Cholesterol is essential for human life. It plays a structural as well as a functional role in our body. It is one of the major components of the cell membrane and helps to maintain the structure of the cell.

Cholesterol is essential for the production of steroids hormone (androgen, cortisol, and sex hormones). Cholesterol is used by the gallbladder for the production of bile salt that is helpful in the absorption of lipid-soluble vitamins like vitamin A, D, E, and K.

Cholesterol is lipophilic, and it traveled through blood in the form of HDL, VDL, IDL, and LDL.

Despite all these important functions of cholesterol, a high level of choke in the blood can cause serious problems. When the cholesterol level increase in the blood it can cause serious problems related to the heart and the blood vessels

According to Diseases Control and Prevention Center, in America, about 37.1% of adults have high levels of LDL-C. An overall elevated level of cholesterol is more common in females than males.

What Are the Symptoms of High Cholesterol in Blood?

There are no specific signs and symptoms of high cholesterol in blood but prolonged high levels of cholesterol can cause conditions that can show symptoms.

High cholesterol in the blood can be one of the reasons for angina and other heart-related complications.

A high level of cholesterol can also cause vessels related conditions like atherosclerosis and arteriosclerosis which can result in high blood pressure.

So high cholesterol levels do not have their signs and symptoms but symptoms related to other conditions due to high cholesterol can be shown by patients.

What Are the Causes of High Cholesterol in Blood?

A high level of cholesterol is considered when the LDL cholesterol level is greater than 190mg/dL, greater than 140mf/dL with one risk factor, and greater than 130mg/dL with two risk factors.

The high level of cholesterol occurs either due to genetic factors or due to acquired factors.

Genetic Cause:

High cholesterol level due to genetic cause is called familial hypercholesterolemia. Familial hypercholesterolemia occurs due to mutation in the LDL receptor coding gene.  

If a mutation is heterozygous then cholesterol level would be greater than 190mg/dL and if the mutation is homozygous the high level of cholesterol can be above 450mg/dL.

1. Mutations in Functional Activity of LDL receptor:

Familial hypercholesterolemia can also be caused due to mutation in genes that controls the function of LDL receptor. Due to a reduction in the functional activity of the LDL receptor, the clearance rate of LDL cholesterol for blood will reduce.

About 1600 plus mutation has been reported in familial hypercholesterolemia. This increase in cholesterol level occurs due to a reduction in clearance of LDL cholesterol from the blood and increase production of cholesterol.

• Mutation in Structure of LDL receptor:

Familial hypercholesterolemia can also occur due to a defect in the gene that encodes the LDL receptor. Due to defective LDL receptors, LDL cholesterol will not attach to the receptor, and there will be no clearance of LDL cholesterol from the blood. Due to decreased clearance LDL levels in plasma will increase.

• Other Genetic Conditions:

• Other genetic conditions that can cause familial hypercholesterolemia are the defect in apoprotein B results in less ligand binding to LDL receptor.
• Mutations in the gene encoding the protein convertase Kexin type 9(PCSK9) results in increase activity of the enzyme. Due to the increased activity of PCSK9, there is increased clearance of LDL receptor by binding it to lysozyme.

Due to the reduction in the number of LDL receptors, there will be an increase in LDL cholesterol in plasma and resulting in hypercholesterolemia.

All these mutations are transmitted in the form of autosomal dominant mode. Autosomal recessive mutations can also occur in rare cases. In autosomal recessive mutations there are changes in the LDL receptor adaptor protein. This mutation results in the endocytosis of LDL receptors.

Other causes of High levels of Cholesterole:

High levels of cholesterol in the blood can also occur due to other than genetic causes. Some of these are given below:

• Hypothyroidism
• Nephrotic syndrome
• Cholestasis
• Pregnancy
• And some drugs like cyclosporin, thiazide, Diuretics

What Are The Risk Factors of High level of Cholesterol:

There are various factors that can increase the chances of high cholesterol in the blood. These factors are:

1)     Poor Diet:

Eating unhealthy food can be one of the risk factors for high levels of cholesterol in the blood. Food rich in unsaturated fatty acids increases cholesterole levels.

• Lack of exercise:

Resting all day in bed can also increase cholesterol. Exercise burns the fat helps to decrease the body fat bit due to lack of exercise fats start to accumulate in the body and results in a high level of cholesterole.

• Obesity:

If your body mass index is more than 30 its means you are at the risk of young high cholesterol in the blood. Because high body mass index means there is excessive fat in your body.

• Smoking:

Smoking increases the level of bad cholesterole in the blood and lowers the good cholesterole level(HDL) in the blood.

• Alcohol:

Drinking too much alcohol increases the risk of having high cholesterol in the blood. Because alcohol increases the level of free cholesterole in blood plasma.

• Age:

Age can also be one of the risk factors of high cholesterole in the blood. As persons become old their ability to lower the bad cholesterole from the body decrease and as a result their bad cholesterole (LDL) level increase in the blood.

• Diabetes :

Diabetic patients are also at great risk of having high cholesterol levels in the blood.

What Are the Complications of High Cholesterole Level?

Complications occur due to the accumulation of cholesterole in the blood vessels. Due to accumulation blood flow to the vital organs decrease and causes severe complications. Some main complications are

• Coronary Artery Disease:

One of the most severe complications of the high level of cholesterol in the blood. This occurs due to high blood levels and the chances of having heart-related problems also increase.

When the level is high in blood it will cause the accumulation of cholesterol in blood vessels supplying blood to the heart.

With time due to continuous accumulation, plaque forms in the coronary artery and decreases the blood supply to the muscles of the heart.

As blood supply decreases it causes the necrosis of heart muscles. This necrotic cell death of heart muscles results in angina(chest pain) and heart attack.

