Every second of us suffers from it, more than half of which do not know about it. Hypercholesterolemia, or the silent killer of the XNUMXst century. We discussed the problem of high cholesterol among Poles with prof. dr hab. n. med. Piotr Jankowski, professor at the Medical Center of Postgraduate Education, Head of the Department of Internal Diseases and Gerontocardiology, as well as the Department of Epidemiology and Health Promotion at CMKP.
Medonet: High cholesterol, what is it? Are the norms different depending on age and gender? What is the difference between the LDL and HDL fractions?
prof. dr hab. n.med. Piotr Jankowski: When we get a cholesterol test result, we tend to pay attention only to the determination of total cholesterol in the blood. We used this parameter in the 4th century, but now, in the XNUMXst century, we already know that the knowledge of total cholesterol is not sufficient. The concentration of individual fractions of this parameter is important. The full lipid profile consists of XNUMX parameters: total cholesterol, LDL and HDL fractions, as well as triglycerides.
HDL cholesterol is called good cholesterol and LDL is bad cholesterol. This is, of course, a simplification. We now know that too much HDL does not fully protect against heart disease. Certainly, however, too high LDL cholesterol is closely related to the risk of developing atherosclerosis and its complications, such as heart attack, stroke, heart failure, coronary artery disease, and even the patient’s death.
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We talked about an increased total cholesterol concentration in the blood when it reached the value of 5 mmol / L, which is equal to 190 mg / dL, which is referred to as hypercholesterolaemia. However, it is worth remembering that we are currently focusing more on the value of the LDL fraction. The criteria for its evaluation are similar for women and men and do not depend on age. However, they differ depending on whether or not there is atherosclerosis.
In addition, it is also important whether there are other risk factors for heart and vascular disease, diabetes and whether the patient has a history of stroke or heart attack. In people without these risk factors, genetic burden, LDL cholesterol norms are below 3 mmol / l, or 115 mg / dl. In patients with single risk factors, e.g. hypertension, the norm is below 2,5 mmol / l, i.e. 100 mg / dl. On the other hand, in patients with numerous risk factors, especially with diabetes, the normal concentration of LDL cholesterol is below 1,8 mmol / l, which is equal to 70 mg / dl. The most difficult situation concerns patients after a heart attack or stroke. In such cases, the norms are 1,4 mmol / l, or 55 mg / dl.
What factors contribute to elevated LDL cholesterol?
There can be a lot of these factors. The non-modifiable factors include, first of all, genes. In some cases, we can diagnose familial hypercholesterolaemia. It is a disease caused by mutations in genes for proteins, enzymes, and substances that are involved in the production of cholesterol. And if there is an excessive production of it in the liver, there is a very high risk of developing atherosclerosis and all its complications.
In some cases of family history, however, cholesterol levels may not be as high. The modifiable factors, in turn, include, first of all, lifestyle. It is mainly an inadequate, unhealthy diet (low in vegetables and fruits, rich in saturated animal fats, simple carbohydrates, i.e. sugars, thick sauces, butter, lard, lard), lack of regular physical activity, overweight and obesity.
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Sugar vs. cholesterol. Is there a dependency?
If we consume large amounts of simple sugars, e.g. in products containing a lot of sucrose or glucose, we promote the increase of triglycerides and cholesterol. In this way, the risk of developing atherosclerosis and its complications increases, independently of the increased risk of developing diabetes. And we know that diabetes also leads to heart and vascular disease. On the other hand, consumption of complex sugars, present in e.g. in pasta and bread is not so closely related to cholesterol levels and the probability of developing heart and vascular diseases. Obviously, consuming excessive amounts poses this risk.
What changes in our body does high LDL cholesterol cause?
Cholesterol-containing lipids build up in the walls of the arteries and cause plaque to form, narrowing the lumen of the arteries. If there is a tight narrowing of the vessel, you may develop chest pain, which is one of the symptoms of coronary artery disease. Its closing may cause a heart attack. If the disease affects the blood supply to the brain, then it may be a stroke. When atherosclerotic plaques are located in the vessels of the lower extremities, the patient may experience pain in the muscles and legs during exercise.
What percentage of Poles have a problem with high cholesterol and where does it come from?
Hypercholesterolemia is found in about 60% of people. adult Poles. In people in the third, fourth and fifth decade of life, the prevalence of excessively high cholesterol increases and reaches about 40%. – 60 percent Unfortunately, from the sixth decade of life, this frequency is already 80%. This tendency to increase LDL cholesterol with age is related to, inter alia, with decreased levels of physical activity, unhealthy food choices, and an increased incidence of obesity (as we get fat with age). At the same time, epidemiological studies show that approx. 60 percent. People with hypercholesterolaemia are unaware that their cholesterol levels are too high. That is why it is so important to check if this disease does not concern us.
