Hypercholesterolemia

Hypercholesterolemia, although common, usually does not present visible symptoms until it causes considerable damage to the body, which is why it is often called “the silent enemy.” This article delves into the causes, symptoms, consequences and strategies to prevent and treat hypercholesterolemia, as well as its impact on society.

What is hypercholesterolemia?

The term hypercholesterolemia refers to the presence of high levels of cholesterol in the bloodstream. Cholesterol is a fatty substance essential for several functions in the body, such as the formation of cell membranes, the production of hormones and the synthesis of vitamin D. However, when it is found in excess in the blood, it becomes a risk factor. crucial for the development of heart disease.

There are two main types of cholesterol carried by different types of lipoproteins:

1. LDL cholesterol (low density lipoproteins): Known as ‘bad’ cholesterol, LDL is primarily responsible for cholesterol buildup in the arteries, forming plaques that can block blood flow. High levels of LDL are a direct risk for cardiovascular health.

2. HDL cholesterol (high-density lipoproteins): This type of cholesterol is known as ‘good’ because it helps transport excess cholesterol from the arteries back to the liver, where it is eliminated. Low levels of HDL also represent a cardiovascular risk, since they decrease the body’s ability to eliminate harmful cholesterol.

The imbalance between high LDL cholesterol and low HDL cholesterol is what sets in motion a process of fat accumulation in the arteries that can eventually lead to obstruction of blood flow, causing serious conditions such as myocardial infarction.

Causes of hypercholesterolemia

Hypercholesterolemia can have multiple causes, ranging from genetic factors to unhealthy lifestyle habits. The main causes are divided into two broad categories: primary hypercholesterolemia and secondary hypercholesterolemia.

Primary hypercholesterolemia

In primary hypercholesterolemia, the main cause is genetic in origin. The most common form of this type is familial hypercholesterolemia, an inherited disorder that affects the body’s ability to remove LDL cholesterol from the blood. People with this condition often have extremely high cholesterol levels from an early age, which predisposes them to premature cardiovascular disease. It is a relatively rare condition, affecting approximately 1 in 200 people, but its impact on health can be devastating if not treated properly.

Secondary hypercholesterolemia

Secondary hypercholesterolemia is much more common and is associated with lifestyle factors and other medical disorders. Among the most common causes are:

1. Diet high in saturated and trans fats: Excessive consumption of saturated fats, found in animal products such as red meat, butter and cheese, as well as trans fats present in ultra-processed foods, increases LDL cholesterol levels.

2. Sedentary lifestyle– Lack of physical activity reduces the body’s ability to process and eliminate cholesterol efficiently, leading to a buildup of LDL.

3. Obesity: Overweight people, especially those with excess abdominal fat, tend to have high levels of LDL cholesterol and triglycerides, as well as low levels of HDL cholesterol.

4. Tobacco and alcohol: Smoking lowers HDL cholesterol levels, while excessive alcohol consumption can increase triglycerides, a type of fat in the blood that also contributes to cardiovascular disease.

5. Underlying diseases: Conditions such as diabetes, hypothyroidism, or kidney and liver diseases alter cholesterol metabolism, raising LDL levels in the blood.

6. Medications– Some medications, such as diuretics or beta blockers, can increase cholesterol levels as a side effect.

Consequences of hypercholesterolemia

Excess LDL cholesterol in the blood accumulates on the walls of the arteries, causing the formation of fatty plaques in a process known as atherosclerosis. Over time, these plaques harden and narrow the arteries, reducing blood flow to vital organs such as the heart and brain.

Atherosclerosis is a slow but progressive process that can go unnoticed for years. As arteries narrow, organs receive less oxygen and nutrients, which can cause symptoms such as chest pain (angina pectoris) or intermittent claudication (leg pain when walking).

The most serious complications of atherosclerosis include:

1. Myocardial infarction (heart attack): If a cholesterol plaque ruptures, it can form a clot that completely blocks blood flow in a coronary artery, causing heart tissue to die.

