Hypercholesterolemia

Hypercholesterolemia is a condition when cholesterol levels in the blood are too high. If left untreated, cholesterol can accumulate and narrow blood vessels, increasing the risk of heart attack or stroke.

Cholesterol is a type of fat produced by the liver. The human body needs cholesterol to form healthy cells, produce a number of hormones, and produce vitamin D. Apart from being produced by the liver, cholesterol also comes from food, such as egg yolks , fatty meats, or shellfish.

Cholesterol in the blood is bound to proteins and forms a combination called lipoprotein. Lipoprotein itself is divided into two types, each of which has a different function, namely low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL functions to carry cholesterol throughout the body through the arteries. If the levels are too high, LDL will accumulate on the walls of blood vessels and form plaques called atherosclerosis . This plaque can make blood vessels narrow and harden. Therefore, LDL is commonly referred to as bad cholesterol.

Meanwhile, HDL functions to return excess cholesterol to the liver to be removed from the body. Therefore, HDL is also known as good cholesterol.

Apart from cholesterol, there is another type of fat known as triglycerides. This fat is obtained from excessive calorie intake. Unlike cholesterol, which produces certain cells and hormones, triglycerides function to produce energy.

Hypercholesterolemia is the term for an increase in total cholesterol levels, LDL levels, and triglycerides in the blood, which exceed normal limits.

Causes and Risk Factors for Hypercholesterolemia

There are several factors that can increase the risk of developing hypercholesterolemia. Some of these factors can be controlled, while some other factors cannot, because they are related to genetic factors.

Some of these risk factors are:

Have a family that suffers from familial hypercholesterolemia , which is a genetic disorder that causes high cholesterol levels from birth
Eating too many foods high in saturated fat, such as red meat, and high in trans fat, such as cake
Suffering from obesity with a body mass index (BMI) of 30 or more
Suffer from certain diseases, such as diabetes, hypothyroidism , or kidney disease
Have a habit of smoking and consuming alcoholic beverages excessively
Rarely do physical activity or exercise
Age 55 and over in women and 45 years in men

Symptoms of Hypercholesterolemia

Hypercholesterolemia does not show any symptoms. Generally, a person is not aware of high blood cholesterol levels until they experience complications due to hypercholesterolemia.

Although generally do not cause symptoms, someone with very high cholesterol levels can experience the following complaints:

Xanthomas, namely fat lumps found in the skin
Xanthelasma , namely fat lumps that appear on the eyelids
Arcus senilis, which is a circle like a grayish white ring around the cornea of the eye

When to see a doctor

It is recommended that children undergo cholesterol level checks every 5 years, which can be started in the age range of 9-11 years. Meanwhile, for people over the age of 21 years, an examination should be done every 4-6 years.

Checking cholesterol levels should be done more often in people with the following conditions:

Has a family history of hypercholesterolemia and coronary heart disease
Suffering from heart disease
Having excess body weight
Have diabetes or hypertension

Diagnosis of Hypercholesterolemia

The doctor will ask about the patient's lifestyle, for example whether the patient smokes, rarely exercises, or often eats high-fat foods. The doctor will also ask about medical history in the family, especially heart disease, hypercholesterolemia, or diabetes.

Next, the doctor will carry out a thorough physical examination, followed by taking the patient's blood sample for testing in the laboratory. Through this blood sample, the doctor can find out the total cholesterol level in the patient's blood.

To get an accurate result, the doctor will ask the patient to fast 9–12 hours before taking the blood sample. Ideally, normal cholesterol levels in adults are as follows:

LDL: 70–130 mg/dL
HDL: more than 60 mg/dL
Triglycerides: less than 150 mg/dL
Total cholesterol: less than 200 mg/dL

Meanwhile, the ideal cholesterol level in children or adolescents under 19 years of age is:

LDL: less than 100 mg/dL
HDL: more than 45 mg/dL
Triglycerides: less than 150 mg/dL
Total cholesterol: less than 170 mg/dL

If the blood test results show that the patient's cholesterol level is outside the above range, the doctor will carry out several investigations. The goal is to determine the method of treatment to be given and to prevent complications.

Treatment of Hypercholesterolemia

To treat hypercholesterolemia, the doctor will first advise the patient to live a healthy lifestyle, such as:

Reduce consumption of high-fat foods, such as meat and cakes
Exercise regularly
Stop smoking
Reducing consumption of alcoholic beverages

If these recommendations have been followed but cholesterol levels are still high, the doctor will prescribe drugs of the type adjusted to the patient's age and health condition. Some drugs to treat hypercholesterolemia are:

Statin class drugs, such as atorvastatin , rosuvastatin , and simvastatin , to inhibit substances needed by the liver to produce cholesterol
Bile acid binding drugs, such as cholestyramine , to produce bile acids with excess cholesterol levels
Cholesterol absorption inhibitors, such as ezetimibe , to limit cholesterol absorption in the small intestine
PCSK9 inhibitor drugs, such as alirocumab and evolocumab , to help the liver absorb more LDL cholesterol thereby lowering total cholesterol in the blood

In patients with high triglyceride levels, doctors will prescribe medications, such as:

Fenofibrate , to reduce the production of VLDL ( very-low density lipoprotein ), which is a type of cholesterol that contains a lot of triglycerides so that triglyceride levels can decrease
Niacin , to limit the liver in producing VLDL and LDL
Omega-3 fatty acid supplements, to help lower triglyceride levels

Hypercholesterolemia Complications

If left untreated, hypercholesterolemia can lead to atherosclerosis, namely cholesterol buildup in the walls of blood vessels. The buildup will block blood flow and trigger complications, such as: