Hypercholesterolemia is an excessive level of cholesterol in the blood. Inadequate diet can lead to hypercholesterolaemia, but also various diseases, such as disorders of the thyroid gland or kidneys. Hypercholesterolaemia may be asymptomatic, and at the same time it is associated with a significant he alth risk - it is conducive to cardiovascular diseases, such as ischemic disease or heart attack.

What is hyperholesterolaemia?

Hypercholesterolemiais a state of elevated blood cholesterol levels. Unfortunately, it is not a rare phenomenon - it can be found in up to 6 out of 10 adult patients. The incidence of this lipid disorder increases with age - the highest percentage of patients with hypercholesterolaemia is observed in the elderly group.

All over the world - including Poland - cardiovascular diseases are still the dominant cause of patient deaths. Many phenomena, such as addictions (e.g. smoking), low physical activity or lipid disorders (dyslipidemias), can contribute to these diseases. One of the most common forms of dyslipidemia in patients is hypercholesterolaemia, i.e. the state of elevated blood cholesterol levels.

Causes and types of hypercholesterolaemia

Due to the causes of hypercholesterolaemia, there are two types of this lipid disorder.

The first of them isprimary hypercholesterolaemia , this category includes polygenic hypercholesterolaemia (the appearance of which is favored by, among others, improper diet) and familial hypercholesterolaemia.

Secondary hypercholesterolaemiais a situation when lipid disorders appear in the course of some other diseases. Examples of units in which the blood cholesterol level may be elevated are:

  • kidney failure
  • hypothyroidism
  • anorexia
  • bile-related liver disease
  • Cushing's syndrome

Secondary hypercholesterolaemia can also occur in connection with taking certain medications - examples of preparations that may contribute to the occurrence of such lipid disorders includethiazide diuretics, glucocorticosteroids and progestogens.

Symptoms of hypercholesterolaemia

The most common form of hypercholesterolaemia (multigene hypercholesterolaemia) generally - apart from laboratory deviations - does not lead to any discomfort in patients. In the case of secondary hypercholesterolaemia, patients may in turn experience symptoms of these diseases, which have led to an increase in blood cholesterol levels.

The situation is different for familial hypercholesterolaemia, in which patients may already develop some specific he alth problems. An exemplary symptom of this form of hypercholesterolaemia may be the appearance of jaundice, e.g. around the eyelids or joint tendons.

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Diagnostics of hypercholesterolaemia

The diagnosis of hypercholesterolaemia is made on the basis of a blood test. A specific test that determines the level of blood lipids is the lipid profile, in which the concentrations of, among others, total cholesterol or LDL cholesterol.

It is generally accepted that hypercholesterolaemia may occur when the patient's blood LDL cholesterol level exceeds 115 mg / dL (>3 mmol / L).

Considering the above, patients may be surprised when their LDL cholesterol level is lower, and they are still diagnosed with hypercholesterolaemia. This situation is not a mistake of medics, and is related to the fact that the above-mentioned values ​​apply to the diagnosis of hypercholesterolaemia in people not burdened with additional risk factors for cardiovascular diseases.

For example, in diabetic patients, an LDL cholesterol concentration in the blood of less than 100 mg / dl may be expected, while in people with diagnosed ischemic heart disease, it is possible to aim at lowering this lipid fraction to less than 70 mg / dl. for This is where the differences in the criteria for diagnosing hypercholesterolaemia in different patients come from.

In the diagnosis of dyslipidemia, the determination of cardiovascular risk is also very importantpatient - this can be done by classifying the patient to the appropriate risk group according to the SCORE (Systematic COronary Risk Evaluation) scale.

Treatment of hypercholesterolaemia

The aforementioned need to assess the risk of cardiovascular disease is important not only for the diagnosis of hypercholesterolaemia, but also for determining what treatment - and whether at all - a patient needs.

With a slight excess of the cholesterol level in the blood, with a simultaneous low cardiovascular risk, patients are primarily offered a change in lifestyle. It includes dietary changes: In order to lower cholesterol levels, you need to limit your consumption of saturated fats and trans fats, and replace them with unsaturated fats. In addition to modifying the diet, increasing the intensity of physical activity is also of great importance in reducing high cholesterol.

Pharmacological treatment may be recommended to patients with hypercholesterolaemia when blood cholesterol is significantly increased, as well as with significant cardiovascular risk.

In the treatment of hypercholesterolaemia, preparations from several different groups are used, but the basic drugs for this problem are statins (such as, for example, atorvastatin or rosuvastatin). Other agents that are used to lower cholesterol are:

  • ion exchange resins (e.g. cholestyramine)
  • ezetimibe (a drug that reduces the absorption of cholesterol from the gastrointestinal tract)
  • PCSK9 inhibitors (such as e.g. evolocumab - these are one of the newer preparations used in the treatment of hypercholesterolaemia, they are administered subcutaneously and lower LDL cholesterol)

Patients with hypercholesterolaemia may be offered treatment with only one drug, and may be recommended combination therapy based on the use of different drugs simultaneously. Another method of treating hypercholesterolaemia, which has not been mentioned so far, is LDL apheresis, i.e. the procedure of extracorporeal removal of cholesterol compounds from the patient's blood. The use of this procedure, however, is limited and is generally only performed in those patients who have extremely high blood cholesterol levels (this is the case, for example, in some forms of familial hypercholesterolaemia).

How to prevent hypercholesterolaemia?

Hypercholesterolaemia and the associated risk of cardiovascular disease are happily preventable.

The most important in thisappropriate physical activity and a diet consisting in limiting the content of saturated fats and processed trans fats in the diet - these lipid compounds have the greatest impact on the risk of hypercholesterolaemia.

It is also important to maintain a proper body weight, as well as avoid stimulants such as cigarettes or alcohol.

Category:

Cardiology