How Can I Reduce My Risk Of Hyperlipidemia
Even children can get their blood checked for high cholesterol, especially if someone in the childs family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.
Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.
Medications To Treat High Cholesterol
For most people who need medication to manage high cholesterol, doctors will prescribe statins. Statins, also known as HMG CoA reductase inhibitors, are a class of drugs that prevent cholesterol from forming in the liver, where both LDL and HDL cholesterol are made. This lowers the amount of cholesterol circulating in the blood. They are most effective at lowering LDL cholesterol but can also lower triglycerides and HDL cholesterol.
If you have certain conditions, or if statins arent working to decrease your high cholesterol sufficiently, your doctor may prescribe one of these other cholesterol-lowering medications:
- PCSK9 Inhibitors A newer type of medicine, PCSK9 inhibitors bind to and inactivate a protein on certain liver cells, which then lowers LDL cholesterol. Administered by injection, they are often used in patients with high cholesterol that doesnt respond to statins or people with familial hypercholesterolemia.
- Selective Cholesterol Absorption Inhibitors The most commonly used nonstatin agent, according to the AHA, selective cholesterol absorption inhibitors prevent cholesterol from being absorbed in the intestine. This means less cholesterol is delivered to the liver and, ultimately, the blood.
- Bile Acid Sequestrants Also known as bile-acid-binding agents, these drugs work by removing bile acids from the liver. Since LDL cholesterol is needed to make bile acids, the body then breaks down more LDL cholesterol particles.
Causes Of High Cholesterol
A build-up of cholesterol is part of the process that narrows arteries, called atherosclerosis. In atherosclerosis, plaques form and cause restriction of blood flow.
Reducing the intake of fat in the diet helps to manage cholesterol levels. In particular, it is helpful to limit foods that contain:
- Cholesterol: This is present in animal foods, meat, and cheese.
- Saturated fat: This occurs in some meats, dairy products, chocolate, baked goods, deep-fried, and processed foods.
- Trans fats: This occurs in some fried and processed foods.
Excess weight or obesity can also lead to higher blood LDL levels. Genetic factors can contribute to high cholesterol. People with the inherited condition familial hypercholesterolemia have very high LDL levels.
Other conditions that can lead to high cholesterol levels, include:
In adults, total cholesterol levels less than 200 milligrams per deciliter are considered healthy.
- A reading between 200 and 239 mg/dL is borderline high.
- A reading of 240 mg/dL and above is considered high.
LDL cholesterol levels should be less than 100 mg/dL.
- 100129 mg/dL is acceptable for people with no health problems but may be a concern for anyone with heart disease or heart disease risk factors.
- 130159 mg/dL is borderline high.
- 160189 mg/dL is high.
- 190 mg/dL or higher is considered very high.
- eat a heart-healthy diet
- achieve and maintain a healthy weight
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Damage To The Arteries
LDL or low density lipoprotein is commonly known as bad cholesterol is the trigger for heart disease and stroke although it isnt quite clear what causes this. It is thought that when white blood cells link with LDL plaque formation occurs, plaque is made up of cholesterol, fatty materials, calcium and dead cells, the gradual formation of plaque build up increases what causes inflammation in the arteries resulting in continuous damage the arteries.
Residual Inflammatory Risk Versus Residual Cholesterol Risk: No More Coin Flipping
High-dose statin therapy and other contemporary standard therapies, including potent novel anti-platelets, can only prevent a fraction of events associated with residual burden These rather refractory/recalcitrant events represent an intriguing unmet medical challenge. This shifts treatment decisions from the flip of a coin to the era of precision medicine , in which treatment plans are tailored based on readily measured biomarkers. Those with LDL-C levels above the target levels despite the maximum-tolerated statin therapy are considered to have residual cholesterol risk, and should have either ezetimibe and/or a PCSK9 inhibitor added to their treatment . Those who have persistently high inflammation burden, as demonstrated by a persistent hsCRP > 2mg/L, are considered to have residual inflammatory risk, and could be assigned to an evidence-based anti-inflammatory treatment such as canakinumab if demonstrated safe over the long term. Both strategies lead to an additional relative risk reduction of 15%.
