High Blood Cholesterol

For most people, the word cholesterol means “enemy of the body”; little they know that human cells need cholesterol to establish proper membrane permeability and fluidity. Cholesterol is produced by the liver (about 1 gram per day) and absorbed in certain foods (meat, egg, milk products, getable oil, etc.), and then transported to and from the cells by the lipoproteins, molecules made of proteins and fat that transport cholesterol and triglycerides from the liver to peripheral tissues. To be healthy, your body needs cholesterol. The problem occurs when you have too much in your blood, hypercholesterolemia. Hypercholesterolemia is not a minor issue; it can increase the risk of heart attack, stroke, and certain types of cancer.

Unlike many other substances, cholesterol is not soluble in your blood; it is transported throughout the body by special proteins and lipids called lipoproteins. This transportation is provided by two groups of lipoproteins: High Density Lipoproteins (HDL) or low density lipoprotein (LDL).

HDL (High Density Lipoproteins) – also known as good cholesterol, carries cholesterol to your liver where it can be eliminated. HDL prevents accumulation of cholesterol in your blood vessels, and thus prevents the risk of atherosclerosis, thickening or hardening of an artery wall due to accumulation of fatty materials.

LDL (Low Density Lipoproteins) – also known as bad cholesterol, LDL is produced by the liver. It transports cholesterol and triglycerides from the liver to peripheral cells in your body. High levels tend to lead to the development or formation of atherosclerosis and coronary heart disease.

When cholesterol becomes a health problem?

A normal blood cholesterol levels should be < 200 mg/dL.  You have high blood cholesterol (also known as hypercholesterolemia, hyperlipidemia, or dyslipidemia) when your total blood cholesterol level is above 200–239 mg/dL. High cholesterol is harmful to your body if left untreated. It builds up in the walls of your arteries (clot or plaque), narrowing and hardening them so that transport of blood and oxygen to the heart and brain becomes slowed down or blocked. When the clots block the blood flow to your heart, you have a heart attack; when clots block blood flow to your brain, you have a stroke.

Causes and Risk Factors

Although several factors may lead to high levels of cholesterol in your blood, in most cases, excess cholesterol is caused by unhealthy diet or genetic factors (familial hypercholesterolemia). In general, the most common causative factors of high blood cholesterol include:

Unhealthy diet – some foods of animal origin such as liver, egg yolks, fatty meats, sausages, butter, cheese, ice cream, cake and shellfish are rich in cholesterol. Regular consumption of these foods can lead to high levels of cholesterol in your blood. Similarly, some products containing hydrogenated vegetable oils may increase your cholesterol. Some of these products include biscuits, pasta, viennoiseries (all products made from fermented dough, sugar, butter, cream, etc.) and all the other vegetable products containing trans fats/ unsaturated fats.

Genetic factors (familial hypercholesterolemia) – familial hypercholesterolemia, also known as hyperlipoproteinemia type II, is a predisposition to high cholesterol in your blood. If one of your parents has high cholesterol, you’re more likely to suffer from this type of high blood cholesterol. However, familial hypercholesterolemia is rare and can be prevented by a healthy lifestyle.

Disease – certain diseases such as diabetes type 1, chronic renal failure and under active thyroid (hypothyroidism) can contribute in the elevation of cholesterol in your blood.

Medications – taking certain medications such as birth control pills containing progestin, corticosteroids, anabolic steroids or anabolic-androgenic steroids (AAS) can increase your blood cholesterol levels

Overweight –excess weight, especially in the abdomen, is a common cause of high cholesterol in a great number of people. In fact, without even taking medication, certain obese individuals find a complete solution with high cholesterol after losing a few pounds of weight. Besides cholesterol, being overweight is associated with many other serious health problems.

Physical inactivity – Your body is “use it or lose it”. Regular physical activities have many beneficial effects on your health and your physical appearance. It is shown in many studies that men who live a sedentary lifestyle are the most victims of cardiovascular problems including heart attack. In addition, people who exercise regularly tend to have a youthful look and a good mental clarity.

Age – as you get older, there are hormonal changes in your body that may lead to increased levels of cholesterol. In women, there is a loss of estrogen around the time of menopause. This hormonal change can cause a decrease of high density lipoproteins (HDL), which tends to lead to high cholesterol.

High Blood Cholesterol Warning Signs and Symptoms

As most people do, you may say that you feel nothing wrong with your heart, your cholesterol level is normal. Your logic is not so wise. As long as there is no obstruction of your arteries, you may feel no symptoms. Symptoms start occurring when your arteries are up to 90% blocked, and blood circulation becomes extremely difficult. In fact, if you have signs or symptoms of high cholesterol in its early stage, you are very lucky.

High cholesterol is often discovered during a routine clinical exam including blood test or during an exam for other complications of atherosclerosis: heart failure; abnormal heart rhythms, stroke, heart attack, angina, etc. In most advanced stages, you may feel angina pectoris or pain in your legs caused by the blockage in the leg arteries.

