Lipid metabolism disorders / cholesterolLipid metabolism disorders / cholesterol

High cholesterol – a risk of heart attack and stroke

LDL cholesterol is deposited in the wall of blood vessels and the resulting plaques can narrow or even block the vessels. The possible consequences are heart attacks and stroke. Some people have a so-called Familial Hypercholesterolemia, which leads to high cholesterol levels in childhood and promotes premature atherosclerosis. An increased lipoprotein (a) value also results in a higher risk of vascular complications. The level of this blood value is genetically determined and cannot (yet) be significantly influenced with drugs. However, everyone should know his/her lipoprotein (a) level. If it is too high, LDL cholesterol must be significantly lowered.

Treating Hypercholesterolemia – But how?

The first step in the treatment of hypercholesterolemia is to change your diet by avoiding saturated (animal) fats and increasing the intake of mono- (olive oil) or poly- (omega 3) unsaturated fatty acids. This corresponds to a Mediterranean diet with little meat, lots of fish, vegetables, fruits and salad. Most of the time, changing your diet is not enough to reduce high cholesterol levels. 85% of the circulating cholesterol in the blood is made in the liver and is not sufficiently broken down in people with hypercholesterolemia.

Medicines to lower cholesterol and blood lipids

Statins are most effective for treating hypercholesterolemia. They reduce the production of cholesterol in the liver and promote breakdown of cholesterol. Rarely do they result in muscle pain that typically occurs in the upper arms and thighs. Statins, especially the highly potent ones like atorvastatin and rosuvastatin, have been shown to be effective in reducing the risk of heart attack, stroke and cardiac death. If statins are not tolerated or if the effect is insufficient, ezetimibe, which reduces the absorption of cholesterol from the intestine, can be prescribed. There are also highly potent combinations of statins and ezetimibe. Finally, there are the new PSCK9 inhibitors, which, in addition to statins, further reduce LDL cholesterol very significantly. They are injected under the skin every 14 days or 6 months and have virtually no side effects. Since they are very expensive, they can only be prescribed by endocrinologists in Austria.

How low should my LDL cholesterol level be?

The upper target value for LDL cholesterol is to be set individually, depending on the risk and any events that have taken place, such as heart attacks or stroke. People with diabetes should definitely achieve an LDL cholesterol of less than 70 mg/dl, if atherosclerosis is already present, less than 55 mg/dl. There is no lower limit, the lower the better. And don’t be afraid: every cell produces the necessary cholesterol it needs, and babies have an LDL cholesterol between 20 and 50 mg/dl (and no atherosclerosis …)!

Triglycerides can also be increased, especially in the case of obesity, high alcohol consumption and genetic disposition. A change in lifestyle (diet, exercise, weight loss) is of major importance to lower triglycerides. In addition, so-called fibrates can be prescribed.