Hypercholesterolemia

The pathological deviation that will be discussed in this article is not a disease, but a deviation from the norm, a serious deviation. Hypercholesterolemia initially does not seem very dangerous, think about a high cholesterol level in the plasma. But with prolonged observation of such values, the situation only worsens, leading to severe pathologies.

ICD-10 code

As already stated, the ailment in question is not a disease, but only a deviation. But the seriousness of the changes they entail is confirmed by the serious attitude of doctors to this problem. After all, hypercholesterolemia has its own personal code in the international classification of diseases. According to ICD 10, pure hypercholesterolemia is coded as E78.0 and is an item in the category of ailments affecting lipoprotein metabolism (subsection code - E78).

Causes of hypercholesterolemia

A certain pathological syndrome called hypercholesterolemia is a precursor indicating the development of damage to the blood vessels of the entire circulatory system of the human body. Such changes affect the nutrition of the heart and other internal organs, the capillaries of the brain, and the upper and lower extremities. The malfunction in question is a precursor to developing atherosclerosis, a complication that can affect any part of the human body, serving as an impetus for the development of other, more serious diseases.

The causes of hypercholesterolemia are varied and have a multifaceted nature.

• A person can inherit this deviation at birth. The source of the altered gene can be either one or both parents. Defective changes in the gene are associated with a violation of the information responsible for the production of cholesterol.
• The development of disorders is practically impossible to prevent if a person abuses food containing large amounts of animal fats.
  • Transient manifestations of the disease in question can be observed if the patient ate a lot of fatty foods the day before.
  • A constant manifestation can be observed when high fat content of foods is the norm for the patient’s diet.
• The source of the disruption in the normal functioning of the body, leading to the clinical picture under consideration, may be a disease:
  • Hypothyroidism is a condition that develops due to a lack of hormones in the thyroid gland, resulting from surgery or an ongoing inflammatory process.
  • Diabetes mellitus is a disease in which the ability of glucose to penetrate into cellular structures is reduced. Sugar levels are higher than 6 mmol/l with normal levels being 3.3-5.5 mmol/l.
  • Obstructive changes affecting the liver. This pathology is caused by the deterioration of the outflow of bile from the liver, where it is produced. For example, this may be cholelithiasis.
• Long-term use of certain medications can also cause similar changes in the body. These include immunosuppressants, diuretics, beta blockers, and some others.
• Modifiable causes of the development of pathological disorders are those that are corrected when the patient revises his lifestyle.
  • Leading a sedentary lifestyle, expressed in physical inactivity.
  • Nutrition.
  • The presence of bad habits: abuse of alcoholic beverages, drugs, nicotine consumption.
• Hypertension is persistently high blood pressure.
• The development of this pathology is also influenced by non-modifiable factors:
  • The predominant predisposition is men over 45 years of age.
  • It is aggravated by a family history if the patient’s closest male relatives (before age 55) have already been diagnosed with early atherosclerosis.
• The patient has a history of myocardial infarction, the consequences of which are blockage of blood supply to a certain area of the heart muscle, after which it dies.
• A stroke of ischemic nature that provokes necrotic processes affecting a part of the brain.

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Biochemical disorders

In order to understand the causes and consequences of the appearance and development of a particular ailment, it is necessary to understand as best as possible the mechanism of the course of changes that differ from the norm. The biochemistry of hypercholesterolemia is a disorder affecting the lipid metabolism process.

Fatty structures of various classifications enter the human body with food: complex lipid formations, glycerol esters, free cholesterol, triacylglycerides, and others.

After food has entered the digestive tract, the body begins to process it. The food product is "broken down" into components, each of which is processed by a specific enzyme. Fats are also broken down. In this case, each type of fat structure is processed by its own enzyme. For example, triacylglycerides are broken down into smaller compounds under the influence of liver and pancreas biocatalysts (bile and pancreatic acids). A similar process occurs with other lipids.