2. Stroke: Blockage of the arteries that supply blood to the brain can cause a stroke, a condition that can result in paralysis, loss of motor function, or even death.

3. Peripheral arterial disease: Cholesterol buildup can also affect the arteries that supply blood to the extremities, causing pain, ulcerations, and, in severe cases, gangrene.

4. Aneurysm: Atherosclerosis weakens the arterial walls, which can lead to the formation of an aneurysm, an abnormal dilation of an artery that, if ruptured, can be fatal.

Symptoms and diagnosis of hypercholesterolemia

Hypercholesterolemia is an asymptomatic condition in most cases, meaning that many people may have dangerously high cholesterol levels without knowing it. Symptoms usually only appear when atherosclerosis has progressed significantly, underscoring the importance of regular medical checkups, especially in people with known risk factors.

The diagnosis of hypercholesterolemia is made through a blood test known as a lipid profile, which measures levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. The recommended cholesterol levels are as follows:

• Total cholesterol: less than 200 mg/dL (optimal).

• LDL cholesterol: less than 100 mg/dL (optimal), but in people with high cardiovascular risk it is recommended that it be less than 70 mg/dL.

• HDL cholesterol: more than 60 mg/dL (optimal), since high levels of HDL protect against cardiovascular disease.

• Triglycerides: less than 150 mg/dL (optimal).

It is important for people with a family history of hypercholesterolemia or heart disease to have these tests done more frequently, as they may be at higher risk of developing this disorder.

Treatment of hypercholesterolemia

Treatment of hypercholesterolemia focuses on reducing LDL cholesterol levels to prevent or slow the progression of atherosclerosis. There are two main approaches to achieve this: lifestyle changes and drug treatment.

Lifestyle changes

Changes in diet and exercise are the first line of treatment for hypercholesterolemia, and in many cases may be sufficient to control cholesterol levels. Recommendations include:

1. Healthy diet: It is advisable to reduce the consumption of saturated and trans fats, and increase the intake of healthy fats (such as olive oil and omega-3 fatty acids present in fish), as well as fruits, vegetables, and soluble fiber (such as found in oats and legumes), which helps reduce LDL cholesterol.

2. Regular exercise– Physical activity, such as walking, swimming, or cycling for at least 150 minutes a week, can increase HDL cholesterol levels and lower LDL and triglycerides.

3. Weight loss: For overweight people, losing even a modest amount of weight can improve lipid profile and reduce cardiovascular risk.

4. Tobacco cessation– Quitting smoking improves HDL cholesterol levels and significantly reduces the risk of heart disease.

Pharmacological treatment

When lifestyle changes are not enough to control hypercholesterolemia, medications are used. Pharmacological treatment includes:

1. Statins: They are the most used medications to reduce LDL cholesterol. They work by inhibiting an enzyme that the liver uses to make cholesterol, which reduces the amount of cholesterol in the blood.

2. Cholesterol absorption inhibitors: These medications, such as ezetimibe, limit the absorption of cholesterol in the intestine.

3. Lipid-lowering drugs: include fibrates and niacin, which are used to reduce triglycerides and increase HDL cholesterol.

4. PCSK9 inhibitors: These new medications are especially effective in patients with familial hypercholesterolemia or those who do not respond well to statins.

Hypercholesterolemia is a common but serious disorder that can have devastating consequences if not detected and treated early. Although the disease itself has no symptoms, the damage it causes to the arteries can lead to catastrophic cardiovascular events. Therefore, it is essential to carry out regular check-ups and adopt a healthy lifestyle to keep cholesterol levels under control.

The fight against hypercholesterolemia is both an individual and collective task, and prevention is the most powerful weapon. Changing eating habits, increasing physical activity and, if necessary, seeking medical treatment, can make the difference between a healthy life and one affected by the serious consequences of heart disease.