AUTHOR: Benjamin Heisler
What is Cholesterol and why is it important?
Cholesterol is a lipid (fatty) molecule that is found in the blood and cells of animals. It is an important molecule for making up the membranes, or lining, of our body's cells and it is used by the body to make bile salts and steroid hormones such as testosterone and estrogen.
What causes high Cholesterol?
Some forms of high cholesterol run in families and are inherited. These conditions are called inherited hyperlipidemias and there are several types of them.
What are the symptoms of elevated Cholesterol?
There are very few symptoms of elevated (high) cholesterol. Some people can develop xanthalomas which are small, yellowy lumps that are seen on the eyelids and over tendons. Other people can develop a pale arc or circle around the iris of the eye.
Diagnosis and tests for elevated Cholesterol
Testing for high cholesterol is done with a simple blood test called a serum lipid profile. Iin order to do this test, you usually have to be fasting before midnight and have the test done in the morning. Your doctor will usually give you an order sheet for the test which will typically have the instructions for the test on it.
Lifestyle modification for elevated Cholesterol
Cholesterol is found in fatty meats and processed foods. Limiting intake of these is of utmost importance. Cholesterol is also found in eggs, which in moderation can be good for you.
Non-surgical and medical management for elevated Cholesterol
There are a number of medications that are being used to treat high cholesterol. Statins such as Lipitor (atorvastatin), Zocor (simvastatin) and Crestor (rosuvastatin), just to name a few, are probably the most commonly prescribed drugs for this. They will reduce LDL, elevate HDL and have been shown to reduce the risk of heart attack and stroke in certain circumstances. Fibrates such as Lipidil, vitamins such as Niacin and agents that block the bowel from absorbing cholesterol from food are also sometimes prescribed. There are a number of herbal and alternative remedies out there as well and if you use these you should let your doctor know as some do not react well with precriptions.
Guidelines for Intervention for elevated Cholesterol
Numerous physician groups have come out with guidelines for treating high cholesterol levels. The American Heart Association and the Canadian Cardiology Association have similar "target levels" for treating LDL and cholesterol ratios depending upon what a person's risk level is for a heart attack or stroke over the next few years. For example, for someone who has trouble walking due to peripheral arterial disease, the targets for therapy would be an LDL level less than 2 mmol/L and a cholesterol level of less than 4.
Surgical treatment for elevated Cholesterol
Endovascular Treatment for Cholesterol
When should I see my doctor?
Certainly, if you have a family history or hyperlipidemia or a family history of early heart disease, stroke of peripheral arterial disease (PAD), you should consider consulting your doctor who will likely order a lipid profile test. Similarly, a screening test might be orderred by your doctor once you have turned 40 if you are a male and 50 if you are a female. If you have ever had a heart attack, angina, stroke, aneurysm or trouble walking due to PAD, your doctor will also likely order a lipid profile.
References and Resources
Canadian Heart and Stroke
The benefits of a tobacco free life are felt quickly. Here's a resource for smoking cessation.
CSVS Guidelines for Abdominal Aortic Aneurysm screening
“The 2018 CSVS guidelines suggest all men 65-80 and all women who have smoked or have heart disease and are between the ages of 65-80 should have an abdominal ultrasound (US) to rule out an abdominal aortic aneurysm (AAA).
Those older than 80 can be considered for screening, but it is important to talk to your doctor. Speak to your primary care physician or vascular surgeon to ensure you have been screened.