Diagnosis

High blood pressure diagnosis is based on blood test to measure your levels of LDL cholesterol and HDL cholesterol. In general, the lower your bad cholesterol (LDL) is, the higher is your good cholesterol (HDL). This exam allows your doctor to know not only the levels of your HDL and LDL cholesterol but also your total cholesterol and triglyceride levels.

You have high cholesterol if your total cholesterol exceeds 240 mg/dL or your LDL is higher than 160-189 mg/dL. However, these levels may vary from one person to another; your physician will base on other criteria to confirm the diagnosis.

High Blood Cholesterol Treatment

 Home Remedies and Lifestyle

The treatment of high blood cholesterol requires a lifestyle change and taking medications. In fact, some people get complete relief from the disease without taking medication; they change their diet and do regular exercise. You need to eliminate or control every factor that can lead to increased cholesterol levels:

Disease – if you suffer from any disease that makes you a risk of high blood cholesterol, you should check your cholesterol regularly and take your medicines as prescribed. There are many diseases that can raise your cholesterol levels; the most common are mainly type 1 diabetes, chronic renal failure and hypothyroidism.

Hormone Replacement Therapy – If you are menopausal, with approbation of your doctor, you can follow a hormonal therapy adapted to your health. Along with a healthy diet, estrogen and progesterone replacement therapy can reduce in your blood the levels of LDL cholesterol and increase your HDL cholesterol levels.

Physical activity – regular exercise is the most effective way to keep your body healthy. Physical exercise stimulates your heart muscle, increases the production of your HDL cholesterol and helps you lose weight. In addition, physical exercise enhances and maintains your physical fitness and overall health. You do not need to lift heavy weight to exercise; fast walking for 30 to 45 minutes at least three times a week is enough to keep you in good shape.

Stop smoking – smoking increases not only cholesterol but also the risk of heart attack. Nicotine may decrease up to 15% of your HDL cholesterol (the good cholesterol). It is shown in many studies that smokers tend to have higher levels of LDL cholesterol in their blood than non-smokers do. In addition, smoking is the major factor of many types of cancer and cardiovascular disease.

Healthy Diet – to have normal cholesterol levels, it is important to reduce your fat intake. Therefore, eat lot of legumes, fruits and cruciferous vegetables, and whole grain breads. Eliminate or reduce in your diet coffee, salt, soft drinks, fatty meats, offal, egg yolks, fried foods, butter, desserts, sweeteners and sauces. Certain fats such as olive oil, flaxseed oil, fish oil are strongly recommended.

According to the American Heart Association and other credible health organizations, if you have high cholesterol, you should:

• limit your intake of salt
• limit your saturated fat to less than 7% of your total calories intake.
• Limit your polyunsaturated fat less than 10% of your total calories
• Take up to 25 g of dietary fiber per day
• Take up to 20% monounsaturated fat of your total calories intake.
• Consume less than 200 mg cholesterol per day if you already have a cardiovascular problem.

In addition, you can take the following supplements to help your cardiovascular system remain or become healthy: guggul, garlic, yeast rice, artichoke, boldo, turmeric, fumitory, dandelion, rosemary, green tea, ginseng, red vine, etc.

Drug Therapy

Medications – Many medicines are used to treat high blood cholesterol. Their effects vary from one person to another, depending on the cause of the hypercholesterolemia and the lifestyle of the patient; the most common include:

Statins– also called HMG-CoA reductase inhibitors, the statins are a group of lipid-lowering drugs, used to treat many diseases of the cardiovascular system including high blood cholesterol. They are effective in reducing cholesterol in people at risk of cardiovascular problems. Some of the satins include rosuvastatin (Crestor), simvastatin (Zocor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), atorvastatin (Lipitor), and pravastatin (Pravachol).

Fibrates – Fibrates lowers fatty acids and triglycerides levels. This class of drugs works by decreasing your hepatic synthesis of very low-density lipoprotein (VLDL) which transport triglycerides in the blood plasma and increase their catabolism. Along with a healthy lifestyle, fibrates can increase your HDL-cholesterol and decrease your total cholesterol and LDL-cholesterol up to 30%. Fenofibrate (Lofibra, Tricor) and gemfibrozil (Lopid) are the two most common of fibrates.

Ezetimibe – ezetimibe is also used to lower cholesterol levels. It is a selective cholesterol absorption inhibitor which reduces the absorption of cholesterol during digestion by acting directly on the intestinal cells, thereby significantly lowering blood cholesterol. Ezetimibe can be used alone or in combination with other medications.

Anacetrapib – anacetrapib is another drug that efficiently works in reducing the LDL cholesterol levels. It significantly increases HDL cholesterol and reduce LDL cholesterol. According to an eight-week study made by Merck & Co., Inc. on 589 patients, anacetrapib raised HDL between 44% and 139% in those patients.

