What is hypercholesterolemia?

Causes and Symptoms

In the recent past, it has been difficult for medical professionals to establish a clear, causal connection between high cholesterol
in the blood and heart
disease. After numerous studies involving large numbers of patients over extended periods of time was it possible to establish the now widely accepted statistical correlation between high cholesterol and cardiovascular problems. Cholesterol is a fatty material similar to animal fats, which are called lipids. In the bloodstream, cholesterol lipids combine with proteins to form either a low-density lipoprotein (LDL) or high-density lipoprotein (HDL). LDL transports cholesterol from the liver and intestines to other parts of the body where it is needed. HDL transports excess cholesterol back to the liver where it is metabolized and excreted. HDL prevents excess fat from being deposited on the walls of arteries and therefore is commonly called the “good” cholesterol. Research has established that LDL in blood should be less than 200 milligrams per deciliter, whereas HDL should be greater than 50 milligrams per deciliter, with a ratio of LDL to HDL of preferably four or less. A person is not aware of having high cholesterol. If the condition is not treated, however, then the likelihood of plaque buildup on artery walls and a possible blockage, which could then cause a stroke or heart attack, is increased.

Treatment and Therapy

The first step to reduce excess cholesterol in the bloodstream is a change in diet. As a general guideline, the consumption of vegetables, fruits, and grains should be increased, while red meat, egg yolks, and high-fat dairy products should be decreased. Vegetable oils made from corn, olives, or soybeans, which are low in saturated fats, are preferable to butter and animal fats. The next step is to increase physical exercise, which generally raises HDL, the good cholesterol. Several prescription medications, such as the statins Zocor or Lipitor and nicotinic acid medication such as nicolar and niaspan have been shown to be effective in lowering LDL. A physician needs to monitor a patient’s liver function to verify that no harmful side effects are occurring.

Perspective and Prospects

The 1985 Nobel Prize in Physiology or Medicine was awarded to Michael S. Brown and Joseph L. Goldstein for their study of cell-surface receptors that control the entry of LDL into cells. They showed that some people have a deficiency of these receptors. As a result, LDL does not enter cells at the normal rate but continues to circulate in the bloodstream, where it then can adhere to artery walls. In the future, it may be possible to produce drugs that stimulate the body to make more LDL receptors, which would remove excess LDL from the bloodstream.

Bibliography

American Medical Association. American Medical Association Family Medical Guide. 4th rev. ed. Hoboken, N.J.: John Wiley & Sons, 2004.

Antman, Elliott M., and Marc S. Sabatine, eds. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. Philadelphia: Elsevier/Saunders, 2013.

Cooper, Kenneth H. Controlling Cholesterol the Natural Way. New York: Bantam Books, 1999.

Estren, Mark James. Statins: Miracle or Mistake? Berkeley, Calif.: Ronin Publishing, 2013.

Kowalski, Robert E. The New Eight-Week Cholesterol Cure. New York: Harper & Row, 2006.

Randall, Brian. "High Cholesterol." Health Library, March 22, 2013.