Hypercholesterolemia: Causes, Risk Factors and Treatment

1. Hypercholesterolemia: what is it?

If the concentration of cholesterol in the blood is too high, it is called hypercholesterolemia. “hyper” means “too much” and “emia” stands for “blood”. Cholesterol is a fat-like substance and hypercholesterolemia is therefore a lipid metabolism disorder.

Too much cholesterol is unhealthy, but cholesterol is not inherently bad. Our body even needs a sufficient amount of cholesterol to survive. It is needed, for example, for the formation of cell walls or for the production of certain hormones and vitamins. The liver is able to produce cholesterol on its own. If additional cholesterol is obtained from food, the cholesterol production in the liver is normally reduced in return. However, this control mechanism only works to a limited extent and does not work equally well in all people, so it is possible for cholesterol levels in the blood to rise.

However, cholesterol is not all the same. There are different types of cholesterol. To be transported in the blood, the cholesterol has to connect to a water-soluble transport substance. This creates the so-called lipoproteins. The low density lipoprotein (LDL cholesterol), for example, is commonly referred to as “bad” cholesterol because it has a very high fat content. High-density lipoprotein (HDL cholesterol), on the other hand, is known as “good” cholesterol because it has a much lower fat content and also helps transport excess fat from the blood to the liver, where it can be broken down.

2. Causes and risk factors

Hypercholesterolemia can have various causes and often several factors add up. One third of hypercholesterolemia is inherited, the other two thirds are the result of lifestyle and comorbidities. In particular, a diet that is too high in fat contributes to the development of hypercholesterolemia. But other diseases, such as diabetes or diseases of the thyroid gland, as well as some medications, can increase the cholesterol level in the blood too.

3. Symptoms

Hypercholesterolemia alone does not cause symptoms. This is why it is often discovered late or not discovered at all. However, since high cholesterol levels can cause serious secondary diseases, it is important in many cases to treat the high levels, even if they do not cause any symptoms.

4. Secondary illnesses

High cholesterol alone is not an illness. However, it contributes to what is known as vascular calcification or atherosclerosis in the long term. In particular, if the vessel walls have already been damaged from the inside, for example from smoking or diabetes, the excess cholesterol from the blood can settle on the vessel walls and form so-called plaques. This constricts the vessels and there is also the risk that a plaque will break off and occlude a blood vessel. Therefore, hypercholesterolemia is a risk factor for cardiovascular diseases.

There are many different risk factors, and the more they sum up, the higher the risk. The personal risk must be determined individually, ideally together with the doctor. On this basis, a strategy and therapy should then be developed to reduce the risk of consequential damage as much as possible.

Risk factors for cardiovascular disease include among others:

Increasing age
Male gender
Smoking
Obesity
Unhealthy diet
Little physical activity
High blood pressure
Hypercholesterolemia
Diabetes mellitus (Type 2)
Family predisposition

5. Examinations

Cholesterol values are usually measured by taking a blood sample. The total cholesterol level and the various types of cholesterol (e.g. LDL cholesterol and HDL cholesterol) are determined among other things. Sometimes it can be useful to also examine other fat values in order to be able to evaluate the fat metabolism even better.

6. Normal values

It is not easy to define normal values for cholesterol. It has been shown that the higher the cholesterol, the higher the risk of cardiovascular disease and vice versa. It can therefore make sense to speak of target values instead of normal values. The personal treatment target should be discussed with a doctor and depends on the individual risk for cardiovascular diseases. In simple terms, it can be said that the higher the individual risk, the lower the cholesterol should be.

7. Treatment

The treatment of hypercholesterolemia is less about lowering the cholesterol level itself and more about lowering the risk of damage to the cardiovascular system.

Not everyone with high cholesterol needs to take medication. On the one hand, cholesterol levels can also be lowered by changing lifestyle habits; on the other hand, the decision to pursue therapy or not depends on the individual risk of secondary damage and on the cholesterol levels. The most popular cholesterol-lowering drugs are statins. They lower the LDL cholesterol by inhibiting the production of cholesterol in the liver and also have a positive effect on the blood vessels. There are also several other drugs that lower cholesterol in different ways. They are sometimes prescribed in addition to statins and sometimes instead of them. Which drug or which drug combination is best should be discussed individually with the doctor.

Regardless of drug therapy, general measures to reduce the cardiovascular risk are strongly recommended. These include quitting smoking, losing weight if overweight, exercising and eating healthily.

According to current studies, the decisive factor in nutrition seems to be less the absolute amount of dietary fats or the amount of cholesterol contained in the food, but rather the quality of the fats. For example, it is important to eat as few saturated fatty acids as possible and instead eat more unsaturated fats. Saturated fats are considered “bad” fats and are mainly contained in animal products such as meat and sausage. Unsaturated fats are considered “good” fats and are found in fish, nuts and avocados, for example. The so-called Mediterranean diet with olive oil, fish and lots of fresh fruit, vegetables and salads and as little meat and animal fats as possible can help, for example, to lower the cholesterol level.