Tentative algorithm for guiding system of care selection of the appropriate treatment customized to the patients residual cholesterol versus inflammatory risk, when long-term anti-inflammatory therapy appears to be safe. CV cardiovascular, hsCRP high-sensitivity C-reactive protein, IL interleukin, LDL-C low-density lipoprotein cholesterol, PCSK9 proprotein convertase subtilisin/kexin type 9
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The Blood Clotting Hypothesis
Many diseases are simply the result of normal healthy processes going wrong. Blood clotting is a normal healthy process. If our bodies werent able to form blood clots then we would bleed to death anytime we cut ourselves. This theory proposes that heart disease is a disease where the normal, healthy process of blood clotting goes wrong.
A small amount of damage to the blood vessel endothelium isnt a big problem. When this happens, a blood clot will form, be shaved down in size, and then a new layer of endothelium grows on top. This means the blood clot gets incorporated into the artery wall.
Interestingly, when you look at atherosclerotic plaques, they contain many similar components to a blood clot. By this theory, theyre the same thing.
When the blood clot is being shaved down in size, it triggers repair systems that increase inflammation. As we said earlier, inflammation is the bodies natural immune response to any injury. This explains why individuals with heart disease seem to have higher levels of inflammation in the body.
So up until this point, everything is a normal healthy process. Where does it go wrong? The blood clotting theory suggests that problems occur when the rate of endothelium damage is higher than the rate of repair.
- An increased rate of endothelium layer damage occurs
- Larger, harder to remove blood clots form
- The body has a reduced ability to repair/remove these blood clots
- Atherosclerosis develops over time
1) Endothelium damage
Guidelines On Risk Enhancers
Guidelines from the American College of Cardiology and American Heart Association recommend that healthcare providers consider chronic inflammatory conditions like RA, lupus, and psoriasis as “risk enhancers” for cardiovascular disease. Those with these conditions have a lower threshold and should be considered for cholesterol-lowering medications to lower their risk of heart disease.
Furthermore, some specific anti-inflammatory medications have shown promise in preventing heart disease. This is an area that researchers are investigating with the hope of improving our understanding of inflammation and CVD and potentially targeting specific inflammatory pathways to prevent heart disease.
One important study called the CANTOS trial looked at the monoclonal antibody drug called canakinumab. This medication targets a specific pathway to decrease inflammation. In people who had previously had a heart attack, canakinumab decreased the risk of a stroke or second heart attack.
Additionally, the COLCOT trial demonstrated that low-doses of the anti-inflammatory medication colchicine given after a recent heart attack was associated with less cardiovascular events.
Anti-inflammatory medications aren’t a magic bullet for preventing heart disease, though. A study of low dose methotrexate did not show lower rates of heart attack or stroke.
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Cholesterols Impact On Your Arteries
LDL circulates through your bloodstream, where it delivers cholesterol to cells that need it to produce hormones and strengthen cell membranes. As LDLs travel through your arteries, these little packages of cholesterol can attach to rough or damaged areas of arterial walls.
Once LDL sticks to the lining of the artery, it penetrates the wall and causes inflammation. This is the start of atherosclerosis. The higher your blood levels of LDL, the more likely you are to develop atherosclerosis.
Over time, a variety of biochemical reactions take place, leading to smooth muscle cells and other fats mixing in with the cholesterol plaque. Calcium also joins the group, which makes the plaque harden.
As the plaque increases in size, it blocks blood flow through the artery. If the plaque is unstable, it can rupture, sending pieces of the plaque through your bloodstream. When a piece of plaque gets caught in your heart, brain, or lungs, you have a heart attack, stroke, or pulmonary embolism.
The Link Between High Blood Pressure And Inflammation
The evidence reviewed with the help of past research studies has suggested that inflammation can even lead to hypertension development.
Both ageing and aldosterone even have a relationship in both hypertension and inflammation.
Therefore, when there would not be serious side effects, anti-inflammatory drugs could play a vital role in the treatment of hypertension in the future. Secondly, adopting healthy lifestyle choices is even indeed the best technique in lowering the risk factor.
Though, doctors can also advise a statin drug for those people who have a high risk of suffering from heart disease. The doctor can even determine the risk level and even the next steps that are most valuable for you.
