Contents
Increased LDL cholesterol affects every second Pole [1]. Long-term hypercholesterolaemia is the main factor in the development of cardiovascular diseases, and these in turn are responsible for 43,3 percent. deaths in Poland [2]. What are the risk factors for cardiovascular disease? Why do patients rarely follow their doctor’s instructions?
Continuum of pathology of the cardiovascular system
Heart failure is a condition that develops gradually in the body, initially without any specific symptoms. However, it is worth remembering that for pathological changes in the cardiovascular system to occur, and consequently the occurrence of an episode of infarction, stroke or peripheral vascular diseases, the vascular endothelium must be damaged [3]. It is a natural anatomical barrier that ensures the integrity of blood vessels, conditions the physiological blood flow and maintains the optimal tension of the vessel walls [3]. Its dysfunction is the first rung of the pathological continuum of the cardiovascular system. High level of LDL cholesterol (low-density lipoprotein), i.e. bad cholesterol that persists for a long time inhibits the vascular endothelial function, which in turn leads to the development of arterial hypertension, hypertrophy of the heart muscle (within the ventricles), heart failure, and in extreme cases even death [3].
Hypercholesterolaemia, the “invisible” enemy
High LDL cholesterol does not cause pain or any other symptoms, and therefore does not “force” the patient to check-ups or see a doctor. Very often, elevated LDL cholesterol is detected only when a heart attack or stroke occurs [1], that is, when it is too late to implement prevention.
Hypercholesterolaemia may be primary or secondary. The appearance of the former is genetic, while the latter is associated with the long-term use of certain medications or may be a symptom of other diseases [4].
The problem is more serious than it might initially seem. According to statistics, the increased level of total cholesterol (> 190 mg / dl) affects approx. 67 percent. Poles (18 million people between 18 and 79). From this group, as much as 60 percent. people are not aware of their health condition [5]. It is related to the reluctance to perform simple tests to assess the concentration of LDL cholesterol, ie the lipid profile [6]. As it turns out, only 6 percent. the patients were aware of their disease and applied treatment that allowed them to achieve the target lipid profile [7].
Cardiovascular risk factors
The vast majority of factors leading to the development of hypercholesterolaemia and, consequently, to cardiovascular diseases, can be modified. They include, among others:
- smoking tobacco,
- diabetes,
- obesity,
- hypertension,
- lack of or low physical activity,
- psychosocial factors [8].
By modifying the lifestyle (more frequent preventive examinations, changing the diet to an easily digestible one, with a lower glycemic index, with a lower content of saturated fatty acids and systematic physical activity), it is possible to both prevent hypercholesterolemia and reduce the level of LDL cholesterol, and thus reduce the risk cardiovascular diseases. However, it should be remembered that if the modification does not bring significant changes to the lipid profile, there is effective pharmacotherapy in this area [8].
In the case of primary or familial hypercholesterolaemia (1 in 250 patients), the cause of a mutation in a gene encoding a specific protein is not subject to any modification. In such situations, the only solution is a quick diagnosis in all members of the immediate family and the implementation of pharmacological treatment [9].
Patients still do not follow the doctors’ recommendations
Preventive behavior and frequent diagnostic tests allow for early detection of the problem of hypercholesterolaemia and medical intervention. The test that will assess the level of total cholesterol, LDL and HDL fractions, as well as triglycerides is the lipid profile. The biological material is blood taken from the cephalic vein. The examination is recommended mainly for men over 40, as well as for women over 50 and after the menopause [7]. It is worth adding, however, that hypercholesterolaemia may appear at any age, regardless of gender.
For years, experts have emphasized the fact that Poles have a big problem with cholesterol. This is believed to be related to the fact that high LDL cholesterol is asymptomatic and may develop “quietly” for many years [10]. It turns out, however, that the problem does not only concern the diagnosis itself, but also compliance with doctors’ recommendations. Meanwhile, long-term therapy will avoid the development of heart attacks or strokes [10].
PL2110290406