Hypercholesterolemia (high cholesterol levels in the blood) is associated with v
ID: 3523368 • Letter: H
Question
Hypercholesterolemia (high cholesterol levels in the blood) is associated with various cardiovascular diseases such as atherosclerosis, stroke, and myocardial infarction. Research how hypercholesterolemia develops, as well as its complications.
A common treatment for hypercholesterolemia is a class of drugs called statins. In your post, address the following questions:
Are statins the best course of treatment for hypercholesterolemia in adults? Why or why not?
Should they be prescribed to adults with hypercholesterolemia with no evidence of heart disease?
Should teenagers be prescribed statins if they are diagnosed with hypercholesterolemia? Why or why not?
Is there a better solution for these situations?
Explanation / Answer
A Report on Hypercholesterolmia:
Introduction: Hypercholesterolmia is a medicinal condition where the blood level of cholesterol is increased. People having this condition have high chance of developing heart diseases and which may lead to heart stroke.
Cholesterol is a complex fat, which is highly hydrophobic. Cholesterol is made from fatty acids derivative acetyl-CoA. Also cholesterol can enter body from food. Cholesterol is transported in blood via binding to lipoproteins as cholesteryl esters. Low dense lipoprotein (LDL) carries cholesterol from intestines to tissues, whereas High dense lipoprotein (HDL) transport them from tissue to liver for excretion. So HDL is called good cholesterol as it reduces the level of body cholesterol. Also there are Very low dense (VLDL) and Intermediate dense lipoproteins (IDL) work same as LDL.
Cholesterol generally is important for bio-membrane build up as insulator, production of steroid hormones and vitamin D etc. But excess of cholesterol level can be harmful.
Reasons of hypercholesterolmia development: Hypercholesterolmia can be developed for different reasons. Excessive consumption of fatty food can increase production of cholesterol in body as well as entering of dietary cholesterol is one of the main reasons of hypercholesterolmia. Obese people tend to develop this condition more often.
There are also genetical reasons. Gain of functions or loss of functions of cholesterol metabolism related genes can lead to hypercholesterolmia. The most common congenital condition of this disease is called familial hypercholesterolmia which results from LDL-receptor gene defect. LDL-receptors are required for proper clearance of LDLs from blood, reducing 'bad cholesterol'. But defect in LDLR may increase LDL as dysfunctional clearance of LDL. There are other genes like APOB, LDLRAP1 and PCSK9, which when gets mutated may lead to some form of hypercholesterolmia; but this is less frequent.
Environmental causes and smoking can also lead to development of hypercholesterolmia.
Risk factors of Hypercholesterolmia: Hypercholesterolia can lead to several heart diseases. One of the most common results of hypercholesterolmia is Artherosclerosis or coronary artery disease. Cholesterol gets build up inside the blood vessels leading to reduction of vessel diameter. This hinders the smooth transport of blood, increases blood pressure. When the build up is so great that blood cannot pass at all, heart does not receive any blood which leads to heart attack. This clog when happen in any other part of the body, especially brain can lead to stroke. In case of limited blood flow, a tissue may receive less blood, which after a long period can cause tissue ischemia. Limited blood flow in heart can give rise to chest pain.
Cholesterol can also build up in other tissue. Cholesterol has also a probability to store in tendons, a condition called as tendon xanthomas. Achilies' tendon is most vulnerable. When cholesterol builds up under skin of eyelids is called xanthelasmata.
Diagnosis of hypercholesterolmia: Hypercholesterolmia can be concluded from report of Lipid profile of an individual. Excess levels of total cholesterol and LDL cholesterol and/or low HDL cholesterol are the observable points. Total cholesterol level should be <200 mg/dl and for LDL it should be <100 mg/dl and the level of HDL should be more than 60 mg/dl. Hypercholesterolmia can easily be confused with hyperlipidemia. To separate from hyperlipidemia, level of lipoproteins needs to be determined.
Treatment: Statins is the most popular drug that are used to treat people with hypercholesterolmia. It is an HMGCoA reductase inhibitor, key enzyme of cholesterol biosynthesis. But this drug has more of a global effect as it reduces many other cardiovascular diseases. Statin can reduce LDL concentration and thus decreasing mortality rate from cardiovascular diseases and hypercholesterolmia.
Like other drug side effects of statin includes increase risk of diabetes mellitus amd muscle pain. It also affects activity of other liver enzyme.
Effectivity of Statin: New studies are showing that statin may be exaggerated. It is very effective in reducing blood cholesterol in adults having cardiovascular diseases, but has no effect on the complications arised by cardiovascular diseases. It cannot prevent stroke, heart attack for that matter. No reduction in artherosclerosis can be seen. On top of that the adverse effects of statin are far worse than beneficial effects. Statin increases the risk of diabetes. It also increses risk of cancer, cognitive functions and development of musculoskeletal disorders. So it may seem that Statin is not the best medicine for hypercholesterolmia.
Person who has hypercholesterolmia but no additional heart disease can take statin as prescribed drug. As it is effective reducer of blood cholesterol, so the person might get benefit from the drug in managing his/her hypercholesterolmia. But the person also needs to consider the risks of taking the drugs.
Young people or teenagers on the other hand have a fluctuating level of blood cholesterol, as they are at their developmental stage. It is always best to have a thorough check up before diagnosing hypercholesterolmia. Reduced cholesterol level by statin may interfere with their development. Statins are prescribed to young people having inherited hypercholesterolmia, with short term benefits. But the long term effects of this drug should be considered for them.
Alternate to Statin: Diet management is the best way to treat hypercholesterolmia. Less consumption of saturated fat and cholesterol and more poly-unsaturated fat consumption will reduce blood cholesterol level. Dietary fibre, vegetables and fruit has moderate effect on reducing cholesterol. Healthy life style, more cardiac exercise and smoking and drinking less life can be beneficial to hypercholesterolmia.
There are efforts in producing alternate drug for hypercholesterolmia. Plant derived products like phytosterol are one promising candidate.
Conclusion: Hypercholesterolmia is a serious problem for this generation as more comfort and ease of living is making hypercholesterolmia more prevalent. About 17.7 mil deaths (30% of total death) worldwide was due to cardiovascular diseases in 2015. Hypercholesterolmia is one leading cause of that. It is now the choice for us to live a comfort life with all the heart diseases or an energetic life with no complications.
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