It is still not clear whether inflammation is a significant effect resulting from hypertension. Though, there is some evidence related to the studies carried out on humans and animals that inflammations can lead to the development of hyperinflation.
Both the endothelial dysfunction and oxidative stress have an association with inflammation and can have a contribution to hypertension. It can inevitably exacerbate the inflammatory response.
There are some other factors which even have a contribution towards hypertension such as ageing, aldosterone and
sympathetic nervous system activation. They have an association with inflammation.
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The Forming Of A Grey Ring Around Your Cornea
This one is pretty tough to spot, so look closely. If you notice that theres a greyish ring around the cornea of your eye, that could be a pretty good indication of high cholesterol being built up in that area. The cornea covers the iris of the eye. Because the grey rings are common with older people, its only a reliable indicator of high cholesterol for people under 45.
Tingles In Your Hands And Feet
A sort of tingling sensation in your hands and your feet definitely isnt uncommon if youre dealing with too high cholesterol levels. Because of blocked blood vessels, the peripheral nerves in your feet and hands are also affected as theyre not getting enough oxygen and blood flow. This usually doesnt result in pain, but can induce a rather noticeable tingling sensation instead.
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More About The Symptoms Of Cholesterol
The liver is responsible for producing most of the cholesterol in your body, though you can also absorb it from foods that contain cholesterol. The problem is that, even though many organs need it, too much cholesterol causes irreparable damage. In fact, high cholesterol is a potential killer.
The most worrisome thing is that many are unaware that they have it in high quantities since it isnt usually manifested by blunt symptoms.
Consequently, it can lead to the development of more serious health problems, such as arteriosclerosis, hypertension, and kidney failure. Because of this, its very important to identify any signs that could help detect any problems early on.
Why Is Cholesterol Essential
Your body needs some cholesterol to work properly. For example, cholesterol is used to build cell walls and produce some hormones.
About three quarters of the cholesterol in your body is produced by your liver the rest comes from the food you eat.
Cholesterol is carried in the blood by lipoproteins. The main types of lipoproteins are high-density lipoprotein and low-density lipoprotein .
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How Much Benefit Do I Get If My Cholesterol Level Is Reduced
If you have a high risk of developing a cardiovascular disease, or you already have a cardiovascular disease, lowering your LDL cholesterol level reduces your risk of developing future cardiovascular problems.
For details on exactly how much risk is reduced by lowering and treating risk factors, find out more about the National Institute for Health and Care Excellence Clinical Knowledge Summary , ‘Cardiovascular risk assessment and management’ .
What Causes Inflammation And How Is It Relevant To Cholesterol
The following factors all raise the level of inflammation in your body:
- Being overweight
- Deficiency of omega 3 fats in the diet
- Lack of fresh vegetables in the diet
- Food allergy or intolerance
- Diets high in sugar, alcohol, gluten and omega 6 fats
In most people, the overwhelming cause of excessive inflammation in their body is poor diet choices.
Sugar, flour and vegetable oil high in omega 6 fats all cause wear and tear to your body. Having a fatty liver causes the liver to produce high levels of damaging inflammatory chemicals.
Inflammation damages the lining of your arteries. It actually causes wear and tear to the once smooth inner lining of artery walls. Once youve developed lesions in your arteries, the cholesterol in your bloodstream comes along and tries to repair this damage.
Cholesterol has a vital role in healing and repair of tissues in your body. The problem is, cholesterol can accumulate in your arteries, causing them to narrow and thus restricting blood flow. Cholesterol is not the initiating factor in artery damage it is only serving a protective and healing role.
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Why Does It Matter
You might be asking yourself, why does it matter what causes heart disease? Is it that important to know whether its bad LDL cholesterol or something else?
The reason we believe this is so important is because understanding the cause of a disease is the first step to preventing it. If you know the risk factors, youre likely to change the actions you do every day to lower your risk. However, if we get these risk factors wrong, we might actually be doing more harm than good.
So, whats the answer? Should we be worried about eating foods with saturated fat? Should everyone be taking drugs to reduce cholesterol levels?
Or is there a better way?
Our current view is that high levels of bad LDL cholesterol in the blood are not the main cause of heart disease. Instead, we believe theres another hypothesis that provides a good explanation for all the known risk factors for heart disease.
