High Cholesterol

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

Tests and diagnosis

Fasting lipid profile

HDL levels

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