High Blood Cholesterol Prevention

The key to prevent high blood cholesterol and all other cardiovascular disease is excising regularly, losing weight (if you are obese or overweight) and stopping smoking (including second hand smoke). In addition, it is very important to avoid fast foods and adopt a healthy diet.

• Increase your intake of antioxidants
• Avoid saturated acids, mainly from animal fats, pastries, margarine, etc.
• Increase your intake of carbohydrates and fiber; they play an important role in increasing the levels of good cholesterol
• Reduce bad cholesterol: egg yolk, organ meats (brain, kidney, liver), nuts, almonds, lobster, shellfish, fish eggs, etc.
• Consuming polyunsaturated fatty acids such as omega-6 (sunflower oil) omega 3 (flax seed oil, fish oil), they lower the bad LDL cholesterol and prevent the formation of blood clot.
• Eat plenty of fruits (2 to 3 per day), vegetables (3 to 4 servings per day), polyphenols (moderate consumption of wine and green tea) and phyto-oestrogens: soy, green tea, chickpeas, lentils, beans, grains, carrots, fennel, onions, garlic, etc.

References:

1-http://www.passeportsante.net/fr/solutions/plantessupplements/fiche.aspx?doc=levure_riz_rouge_ps [archive]

2 – Primary prevention of cardiovascular diseases with statin therapy [archive] , Paaladinesh Thavendiranathan, Akshay Bagai, M. Alan Brookhart, Niteesh K. Choudhry, Arch Intern Med. 2006;166:2307-2313.

3 – HMG-CoA Reductase Inhibitors and the Risk of Hip Fractures in Elderly Patients [archive], Philip S. Wang, Daniel H. Solomon, Helen Mogun, Jerry Avorn, JAMA. 2000;283:3211-3216.

4 – Genest J, Frohlich J, Fodor G, McPherson R. Working Group on Hypercholesterolemia and Other Dyslipidemias. Recommendations for the management and treatment of dyslipidemia and prevention of cardiovascular disease: Summary of the 2003 update. CMAJ. 2003;169:921–4. [PubMed]

5 – Davidson MH, Maki KC, Pearson TA, et al. Results of the National Cholesterol Education (NCEP) Program Evaluation ProjecT Utilizing Novel E-Technology (NEPTUNE) II survey and implications for treatment under the recent NCEP Writing Group Recommendations. Am J Cardiol. 2005;96:556–63. [PubMed]

6 – Merck’s Investigational CETP-Inhibitor, MK-0859 (anacetrapib), Produced Positive Effects on Lipids with No Observed Blood Pressure Changes in Phase IIb Study. merck.com/newsroom

7 – Durrington, P (August 2003). “Dyslipidaemia”. The Lancet 362 (9385): 717–31. doi:10.1016/S0140-6736(03)14234-1. PMID 12957096.

8 – Biggerstaff KD, Wooten JS (December 2004). “Understanding lipoproteins as transporters of cholesterol and other lipids”. Adv Physiol Educ 28 (1–4): 105–6. doi:10.1152/advan.00048.2003. PMID 15319192.

9 – Carmena R, Duriez P, Fruchart JC (June 2004). “Atherogenic lipoprotein particles in atherosclerosis”. Circulation 109 (23 Suppl 1): III2–7. doi:10.1161/01.CIR.0000131511.50734.44. PMID 15198959

 10 – Ito MK, McGowan MP, Moriarty PM (June 2011). “Management of familial hypercholesterolemias in adult patients: recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia”. J Clin Lipidol 5 (3 Suppl): S38–45. doi:10.1016/j.jacl.2011.04.001. PMID 21600528.

11- “Hypercholesterolemia”. Genetics Home Reference. Retrieved 16 May 2016.

Bhatnagar D, Soran H, Durrington PN (2008). “Hypercholesterolaemia and its management”. BMJ 337: a993. doi:10.1136/bmj.a993. PMID 18719012

12 – Grundy, SM; Balady, GJ; Criqui, MH; Fletcher, G; Greenland, P; Hiratzka, LF; Houston-Miller, N; Kris-Etherton, P; Krumholz, HM; Larosa, J.; Ockene, I. S.; Pearson, T. A.; Reed, J.; Washington, R.; Smith, S. C. (1998). “Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association”. Circulation 97 (18): 1876–87. doi:10.1161/01.CIR.97.18.1876. PMID 9603549.

13 – Shields, C; Shields, J (2008). Eyelid, conjunctival, and orbital tumors: atlas and textbook. Hagerstown, Maryland: Lippincott Williams & Wilkins. ISBN 0-7817-7578-7.

14 – Zech LA Jr, Hoeg JM (2008-03-10). “Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia”. Lipids Health Dis 7 (1): 7. doi:10.1186/1476-511X-7-7. PMC 2279133. PMID 18331643