Condition Overview:
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Cholesterol is a waxy substance synthetized in the liver; it enters in many functions as:
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        · Build the structure of cell membrane.
        · Make hormones such as Testosterone and Estrogen
         · Has an important role in digestion.
         · Helps in producing vitamin D.
         · Bile synthesis

Cholesterol also comes from the food you eat, like eggs, meat, milk, and cheese.

When it comes to hyperlipidemia, it’s a medical condition due to the increase in one or more of the plasma lipids, including cholesterol, triglycerides, cholesterol esters, phospholipids, lipoproteins as low-density lipoproteins, very low-density lipoproteins, and the reduction of high-density lipoproteins.

There are two main classifications of hyperlipidemia: familial and acquired. The familial type comes from genes you inherit from your parents, the acquired is due to underlying factors such as medical conditions and poor lifestyle.

Hypercholesterolemia and hypertriglyceridemia are the major causes of serious medical conditions as Atherosclerosis, stroke, myocardial infarction and ischemic heart diseases.

Between 2017 and 2020, nearly 10% of adults aged20 years or older have Cholesterol level 240mg/dl or more.

Symptoms:
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Most people with Hyperlipidemia doesn’t show any signs or symptoms until the condition became worsen with complications as Heart attack or Stroke, these can occur when cholesterol plaque is built up in your arteries and causes occlusion in the flow of blood in the blood vessels.

You might notice:

         · Leg cramps
         · Pain in feet or toes
         · Chest pain
         · Difficulty in breathing
         · Trouble in speaking or confusion (first signs of stroke)
         · Weakness

When to see the doctor?

To book an appointment at Fakeeh University Hospital, you are kindly requested to visit the website https://fuh.okadoc.com/.

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Doctors recommend regularly checking your lipid profile every 5 years starting from age21 years if you don’t have any family history of Hypercholesterolemia, patients with high risk should check regularly as per the doctor’s recommendations.
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Diagnosis:
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       Lipid panel blood test which is done when you are fasting from 9 to 12 hours before the test, a healthy adult should have the following levels:

         1. Total Cholesterol: Less than 200 mg/dL.
         2. LDL: Less than 100 mg/dL is considered healthy, though between 100 and 129 mg/dL may be acceptable.
         3. HDL: This is good cholesterol as it helps get rid of excess bad cholesterol in the body. A reading higher than              60 mg/dL is considered ideal.
         4. Triglycerides: Less than 200 mg/dL.
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The doctor may recommend further testing to determine any cardiovascular risks associated with the increase in cholesterol levels as Coronary Artery Calcium measurement (CAC).
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Risk Factors:

         ·       Smoking
         ·       Sedentary lifestyle
         ·       Family history of high cholesterol
         ·       Obesity
         ·       Poor diet habits and eating food with lots of fat.
         ·       Diabetes
         ·       The drop in estrogen that comes with menopause may increase the risk of bad cholesterol.
         ·       Kidney diseases
         ·       Polycystic Ovarian syndrome (PCOS).
         ·       Hypothyroidism
         ·       Fatty liver disease
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Complications
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         ·       Atherosclerosis: which is a process of arteries hardening due to deposition of cholesterol in the arterial wall                  which causes narrowing of the arteries.
         ·       Myocardial infarction: when blood and oxygen supplies are blocked in flowing in cardiac arteries results in                  damage of heart cells.
         ·       Angina
         ·       Heart attacks
         ·       Stroke: which is the fourth leading cause of death worldwide.
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Treatment Options:

         ·       HMG CO-A reductase inhibitors (Statins):this class includes, Atorvastatin, Pravastatin, Rosuvastatin, …
                 It can achieve marked decrease in cholesterol levels up to 20%-50%
                 Statins can cause myopathy and Rhabdomyolysis, it’s important to take Co-enzyme Q10 to prevent these                  symptoms.
         ·       Bile acid sequestrants: as Cholestyramine which helps to increase HDL levels.
         ·       Fibrates: as fenofibrate, it plays an important role in the reduction of coronary artery diseases
         ·       Niacin: Vitamin B derivative.
         ·       Ezetimibe: a combination of statins and Ezetimibe can achieve a reduction in LDL Levels of 25%.
         ·       Omega 3 fatty acid supplements.
         ·       Recent medications as Alirocumab (Praluent)which was approved in 2021 as an add-on treatment of                  Familial Hypercholesterolemia.


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Lifestyle and Selfcare:

Lifestyle changes are a key of managing Hyperlipidemia even if it’s inherited, also if you are taking medications, it can improve their effects.

         ·       Eat a heart healthy diet: which can lower LDL levels and improve HDL levels:
                          1. Avoid saturated and trans fats which are found in processed foods.
                          2. Choose monounsaturated fats like olive, avocado and canola oil.
                          3. Eat more omega-3 which comes from Walnuts, flaxseeds, Salmon and Mackerel.
                          4. Increase your fiber intake which is found in fruits, oats, bran and vegetables.
          ·       Maintain a healthy weight and opt for losing weight.
          ·       Get active: a goal of 150 minutes of physical activity per week is very important to improve your                   cholesterol levels.
          ·       Avoid smoking: smoking raises the risk of heart diseases and can raise the triglyceride levels, talk to your                   doctor about quitting, also you can consider the nicotine Patches or gums.

Patient support:

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‍References:

·       American Heart associationhttps://www.heart.org/en/health-topics/cholesterol/how-to-get-your-cholesterol-         tested

·       https://www.cdc.gov/genomics/disease/fh/talk_family.htm

·       N.I.C.E guidelines for the management of Hyperlipidemia.

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