High cholesterol is a common metabolic disorder in modern society, closely associated with the incidence of cardiovascular diseases. This metabolic abnormality primarily involves an imbalance in lipid concentrations in the blood, particularly the excessive accumulation of low-density lipoprotein cholesterol (LDL-C). According to medical research, long-term high cholesterol levels increase the risk of serious complications such as atherosclerosis, myocardial infarction, and stroke.
This article will comprehensively interpret the causes, diagnostic methods, and treatment strategies for high cholesterol, and discuss how lifestyle adjustments can prevent disease progression. Understanding this information helps the public establish correct health management concepts and seek timely medical attention when necessary.
The formation of high cholesterol is the result of the interaction of genetic, environmental, and behavioral factors. Among genetic factors, familial hypercholesterolemia is the most direct hereditary cause, where this genetic defect leads to the liver's inability to effectively metabolize LDL cholesterol in the blood. In terms of environmental factors, excessive intake of animal fats (such as red meat and full-fat dairy products) and refined sugars in modern dietary structures significantly raises the concentration of low-density lipoproteins in the blood.
Patients with familial hypercholesterolemia may experience abnormal LDL receptor function due to gene mutations, preventing the normal metabolism of low-density lipoprotein in the blood by the liver. This genetic predisposition can lead to patients having high cholesterol levels even when maintaining a healthy diet. Studies show that approximately 1 in 500 individuals carry such genetic defects, with severe cases potentially presenting clinical symptoms such as xanthomas during adolescence.
In modern dietary patterns, excessive intake of saturated fats (such as lard and butter) and trans fats (such as processed foods) directly increases LDL levels. A lack of regular exercise reduces the metabolic efficiency of high-density lipoprotein (HDL), while smoking damages endothelial function, exacerbating lipid metabolism disorders. Research indicates that individuals who sit for more than 8 hours a day have a 40% higher risk of lipid abnormalities compared to those who are sufficiently active.
Age and gender differences also affect cholesterol metabolism: the risk significantly increases for men after age 45 and for women after menopause. Additionally, patients with metabolic diseases such as diabetes and hypothyroidism have a 2-3 times higher likelihood of lipid metabolism disorders compared to the general population. Long-term use of medications such as steroids or antipsychotics may also induce lipid abnormalities.
The characteristic of high cholesterol is that it typically presents no obvious symptoms in the early stages, with patients often diagnosed only after experiencing cardiovascular events. However, extreme cases may exhibit xanthomas (fat deposits under the skin) or corneal arcs (gray contours around the eye's cornea), which are physical symptoms typically seen in patients with hereditary high cholesterol.
More than 80% of patients have no subjective symptoms at the time of diagnosis, making regular health check-ups particularly important. When cholesterol accumulates in the arterial walls over time, it may gradually obstruct blood vessels, leading to symptoms such as chest pain and shortness of breath, but these symptoms usually appear in the late stages of the disease.
When atherosclerosis progresses to critical blood vessels, symptoms such as angina, heart failure, or cerebral ischemia may occur. Peripheral artery disease may lead to leg pain, and during retinal examinations, small lipid deposits may be observed.
Diagnosing high cholesterol primarily relies on blood tests, which should be conducted after fasting for 12 hours for lipid analysis. Standard test items include total cholesterol, LDL-C, HDL-C, and triglyceride levels. According to the American Heart Association, adults over 20 should be screened every 4-6 years.
An LDL-C level exceeding 100 mg/dL is considered abnormal, while the ideal range should be below 70 mg/dL (for patients with existing cardiovascular diseases). An HDL-C level below 40 mg/dL increases risk, and a total cholesterol to HDL ratio exceeding 4:1 is also regarded as a poor indicator.
For patients with a family history, genetic testing may be necessary to confirm familial hypercholesterolemia. In terms of diagnosing children, if there is a family history of heart disease before age 50, screening is recommended between ages 9-11. Other potential causes, such as hypothyroidism or nephrotic syndrome, must be ruled out during diagnosis.