But before we get into this, lets understand a bit more about heart disease and the current widely held hypotheses.
- Its important to know whether LDL cholesterol causes heart disease because understanding the cause of a disease is the first step to preventing it.
- Currently, the evidence suggesting LDL cholesterol is to blame for heart disease seems weak.
Neck Pain And Headaches
Because high cholesterol leads to the blocking of arteries, theres a good chance that the blood flow to and from your head can be disturbed. The result is a sore neck and sudden headaches on an occasional basis, and you might even deal with some pain in your shoulders as well. A nagging headache in the back is a very good indication of excessive cholesterol levels according to doctors.
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The Role Of Hyperlipidemia In Inflammation
Increased cholesterol levels are a major risk factor for atherosclerosis and CAD. It has been evaluated that atherosclerosis begins at the first years of birth and continues through the adulthood, whereas increased cholesterol levels and atherosclerosis are closely related . LDL and specifically ox-LDL triggers a number of inflammatory processes in the vasculature, thus promoting the local production of ROS, upregulating mechanisms, responsible for impaired ejection fraction . Notably, EF is impaired even in children, exhibiting familiar hypercholesterolemia, as this has been assessed by ultrasound techniques including the flow-mediated dilation .
S. Sitaula, T.P. Burris, in, 2016
Things You Can’t Control Like Your Age
While some risk factors of high cholesterol are avoidable, a few aren’t. Namely, increasing age.
“As you age, you lose lean muscle mass. This leads to you becoming naturally more insulin resistant, which increases plaque instability and worsens your lipoprotein particle number, which increases cholesterol deposition in your blood vessels,” warns Dr. Septimus.
Additionally, high cholesterol can be caused by a rare genetic disorder called familial hypercholesterolemia. It can also develop as a complication of other health conditions, particularly type 2 diabetes.
“If you have one or more of these risk factors, it doesn’t mean you will develop high cholesterol, but it does mean you’ll need to be sure you’re adopting and maintaining the healthy lifestyle behaviors that reduce your risk,” adds Dr. Septimus.
The healthy lifestyle behaviors that can help you avoid high cholesterol and its consequences include:
- Avoiding processed/packaged foods and eating a diet rich in vegetables and fruit
- Exercising regularly
- Taking steps to avoid other health conditions, such as type 2 diabetes and obesity
- Losing weight, if you’re overweight
- Stopping smoking, if you smoke
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Treatment And Medication Options For High Cholesterol
Although having high cholesterol numbers can contribute to the long-term risk of heart attack and stroke, you can lower your cholesterol through changes in your lifestyle habits, including adopting a heart-healthy diet, increasing your physical activity level, and quitting smoking. These long-term lifestyle changes can also prevent your cholesterol levels from changing in the first place.
Increased Bone Marrow Myelopoiesis Promotes Monocytosis
In mice, cholesterol efflux pathways mediated by APOE, ABCA1 and ABCG1 suppress the production of inflammatory cells in the bone marrow and the spleen this is observed in chow-fed mice and becomes more prominent in the setting of hypercholesterolaemia,. Transplantation of Abca1/Abcg1/ bone marrow cells into Ldlr/ mice led to dramatic monocytosis and neutrophilia, infiltration of myeloid cells into multiple organs and accelerated atherosclerosis. This leukocytosis reflected markedly increased proliferation and expansion of the HSC population in the bone marrow. Increased HSC proliferation, myelopoiesis and atherogenesis were reversed by overexpression of transgenic human APOA1, which probably reflects increased cholesterol efflux from HSCs, possibly by SRB1-facilitated passive efflux. Subsequent studies showed similar expansion and proliferation of the HSC population in Apoe/ mice and to a lesser extent in Ldlr/ mice. In Ldlr/ mice, reductions in APOA1 and HDL levels because of Apoa1 haploinsufficiency promoted HSC population expansion and monocytosis. LDL or oxidized LDL seem to promote HSC proliferation and this proliferation is reversed by HDL,. Similarly, children with familial hypercholesterolaemia have an inverse relationship between HDL cholesterol levels and blood monocyte numbers, which suggests that these mouse studies are relevant to humans.
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