Why is it important to know our cholesterol level?

High cholesterol (hyperlipidemia) is one of the most significant, yet modifiable risk factors in the development of cardiovascular diseases. High cholesterol is often symptomless, therefore it can only be detected through laboratory testing.

Here are the most important reasons why it is worth having it checked:

1. Hidden dangers (Lack of symptoms)
High cholesterol does not cause pain or visible symptoms until a more serious problem occurs. Meanwhile, excess cholesterol is deposited on the walls of the blood vessels, forming plaques, which leads to narrowing of the arteries and atherosclerosis.

2. Prevention of serious diseases
Knowing that your cholesterol level is high allows you to take steps to prevent the following life-threatening conditions:

• Heart attack
• Stroke (brain hemorrhage / cerebral infarction)
• Peripheral vascular diseases (narrowing of the arteries in the limbs)

3. Distinguishing the “types”

Not all cholesterol is bad. It is important to know the proportions:

• LDL (“bad” cholesterol): If too high, it is deposited in the arteries.
• HDL (“good” cholesterol): Transports excess cholesterol back to the liver, where it is broken down; higher levels have a protective effect.
• Triglycerides: Another type of blood fat, elevated levels of which are also risky.

4. Timely intervention
If you know that your level is high, you can reduce it before serious problems develop through lifestyle changes (diet, exercise) or with medical assistance.

When and How Often Should It Be Checked?

• From the age of 20: It is recommended every five years as part of a full blood test.
• From the age of 30: Annual screening is recommended.
• In the presence of risk factors: Smoking, diabetes, obesity, or a family history of heart disease require more frequent testing.

What can cause elevated cholesterol levels?

Elevated cholesterol levels may be caused by hereditary factors, acquired diseases, and unhealthy lifestyle.

A genetic factor may be an alteration in the proteins that make up lipoproteins, which can be one cause of increased cholesterol levels. If high cholesterol is common in your family and cardiovascular disease has occurred, you are more prone to developing diseases associated with high cholesterol.

During menopause, many individuals experience an increase in cholesterol levels even if they previously had no such problem and do not follow an unhealthy lifestyle.

In addition to hereditary factors, kidney and liver diseases, hypothyroidism, and diabetes may also cause elevated cholesterol levels. It may also develop as a side effect of certain medications taken for other illnesses.

Even without genetic factors or diseases, blood lipid levels may be high if a person follows a lifestyle characterized by little physical activity and excessive calorie intake. Contrary to popular belief, it is not a single specific food that should be avoided; rather, attention should generally be paid to healthy nutrition, regular exercise, and maintaining a normal body weight.

Since in predisposed individuals the formation of calcified plaques in the arteries begins already in young adulthood, and once formed these deposits are not reversible, it is worth establishing a proper lifestyle as early as possible.

Predisposing Factors

Have your cholesterol level checked more frequently if:

• there has been coronary artery disease in your family,
• others in your family also have high cholesterol levels,
• you have high blood pressure,
• you are in menopause or over 40 years of age,
• you have liver or kidney disease,
• you have diabetes or hypothyroidism,
• you are overweight, or
• you follow an unhealthy lifestyle.

If several of the above apply to you, you may belong to a higher-risk group.

Cholesterol should also be checked at a young age

Anyone who already has elevated blood lipid values (LDL, VLDL, total cholesterol, or triglycerides) at a young age definitely requires treatment. Over the years, the damage caused by the deposition of blood lipids in the artery walls accumulates.

Among individuals who already have elevated blood lipid values at a young age, the risk of developing cardiovascular diseases is much higher than among those whose blood lipid levels increase only in older age. However, it should be noted that even in the latter group the risk is higher than in those whose values are within the normal range.

It is important to clarify that HDL cholesterol is also part of the blood lipid values, but this is the so-called “good cholesterol,” which contributes to the protection of the artery walls by transporting the cholesterol present in the blood vessels back to the liver, where it is broken down. Consequently, if HDL cholesterol levels are low, the risk of atherosclerosis and cardiovascular diseases increases.

Therefore, when we refer to the harmful effects caused by elevated blood lipid levels, we mean elevated LDL, VLDL, total cholesterol, or triglycerides, not HDL cholesterol, since in the case of HDL it is an excessively low level that is harmful.

High cholesterol at a young age is particularly dangerous and can be compared to the harmful effects of smoking: the earlier it begins (the more cigarettes someone smokes over their lifetime), the greater the individual’s risk. The earlier high cholesterol develops, the earlier it begins to exert harmful effects on the artery walls. This is why early recognition and prompt appropriate treatment are so important.