• Stroke:

Stroke is a condition in which blood supply to the brain decreases and brain cells starts dying because brain cells are deprived of nutrients and oxygen.

High cholesterole levels in the blood can also be one of the causes of stroke. Hypercholesterolemia results in the deposition of cholesterole in the blood vessels that are supplying blood to the brain.

The lumen of blood vessels becomes narrow due to the deposition of cholesterole and the formation of cholesterole plaque and the supply of blood to the brain decrease.

As blood supply decreases, the supply of oxygen and other essential nutrients also decreases and brain cells start dying and stroke occurs.

• Peripheral Artery Diseases:

Peripheral artery disease occurs due to decrease blood flow to the peripheral areas of our body. High cholesterole is one of the main reasons for peripheral artery disease.

In this disease accumulation of cholesterole, droplets occur in blood vessels that are supplied to peripheral areas of the body other than the brain and heart.

• Type 2 Diabetes Mellitus:

In this type of diabetes, cells become resistant to insulin and high cholesterole in the blood is considered on the reasons due to which resistance develops.

• Hypertension:

An increase in blood pressure is called hypertension. Narrowing of blood vessels due to cholesterole deposition causes an increase in blood pressure.

When to See a Doctor?

When you notice any of the complications you must visit your doctor and have a screening of your blood to check the level of cholesterole

Diagnosis:

Cholesterol being hydrophobic in nature are transported in blood plasma after binding with special proteins called HDL and LDL.

HDL cholesterol is good because it carries cholesterol to your liver where it can be removed from the blood.

LDL cholesterol is bad cholesterol because it transports cholesterol directly to your bloodstream.

Hypercholesterolemia occurs due to a high concentration of LDL in the blood. So for the diagnosis of high cholesterol, LDL concentration is measured.

So for LDL concentration, the plasma lipid level of a person (10-12 hours overnight fasting ) is measured. The lipid count will give the value of total cholesterol level, TAGs, LDL, and HDL by applying the Friedewald Formula:

LDL-C = total cholesterol – VLDL (TAGs/5)- HDL-C

Friedewald formula is used only when the TAGs level doesn’t exceed 400mg/dL.

Normal values

Blood screening is only a test to diagnose the total cholesterol level in the blood.

Screening recommendation :

• Men older than 35
• Women older than 45
• Diabetic patients
• Tobacco users
• A person with family history of cardiac diseases
• Alcoholic person
• Patients of hypertension

What Are the Treatments of High levels?

High cholesterole is treated by medications and by adopting a healthy lifestyle.

The best way to treat is adopting a healthy lifestyle by maintaining optimum body weight, no smoking, exercising daily, eating a diet with lower saturated fatty acids, and eating vegetables and fruits enrich in fibers.

Cholesterol can also be managed by the medication recommended by the doctor on the basis of personal risk factors, age, and tolerance

1. Statins:

Statins block the substance used by the liver to produce cholesterol.

It is used by the liver for the production of bile acids. As liver cholesterol production is reduced by the statins liver will remove cholesteral from the blood to fulfill its requirement and blood cholesteral level will decrease.

Generic Drugs:

• Atorvastatin
• Fluvastatin
• Lovastatin
• Pravastatin

• Cholesterol Absorption Inhibitors:

Cholesterol present in our diet is absorbed in the intestine and enters the bloodstream.

These drugs inhibit the absorption of cholesterol from the intestine and lower the blood cholesterol level.

Generic Drugs:

• Ezetimibe

C.     Bempedoic Acid:

Bempedoic acid drugs have the same mechanism of action as statin but have a lesser number of side effects.

• Bile acid Binding Resins:

Cholesterol in the liver is used for bile acid production. These drugs bind with the bile acid in the intestine and prevent their reabsorption and lower the bile acid level.

This liver absorbs cholesterol from the blood and increases the production of bile acid.

Generic Drugs:

• Cholestyramine
• Colesevelam
• Colestipol

• PCSK9 Inhibitors:

PCSK9 protein breakdown the LDL receptors and decrease the absorption of LDL from the blood.

PCSK9 inhibitors inhibit the function of PCSK9 proteins and lower the blood cholesterol level

Generic Drugs:

• Alirocumab
• Evolocumab

Medications to Lower TAGs:

1. Fibrates:

Fibrates lower the TAGs level by lowering the production of VLDL by the liver.

Generic Drugs:

• Ticor
• Femoglide
• Gemfibrozil

1. Niacin:

Niacin inhibits lipase activity in the cell and lowers the free fatty acid level in the bloodstream.

What are The Home Remedies?

Cholesterole levels can also be lowered at home by changing lifestyles and eating healthy foods.

• Exercising daily to maintain optimum body weight
• Honey:  Use honey in the diet as it is rich in vitamins and minerals and helps us maintain cholesterole.
• Turmeric: Add turmeric to your diet. As it reduced the cholesterole plaque size that is deposited on the walls of blood vessels
• Garlic: Garlic contains a sulfur compound that helps to reduce cholesterole level
• Green tea.
• Fish with omega-3 fatty acids.
• Eating more soluble fiber: fruits, vegetables, oats, beans.

What Are the Preventive Measures of High cholesterol level?

Cholesterole levels can be reduced by changing lifestyles and eating healthy food. Some important preventive measures that can reduce the risk of having high cholesterole levels in the blood are:

• Eating heart-healthy foods like vegetables, fruits, reduced the saturated fats in your diet, eat foods rich in omega-3 fatty acids, including whey protein in your diet and increase soluble fibers
• Exercise daily to maintain optimum body weight and to burn the excessive fats
• Quit smoking
• Reduced the use of alcohol

Sometimes, after adopting a healthy lifestyle an increase in blood cholesterole level can occur due to pathological conditions. In that case, you must visit your doctor for proper medication.