Lipoprotein abnormalities increase the risk of atherosclerotic cardiovascular disease (ASCVD) by disrupting lipid metabolism and leading to plaque buildup. Lowering cholesterol levels reduces mortality and cardiovascular events in middle-aged and older patients. Statin medications are effective in reducing LDL cholesterol and stabilizing plaques. Early diagnosis is crucial for long-term cardiovascular risk mitigation.
What is high Cholesterol?
LDL cholesterol levels above 190 mg/dL, 160 mg/dL with one major risk factor, or 130 mg/dL with two cardiovascular risk factors are considered high cholesterol. Among the significant risk factors are:
- Age: 45 years or older for men and 55 years or older for women
- Premature atherosclerotic cardiovascular disease (defined as younger than 65 years for women and younger than 55 years for men) with a positive family history
- Smoking, high blood pressure, diabetes, and low HDL cholesterol levels (less than 40 mg/dl for men and less than 55 mg/dl for women).
Etiology
Causes of hypercholesterolemia include:
- Pure or familial hypercholesterolemia is a genetic condition.
- An excessive intake of trans and saturated fats in the diet.
- Low physical activity.
- Hepatic illness.
- Anorexia nervosa.
- Persistent renal failure.
- Kidney disease.
Why Are Females at Risk for Hypercholesterolemia?
In addition to differing from pathology in males, the pathophysiology of dyslipidemia in women also changes throughout a woman’s lifespan. Throughout the menstrual cycle, lipid levels fluctuate during the reproductive years, during pregnancy, and after menopause. Estrogen levels can affect cholesterol levels, with fluctuations impacting total cholesterol levels by up to 19% throughout the menstrual cycle. Females with obesity experienced the highest fluctuations. Increased estrogen levels lead to elevated HDL cholesterol, peaking at ovulation, while LDL cholesterol and triglycerides decrease.
Common Symptoms of High Cholesterol in Women
High cholesterol has no symptoms. A blood test is the only way to detect if you have it. High cholesterol is diagnosed through a blood test, and the National Heart, Lung, and Blood (NHLB) Institute recommends initial screenings between 9 and 11 years old, followed by annual tests for individuals over 65. If test results are below desirable ranges, more frequent measurements may be recommended, especially if there’s a family history of high cholesterol or other risk factors.
Preventing and Managing High Cholesterol
Hypercholesterolemia is a major health concern, requiring a healthy lifestyle, weight loss, no smoking, 150-minute exercise, and a low-fat diet. Plant stanols and statins can reduce LDL-C levels but can cause side effects. Additional drugs like ezetimibe, bile acid sequestrants, niacin, LDL apheresis, PCSK9 inhibitors, and HMG-CoA reductase inhibitors may be needed for optimal control.
Take-home Message
Hypercholesterolemia is a prevalent condition with high healthcare costs. To manage it, the healthcare professional team including physicians, pharmacists, nurses, dietitians, and physical therapists is crucial. Nurses educate patients on lifestyle changes, while pharmacists ensure medication compliance and antismoking aids. Dietitians educate patients on dietary modifications and avoiding fatty foods. Exercise programs and healthy weight management are essential. If necessary, bariatric surgery may be recommended.
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References
Patel, N., Mittal, N., Wilkinson, M. J., & Taub, P. R. (2024). Unique features of dyslipidemia in women across a lifetime and a tailored approach to management. American Journal of Preventive Cardiology, 18, 100666. https://doi.org/10.1016/j.ajpc.2024.100666.
Ibrahim, M. A., Asuka, E., & Jialal, I. (2024). Hypercholesterolemia. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459188/