Cholesterol testing in young people

Elevated cholesterol levels may also develop in young people. The critical value above 240 mg/dl (6.2 mmol/l) is present in 5% of those aged between 18 and 29, and in 14% of those between 30 and 40 years of age.

High cholesterol may be the result of an unhealthy lifestyle; however, in some individuals this is only one of the risk factors. Genetic causes are often present in the background, especially in those in whom it develops at a young age. High cholesterol in young people often goes unrecognized. Therefore, doctors recommend that young people also participate in screening, even if they appear completely healthy.

If an LDL cholesterol level above 190 mg/dl (4.9 mmol/l) is measured in a young person, the risk genes associated with this condition should be examined. Furthermore, first-degree relatives — parents, children, and siblings — should also undergo testing and, if necessary, receive treatment.

Treatment options for high cholesterol

Today, more and more new treatment options are available. Statins are generally used to reduce cholesterol levels, but these are not suitable for everyone. In such cases, there are other possibilities.

There are medications that prevent the cholesterol consumed with food from being absorbed through the intestinal wall. These medications work very well in some patients, less effectively in others.

The newest therapeutic option is the use of so-called PCSK9 inhibitors. As a result of their effect, the liver takes up more LDL cholesterol from the blood. The active substance is administered regularly in the form of an injection and may help patients in whom standard treatment methods have not achieved results.

If high cholesterol is inherited

Familial hypercholesterolemia is the result of a genetic defect. As a consequence, body cells are unable to properly absorb LDL cholesterol; LDL cholesterol molecules therefore continue to circulate in the blood and, after a while, are deposited on the inner surface of the artery walls.

The consequence may be atherosclerosis (arteriosclerosis), which may occur at an unusually young age in affected individuals, even if they are slim, exercise regularly, and eat healthily. They are threatened by heart attack and stroke already at a young age.

There are also young people whose cholesterol level is high due to an unhealthy lifestyle. However, the possibility of a genetic cause can only be excluded through genetic testing.

Cholesterol level: risk increases during menopause

Many women believe that diseases associated with high cholesterol, such as heart attack or stroke, are primarily diseases of men. Up to the age of 50, these diseases indeed occur more frequently in men; however, during menopause, due to hormonal changes, women’s risk catches up with that of men.

The effects of the climacteric, or menopause, on the female body are highly varied.

As estrogen levels decrease, the menstrual cycle initially becomes irregular, hot flashes, night sweats, and palpitations occur.

As a result of prolonged hormone deficiency, menstruation later ceases, vaginal dryness develops, which may be followed by more frequent vaginal and urinary tract infections. Libido may decrease, mood changes may occur, anxiety and tension in everyday life may become more frequent, and sleep disturbances may develop.

The quality of connective tissue also changes, thus the elasticity of the skin and joints decreases. Due to increased osteoporosis, fractures become more common.

In addition to all these changes, menopause is often accompanied by weight gain and changes in cholesterol levels, which increase the risk of numerous cardiovascular diseases.

Changes in Cholesterol Levels and Menopause

During menopause, the blood lipid profile changes in an unfavorable direction:

• the level of HDL (“good”) cholesterol decreases,
• the level of LDL (“bad”) cholesterol increases,
• triglyceride levels rise,
• elevated blood glucose values may also be indicated in tests.

The changes measurable by laboratory tests may gradually lead to deterioration of the condition of the blood vessels, atherosclerosis, and increased blood pressure. All of this is a major risk factor for heart attack and stroke.

In younger women, estrogen helps maintain a healthy balance between LDL and HDL cholesterol. After the age of 50, however, when the ovaries no longer produce sufficient estrogen, women lose this advantage, and the risk of cardiovascular diseases reaches the level of men’s risk.

In Hungary, cardiovascular mortality is more frequent among women than among men.

The Risk of Cardiovascular Diseases

If known risk factors are not treated properly, women are more likely to develop cardiovascular diseases during menopause. The risk increases for coronary artery disease, stroke, heart attack, as well as heart failure and sudden cardiac death.

In women whose menopause occurs before the age of 45 (early menopause), the processes damaging the blood vessels begin earlier; therefore, the danger is even greater.

It should also be known that changes in cholesterol levels may begin even before other obvious symptoms of menopause appear.

According to a study, body weight in itself is not a risk-increasing factor; that is, women with a slimmer body type entering menopause may also have elevated cholesterol levels. The reason is that overweight women more often have higher estrogen levels, which have a protective effect from the perspective of cholesterol composition.

The main tool for risk reduction is a proper lifestyle, healthy nutrition, and regular physical activity. Blood cholesterol levels and blood pressure must be checked regularly, and if lifestyle changes do not produce adequate results, it is justified to reduce cholesterol and blood pressure levels with medication in order to prevent severe consequences.