High Cholesterol

Hypercholesterolemia is the presence of high levels of cholesterol in the blood.^[1] It is a form of “hyperlipidemia” (elevated levels of lipids in the blood) and “hyperlipoproteinemia” (elevated levels of lipoproteins in the blood).^[1]

Cholesterol is a vitamin D.

Since cholesterol is insoluble in water, it is transported in the blood plasma within protein particles ([1]

Reducing dietary fat is recommended to reduce total blood cholesterol and LDL in adults.^[6].

[edit] Signs and symptoms

Although hypercholesterolemia itself is [12]

[edit] Causes

Hypercholesterolemia is typically due to a combination of environmental and genetic factors.^[7]

[edit] Diet

Diet has an important effect on blood cholesterol but the size of this effect varies substantially between individuals.^[6]

Maintaining a healthy body weight through increased physical activity and appropriate caloric intake is also important. Overweight or obese individuals can lower blood cholesterol by losing weight – on average a kilogram of weight loss can reduce LDL cholesterol by 0.8 mg/dL.^[6]

[edit] Genetics

Genetic abnormalities are in some cases completely responsible for hypercholesterolemia, such as in familial hypercholesterolemia where there is one or more LDL receptor.

Even when there is no single responsible mutation to explain hypercholesterolemia, genetic predisposition still plays a major role, potentially adding to lifestyle factors and multiplying the risk of late complications. Multiple genes are involved, and hypercholesterolemia where there is probably a genetic predisposition is called polygenic hypercholesterolemia. The involved genes have yet to be discovered.^[18]

[edit] Diagnosis

There is not an absolute cutoff between normal and abnormal cholesterol levels and interpretation of values needs to be made in relation to other health conditions and risk factors. The ideal cholesterol level should be less than 4 mmol/l with a LDL cholesterol less than 2 mmol/l in those at high risk of cardiovascular disease.^[7]

Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease. Levels of LDL or non-HDL cholesterol both predict future coronary heart disease, which is the better predictor is disputed.^{triglycerides were taken as an indicator of VLDL levels (generally about 45% of fasting triglycerides is composed of VLDL), while LDL was usually estimated by the Friedewald formula:}

LDL total cholesterol – HDL – (0.2 x fasting triglycerides).

However, this equation is not valid on non-fasting blood samples or if fasting triglycerides are elevated >4.5 mmol/L (> ?400 mg/dL). Recent guidelines have therefore advocated the use of direct methods for measurement of LDL wherever possible.^[19]

[edit] Classification

Classically, hypercholesterolemia was categorized by lipoprotein electrophoresis and the Fredrickson classification. Newer methods, such as “lipoprotein subclass analysis” have offered significant improvements in understanding the connection with atherosclerosis progression and clinical consequences.

If the hypercholesterolemia is hereditary (family history of premature, earlier onset atherosclerosis.

[edit] Screening

The [23]

[edit] Treatment

Recommendations for both [7]

[edit] Lifestyle

A number of lifestyle changes are recommended in those with high cholesterol including: smoking cessation, limiting alcohol consumption, increasing physical activity, maintaining a healthy weight, and a diet low in [27]

[edit] Medication

[19]

[edit] Guidelines

Various clinical practice guidelines have addressed the treatment of hypercholesterolemia. The American College of Physicians has addressed hypercholesterolemia in patients with diabetes.^[35] Their four recommendations are:

1. Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients (both men and women) with known coronary artery disease and type 2 diabetes.
2. Statins should be used for primary prevention against macrovascular complications in patients (both men and women) with type 2 diabetes and other cardiovascular risk factors.
3. Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least moderate doses of a statin (the accompanying evidence report states “simvastatin, 40 mg/d; pravastatin, 40 mg/d; lovastatin, 40 mg/d; atorvastatin, 20 mg/d; or an equivalent dose of another statin”).^[36]
4. For those patients with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances.

The [38]

In the UK, the National Institute for Health and Clinical Excellence (NICE) has made recommendations for the treatment of elevated cholesterol levels, published in 2008.^[28]

The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) published the ESC/EAS Guidelines for the management of dyslipidaemias in 2011.^[19]

[edit] Alternative medicine

According to a survey in 2002, [41]

[edit] Epidemiology

Rates of high cholesterol in the United States in 2010 are just over 13% down from 17% in 2000.^[42]

[edit] References

Source: Wikipedia