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Is high cholesterol the same as hypercholesterolaemia? Can this trend be inherited?
It is not quite the same. Hypercholesterolaemia is a disease. Nevertheless, it is possible to have hypercholesterolaemia well treated and then cholesterol levels are lowered. As a result of changing eating habits, weight loss, implementation of physical activity and finally pharmacological measures. Then the cholesterol concentration is under control.
Of course, we can inherit hypercholesterolaemia genetically. However, inheriting habits and lifestyle is a much bigger problem. If parents lead exclusively or mostly sedentary lives, spend most of their time watching TV, eat unhealthily, eat too little vegetables and fruit, and eat fatty foods, their children most often follow this pattern. This increases the risk of not only hypercholesterolaemia, but also all complications. To sum up – yes, we can inherit the disease, but in the latter case I have described, we have influence on it and we can change it.
What diseases are caused by hypercholesterolaemia? Who is most at risk?
It all depends on where the vessel stenosis is located, i.e. where the atherosclerosis is located. Most often it occurs in the arteries that supply blood to the heart and is without doubt the most serious complication. This leads to coronary heart disease, heart attack and organ failure. Its location in the carotid or intracranial arteries that supply the brain can cause a stroke. On the other hand, if atherosclerotic plaques are found in the arteries supplying the lower limbs, the symptom may be intermittent claudication. If in the kidneys, then kidney failure, hypertension and other diseases.
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Can we prevent the disease?
Yes. Thanks to simple rules that are not always easy to implement. We are talking about a diet – the diet should be based on a large amount of vegetables and fruits, if the products of animal origin are lean meat and low-fat dairy products. The second way is, of course, regular physical activity, i.e. daily or almost daily. Even 20-30 minutes a day, but so that it leads to moderate fatigue. I emphasize that regularity matters. A healthy diet and regular physical activity can help prevent obesity. Avoidance of tobacco smoke should also be mentioned.
What if my test result shows too high LDL cholesterol? Does medicine have effective treatment methods?
The first thing you should do is introduce a healthy lifestyle. Each of us can do it right away. Regardless of this, it is worth consulting a doctor. It is also worth remembering about using reliable sources of information on the Internet. Unfortunately, the risk of encountering unreliable materials, not confirmed by scientific research, is very high.
- You can do a home test to determine your cholesterol levels. You will need the MultiSure GC Capillary Cholesterol Device, which you can order at an attractive price on Medonet Market.
Depending on the level of elevated cholesterol, age, presence or not of other diseases, the doctor may recommend either relying solely on a healthy lifestyle or using pharmacological measures. We currently have several types of drugs that are effective, safe and well tolerated by patients. Sometimes more than one drug is required. However, it is important to follow your doctor’s instructions closely. Do not stop treatment on your own. Regardless of the choice of treatment method, the risk of developing complications of hypercholesterolaemia, including cardiovascular disease, is significantly reduced. This is confirmed by many clinical studies.
What is the importance of monitoring LDL cholesterol in patients with a history of cardiovascular incident like heart attack or stroke?
After the implementation of any treatment, we control the concentration of LDL cholesterol as standard. If it is lowered to the expected level, the next inspection should take place in a year. However, if it is not, the treatment must be intensified and after about 2 months, the parameter should be re-monitored. In completely healthy patients with normal cholesterol levels, it is worth checking cholesterol levels in a year or in 3-5 years.
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Why is physician-patient collaboration critical to obtain the desired LDL cholesterol result?
prof. dr hab. n.med. Piotr Jankowski: The doctor-patient cooperation may involve both a simple lifestyle change and the regular use of medications. If the patient does not follow the doctor’s instructions, the treatment will not bring the expected results. If the doctor prescribes the drug and we do not buy it or we buy it, but we do not take it, neither the LDL cholesterol level will be lowered, nor the risk of complications (stroke, heart attack, disability) will not decrease. That is why it is so important that doctors have enough time for patients to be able to provide patients with relevant information and clarify any doubts.
Does the KOS-Zawał program, the purpose of which is to improve the quality and effectiveness of care for patients after myocardial infarction, also take into account the management of patients with hypercholesterolaemia?
In 2017, a system of coordinated care for patients after a heart attack (“KOS-Zawał”) was introduced in Poland. From among all implemented or announced systems of coordinated care, KOS-Zawał has been the most successful, improving the quality of medical care to the greatest extent. Patients treated under the KOS-Zawał system die less frequently and have to be re-hospitalized less often than patients without access to this program. However, it is worth emphasizing that the KOS-Zawał could be improved, work even better. For example, by enhancing the control of risk factors, especially hypercholesterolaemia. Too high cholesterol is especially dangerous for people after a heart attack.
The material was created in cooperation with Novartis
MLR ID: 173072
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