and proteins bind in the blood.

They are:

Low-density lipoproteins (LDL),or “bad” cholesterol, transports cholesterol particles throughout the body. LDL cholesterol builds up in the walls of the arteries.

Very low-density lipoproteins (VLDL), carry a great quantity of endogenous triglycerides (synthesized by the liver) from the liver to the tissues. After releasing most triglycerides into the tissues, VLDLs first turn into IDLs (Intermediate Density Lipoproteins) and then, after losing more of their lipid load, in LDL.

High-density lipoprotein (HDL). HDL, or “good” cholesterol, picks up excess cholesterol in the periphery of the body and takes it back to the liver.

Some factors you can control, such as inactivity, obesity and an unhealthy diet, contribute to increase cholesterol and lower HDL cholesterol. Some other you that can’t be controlled, such as family history and age, can play the same role.

Risk factors

The presence of any of the following risk factors, if associated with hypercholesterolemia, can increase the risk of cardiovascular diseases:

Smoking. Cigarette smoking damages the walls of the blood vessels, making them more prone to accumulate fatty deposits. Smoking can also lower the levels of HDL, or “good,” cholesterol.
Obesity. A body mass index (BMI) of 30 or greater.
Diet. Foods that are high in cholesterol, such as red meat, or rich in fat, such as dairy products, increase the fat content of your blood. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, can raise your cholesterol level. A moderate consumption of olive oil, which is rich in unsaturated fats, helps prevent cardiovascular risk.
Lack of exercise. Exercise stimulates the production of HDL, “good” cholesterol, while it can lower “bad” LDL cholesterol. A lack of exercise increases the risk of hypercholesterolemia.
Arterial hypertension. The increased pressure on artery walls can damage the arteries, favouring the buildup of fatty deposits.
Diabetes. High blood sugar contributes to higher levels of a LDL cholesterol and lower levels of HDL cholesterol. High blood sugar can also damage artery walls.

A family history of cardiac diseases. Having a family member, such as a parent or sibling, who developed a cardiac disease before the age of 55, associated with high cholesterol, increases your risk of developing a cardiac disease.

Complications

Atherosclerosis

High cholesterol can cause atherosclerosis, a dangerous buildup of deposits of cholesterol and other substances on artery walls. These deposits (plaques) can reduce the blood flow in the arteries, causing complications such as:

Angina Pectoris. If the arteries supplying the heart (coronary arteries) are affected by atherosclerosis, you may have chest pain (angina) caused by a reduced supply of oxygen to the heart.
Heart attack. If plaques tear or rupture, they can cause the formation of a blood clot blocking the flow of blood of the downstream lumen of the blood vessel, stopping blood flow through the blood vessel. If this happens in heart vessels, you may have more or less severe myocardial infarctions; if it happens in the vessels supplying the brain, it can cause more or less severe ischemic strokes.

Laboratory tests and diagnosis

The blood test usually performed, called lipid panel or lipid profile, usually shows:

Total cholesterol
LDL cholesterol
HDL cholesterol
Triglycerides – a type of fat in the blood

In order for tests to be more accurate, do not eat or drink anything (other than water) for 9-12 hours before the blood sample is taken.

You are considered to be at high risk of cardiac diseases if:

you have had a heart attack or stroke in the past;
have blocked neck arteries (carotid disease)
artery obstruction in the arms or legs (peripheral artery disease)
diagnosed diabetes that needs treatment

You are considered to be at high risk of cardiac diseases if you have two or more of the following factors:

Smoking
Arterial hypertension
low HDL cholesterol
Family history of heart disease at a young age
Aged over 45 (for men), or over 55 (for women)
High concentration of lipoprotein (a) in the blood

Children may have high cholesterol from the age of 2, but not all children need to be screened for high cholesterol. The American Academy of Paediatrics (AAP) recommends a cholesterol test (fasting lipid panel) for all children between the ages of 9 and 11. The AAP also recommends screening 1-year-olds who have a known family history of high cholesterol or premature coronary heart disease.

The American Academy of Paediatrics also suggests to check the lipid panel if the child’s family history is unknown and the child shows risk factors for high cholesterol such as obesity, hypertension, and diabetes.

Cardio-metabolic Area

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Risk factors

Complications

Laboratory tests and diagnosis

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