Free cholesterol is adsorbed unchanged, while its derivatives, which have a more complex structure, are initially subject to modification. Only then do they become adsorbed by enterocytes, the cells that make up the mucous membrane of the small intestine.

In these cells, fats undergo further modification, transforming into forms suitable for transportation, which have their own name - chylomicrons. They are represented by a microscopic fat droplet, covered with a thin protective shell of phospholipids and active proteins.

In this form, former fats pass through the enterocyte barrier into the lymphatic system, and through it further into the peripheral blood vessels.

It should be noted that without the support of other components, chylomicrons cannot independently penetrate into the necessary systems and organs of the human body. They find such support in blood lipoproteins (complete compounds of lipids and protein formations). Such compounds allow chylomicrons to "get" to the necessary organ without dissolving in the blood fluid.

It is lipoproteins that play a leading role in the development of a pathology called hyperlipidemia. This symptom begins to form after a disruption in the normal functioning of lipoproteins occurs.

There is a classification of these enzymatic formations depending on their density. It is the light and ultra-light lipoproteins that are the cause that provokes the development of the disease. They are produced by the liver, after which they are transported to enterocytes, where they are attached to chylomicrons. In such a bundle, this tandem enters the tissue layers.

Low-density lipoproteins (LDL) are the "transport organ" for cholesterol, delivering it to organs and systems.

The functional feature of high-density lipoproteins (HDL) is to remove excess cholesterol plaques from cellular structures, which elevates them to the rank of the main guardian of the body, endowed with anti-atherogenic characteristics.

That is, low-density lipoproteins are transport, and high-density lipoproteins are protection.

Based on this, it can be understood that hypercholesterolemia begins to develop when there is a disruption in the normal functioning of low-density lipoproteins, which, for some reason, stop carrying chylomicrons to the necessary organs.

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Symptoms of hypercholesterolemia

One of the main signs of the occurrence of the deviations in question is the occurrence of "deposits" in the patient's body. There are also symptoms of hypercholesterolemia, which are manifested by the appearance of such factors:

• Areas where tendons are anatomically present (the Achilles joint and the extensor joints of the phalanges of the upper and lower extremities are particularly affected) may become swollen and develop lumpy growths called xanthomas. These are essentially pockets of cholesterol deposits.
• Very similar neoplasms can be observed on the lower and upper eyelids, and the inner corners of the eyes can also be affected. Orange and yellowish spots begin to appear - xanthelasmas.
• If you look closely at the cornea of the patient's eye, you can see a gray stripe along the rim.
• Mostly, one can observe secondary symptoms of deviation from the norm, which are caused by more serious damage to the capillary system, leading to the development of atherosclerosis, strokes, heart attacks, and so on.

The most recognizable signs of the pathology in question are symptoms that appear as indicators of the presence of atherosclerotic changes in a person's medical history. The spectrum of such manifestations is quite wide: from damage to the capillaries of the brain to the circulatory system that supplies nutrition to the upper and lower extremities. Depending on the place of predominant localization, some individual features of the manifestation will be observed.

It should also be noted that the appearance of noticeable symptoms indicates that pathological changes are of an advanced nature, because the real clinical picture becomes noticeable only when the level of cholesterol in the blood serum reaches stable critical values. Before this moment, bright pathological symptoms may be unnoticeable.

Hypercholesterolemia and atherosclerosis

Atherosclerosis is a chronic disease. The basis of its origin is determined by disorders that affect the lipid and protein metabolism in the patient's body. In physical manifestation, these changes are expressed by the loss of elasticity of the vessels, they become fragile. The second significant indicator of the presence of atherosclerosis is the proliferation of connective tissue cells.

High cholesterol levels are often a precursor to atherosclerosis. That is why doctors have paid special attention to this fact. After the study, the results showed that half of the patients diagnosed with atherosclerosis have cholesterol levels within normal limits, while the other half have elevated levels.

Analyzing the results of monitoring, experts note that hypercholesterolemia and atherosclerosis go “hand in hand” when the development of pathology occurs quite quickly.

