Hypercholesterolemia is a metabolic disease in which the cholesterol level in the blood is elevated. An elevated cholesterol level increases the risk of pathological changes in the blood vessels. A first measure is to switch to a low-fat diet and a healthy lifestyle. If this does not help, treatment can include medication known as statins.
You can find further information and selected hypercholesterolemia specialists here.
Cholesterol is a vital fat-like substance. It is involved in cell structure and in the synthesis of hormones, bile acids and vitamin D.
The body, or rather the liver and intestines, mainly produce the necessary cholesterol itself. To a much lesser extent, cholesterol also enters the body via (animal) food.
Elevated cholesterol levels in the blood are considered a risk factor for the development of pathological vascular changes. Excess cholesterol is deposited on the walls of blood vessels and is thus involved in the dangerous formation of plaque(atherosclerosis). Atherosclerosis causes the vessels to become increasingly narrow. This can lead to a heart attack or stroke.
A high cholesterol level is the result of a combination of different factors. In most cases, an unhealthy lifestyle is combined with genetic disorders of the cholesterol metabolism (hypercholesterolemia). An unhealthy lifestyle includes a poor diet and a lack of exercise.
With increasing age, the liver increasingly loses its ability to break down cholesterol. As a result, blood cholesterol levels rise steadily with increasing age.
Cholesterol-rich foods such as
have been thought to have a negative influence on cholesterol levels for decades. To prevent vascular disease, patients at risk should avoid these foods. It is also recommended to take cholesterol-lowering medication (statins) if the cholesterol level is above the guideline value.
However, the general validity of this guideline value of a maximum of 200 mg / dl cholesterol is disputed among experts. Whether there is a causal link between a diet high in cholesterol and the development of arteriosclerotic processes is also still being debated. Researchers are not even sure to what extent dietary habits influence cholesterol levels.
Regardless of this, cholesterol-lowering drugs top the list of top-selling preparations on the pharmaceutical market. The subject of cholesterol therefore not only affects medical and scientific interests, but also economic interests in particular.
Cholesterol ion is a water-insoluble substance. So that it can still be transported through the body by the blood, it is bound to various carrier proteins (lipoproteins).
The most important of these are HDL ("high density lipoprotein") and LDL ("low density lipoprotein"). LDL is responsible for transporting cholesterol to the target organs and tissues. Excess cholesterol is transported back to the liver by HDL, where it is broken down.
For this reason, doctors now believe that it is not so much the total cholesterol value that is of interest, but rather the ratio of LDL cholesterol (LDL-C) to HDL cholesterol (HDL-C).
Excessively high levels of LDL cholesterol are dangerous. If it is present in larger quantities than required, scavenger cells in the blood absorb the LDL-C and deposit it on the vessel walls.
Over a longer period of time, the vessels can become increasingly constricted and endanger the blood supply. There is then a risk of blockage of the coronary arteries(coronary heart disease). Painful angina pectoris attacks or even a heart attack can follow.
Too high a cholesterol level promotes the slow blockage of arteries © freshidea | AdobeStock
The higher the HDL-C value, on the other hand, the greater the protection against arteriosclerosis: HDL causes excess cholesterol to be broken down by the liver even if it has already been deposited on the vessel walls.
The target ratio of HDL to LDL-C is 1:2. If the ratio is less than 1:4, measures should be taken to lower the cholesterol level.
In addition to cholesterol, triglycerides (neutral fats) are also partly responsible for arteriosclerotic processes. They are the main component of the fats ingested with food and are stored as energy stores in body depots. They are also transported by LDL.
Excess triglycerides accumulate in the LDL complexes and make them even more dangerous for the vascular walls.
As a rule, a high cholesterol level and incipient arteriosclerosis do not yet cause any symptoms.
You should therefore take advantage of the preventive check-ups offered by the statutory health insurance companies from the age of 35. Blood lipid levels are determined in the laboratory. However, it is not advisable to interpret general guideline values too strictly.
Blood cholesterol levels above 200 mg / dl are also acceptable without the simultaneous presence of other risk factors such as
do not require treatment from the outset. The doctor decides whether the measured blood lipid values should be lowered or not. He or she must always take the patient's overall individual situation into account.
To treat dangerously high blood lipid levels, it is first of all important to eliminate or reduce the risk factors. This means in particular
In addition, sufficient exercise always has a positive effect on the HDL-LDL ratio. These measures alone almost always reduce the cholesterol level quite a bit "by themselves".
Drug therapy may be necessary if
However, the therapy must always be based on a consistent change in diet and weight reduction.
The most effective drugs for lowering cholesterol levels are cholesterol synthesis enzyme inhibitors (statins). They switch off a specific enzyme required for cholesterol production in the liver. Statins reduce LDLC and triglyceride levels and increase HDL-C levels.
Statins are controversial in terms of their preventive effectiveness against heart attacks. One reason for this is their rare but serious side effects. In addition, statin therapy is expensive and must be continued consistently for years.
Other frequently used groups of drugs are fibrates. They lower triglyceride levels and increase HDL-C levels. Substances that suppress the absorption of cholesterol in the intestine are also frequently prescribed. These include bile acid exchange resins and plant-based phytosterols.
Cholesterol absorption inhibitors (e.g. ezetemib) are a very effective new development. These substances also inhibit the absorption of cholesterol into the blood in the intestine. Their mode of action is still largely unclear. When used in combination with statins, they increase their effectiveness so that lower statin doses are sufficient.
Sometimes none of these drugs help to reduce extremely high cholesterol levels. In exceptional cases, blood washing (apharesis) is then necessary, in which the LDL-C is filtered out of the blood.
The most dangerous side effects of statins can be muscle pain or even pathological changes in the muscles (toxic myopathies). In their most severe form (rhabdomyolysis) they lead to
A few years ago, the Bayer product Lipobay had to be withdrawn from the market for this reason.
The risk of myopathic side effects also increases with the cholesterol-lowering potency of the preparations and their dosage.
As cholesterol plays a decisive role in fetal development, pregnant women must not take statins.
Statins, like other cholesterol-lowering drugs, can also cause a whole range of other side effects such as
skin reactions. The individual drugs are tolerated differently from person to person. These rather moderate side effects can be eliminated in individual cases by switching to substitute preparations.
A balanced diet is anything but wrong - and not just when it comes to preventing vascular disease. Fats should not be avoided completely. However, they should not make up more than 30 percent of your diet.
An excess of saturated fatty acids (animal fats) has a negative effect on cholesterol levels (lowers HDL, increases LDL). Vegetable fats are better. These include
However, even these oils should not be used excessively, as they are very high in calories and therefore promote the development of obesity.
The following foods contain high amounts of cholesterol:
They should be avoided if you have poor blood lipid levels or risk factors. The daily intake of cholesterol from food should not exceed 300 mg.
To summarize the most important elements of a "heart-healthy" diet:
Although diet is very important, it is ultimately only one of several building blocks in the prevention of cardiovascular disease. It must be embedded in a comprehensive concept of a healthy lifestyle.
Above all, this includes developing body awareness. This enables you to recognize how it is not only good for you in the long term, but also immediately,