Treatment strategies typically combine medication and lifestyle adjustments, aiming to reduce LDL-C levels by 30-50%. Treatment plans should be tailored to the patient's age, risk level, and comorbidities, avoiding a "one-size-fits-all" treatment approach.
Statins (such as atorvastatin and rosuvastatin) are the first-line medications, which work by inhibiting cholesterol synthesis in the liver. PCSK9 inhibitors (such as evolocumab) are suitable for patients with insufficient response to statins, while niacin is used to regulate triglyceride levels. Emerging proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors require subcutaneous injection and are suitable for patients with hereditary high cholesterol.
Dietary control is the foundation of treatment, with recommendations to limit daily cholesterol intake to below 200 mg, replacing saturated fats with unsaturated fats (such as fish oil and olive oil). Regular aerobic exercise (such as brisk walking or swimming) can increase HDL-C levels, with at least 150 minutes of moderate-intensity exercise per week effectively improving lipid metabolism. Quitting smoking can reduce endothelial damage, indirectly improving the lipid metabolic environment.
Recent studies have shown that combining cholesterol absorption inhibitors (such as ezetimibe) with PCSK9 monoclonal antibody therapy can reduce LDL-C by more than 60%. The field of gene therapy is developing CRISPR technology to repair LDL receptor gene defects, which is currently in clinical trial stages. Medical teams will formulate individualized treatment plans based on the patient's age, comorbidities, and drug tolerance.
Prevention strategies should start from childhood, establishing healthy eating habits through dietary education. Adults should undergo lipid screening every 3-5 years, while high-risk groups (such as those who are obese or have diabetes) need annual checks. Lifestyle adjustments include:
Work stress and lack of sleep may disrupt lipid metabolism through cortisol secretion; it is recommended to alleviate stress through mindfulness meditation or yoga. Community health promotion activities should strengthen health check advocacy targeting middle-aged and elderly groups, especially high-risk populations with a family history.
Immediate medical attention should be sought in the following situations:
Even in the absence of symptoms, regular follow-up is necessary if you meet the following conditions: over age 40, BMI over 27, or a smoking habit. It is recommended to establish a long-term health follow-up plan with a family doctor.
If experiencing chest pain lasting more than 15 minutes, radiating pain to the left arm, or cold sweats, it may be a precursor to myocardial infarction, and immediate medical attention is required. Acute chest pain accompanied by difficulty breathing or dizziness needs to rule out acute coronary obstruction or other cardiovascular emergencies.
Simply avoiding all fats may not be effective; the key lies in choosing "good fats." It is recommended to reduce saturated fats (such as animal fats) and trans fats (such as processed snacks) while increasing sources of unsaturated fats, such as fish, nuts, and olive oil. Dietary adjustments should be combined with overall calorie control to truly improve lipid indicators.
High-density lipoprotein (HDL) is known as "good cholesterol"; how does it affect heart health?HDL can transport excess cholesterol from the blood vessels back to the liver for metabolism, reducing the risk of atherosclerosis. Maintaining HDL levels within the ideal range (at least 1.0 mmol/L for men and 1.3 mmol/L for women) helps alleviate cardiovascular burden, and exercise and quitting smoking can increase HDL levels.
Can patients with familial hypercholesterolemia improve without medication?Even with a genetic predisposition, lifestyle adjustments still play a crucial role. A low-fat diet, regular exercise, and quitting smoking can enhance the efficacy of medications and reduce the risk of cardiovascular damage. Some patients may require genetic testing to develop a more precise treatment plan.
How should the frequency of cholesterol checks be determined?The ideal check-up interval depends on individual risk: those over 40 or with diabetes or hypertension should be checked annually; low-risk individuals should be screened every 3-5 years. If already receiving medication treatment, follow-up lipid indicators should be monitored every 3-6 months as per medical advice to assess drug response and treatment effectiveness.
Are plant sterol supplements suitable for all high cholesterol patients?Plant sterols can hinder cholesterol absorption and may be beneficial for some individuals, but they are not recommended for those with liver dysfunction or those taking fat-soluble medications. The daily intake should not exceed 2-3 grams and should be spaced out from medication intake by several hours to avoid affecting drug absorption.
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