Various sources cite such figures for the frequency of the joint manifestation of these two diseases - from 60 to 70%. These data were obtained not only by studying the clinical picture of the disease, but also by comparing it with the pathological examination of the condition of the vessel walls. Comparative analysis showed that if a person had problems with excess cholesterol during life, then his postmortem histology showed the progressive development of atherosclerotic characteristics, in the form of recently formed cholesterol deposits inside the capillary passages.

If histology showed regression of atherosclerotic changes, the lifetime medical record showed normal or, conversely, low cholesterol levels.

Observations have shown that high cholesterol levels together with atherosclerosis are more often observed in their early manifestation, when the patient has not yet reached the age of 55. Over time, the clinical picture of the disease changes, “acquiring” various complications.

Hypercholesterolemia in children

The disease in question can be diagnosed in a baby immediately after birth. Such pathology can haunt a person throughout life. Swelling of the Achilles tendons in small patients should alert a qualified doctor to the possibility of family pathology.

Hyperlipidemia in children is usually indicated by an increase in blood cholesterol levels from 8.0 to 12.0 mmol/l. This indicator can be detected even in the first hours of life.

Classification of hypercholesterolemia

Having different sources of manifestation, the pathology is divided into different groups. The classification of hypercholesterolemia consists of several points:

Primary – pathological changes of a congenital nature.

• Secondary pathology is one in which the provoking factor is one of the diseases. That is, the person was born healthy in terms of the factor in question, but acquired it during life.
• The alimentary form of the disease is a sublevel of the secondary one, but is somewhat taken out separately due to the fact that the impetus for the progression of the disease in question is not a specific disease, but the way of life that a person leads - his habits. These include:
  • Smoking.
  • Abuse of alcoholic beverages.
  • Addiction to fatty foods.
  • “Love” for fast food products, food products that contain all sorts of chemical additives: stabilizers, colorants, and so on.
  • Leading a sedentary lifestyle.
  • And other things.

The most detailed and more ramified classification was made by Fredrickson. This is a generally accepted distinction between pathologies, depending on the causes that provoked their appearance. Although the specificity of the differences in the failure of lipid metabolism processes is fully understood only by a qualified physician.

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Types of hypercholesterolemia

Fredrickson's classification of the disease involves dividing the problem under consideration by etiology, determining its typical affiliation.

The following types of hypercholesterolemia are distinguished:

• Type I pathology is primary, hereditary. Rarely encountered. It progresses with lipoprotein lipase deficiency, as well as in case of a violation of the structure of the activating protein of lipoprotein lipase - apoC2. Symptomatically defined as a high concentration of chylomicrons. The incidence is 0.1%.
• Type II pathology is polygenic or congenital. It is divided into:
  • Type IIa - lack of low-density lipoprotein lipase. May be the result of improper nutrition, or a congenital factor has been triggered. The incidence is 0.2%.
  • Type IId - decreased levels of low-density lipoprotein lipase receptors and increased apoB. The incidence rate is about 10%.
• Type III pathology - hereditary dys-β-lipoproteinemia. ApoE defect. Frequency of occurrence is 0.02%.
• Pathology type IV is endogenous. Increased intensity of formation of triglycerides, as well as acetyl-coenzyme A and apoB-100. Frequency of occurrence is 1.0%.
• Type V pathology is hereditary. Increased formation of triglycerides and decreased lipoprotein lipase.

Primary hypercholesterolemia

To understand the difference, it is necessary to become more familiar with at least the most common sources of changes that lead to the disease in question. The term primary hyperlipidemia has been given to a disorder whose main causes are:

• A disruption in the structural composition of lipoprotein proteins, which leads to a failure in the functional capacity of low-density lipoproteins, which lose the ability to attach to tissue cells, and, consequently, the chylomicrons with cholesterols transported by them cannot penetrate the cell.
• The process of production of transport enzymes responsible for the capture of chylomicrons by lipoproteins for further transfer through the body's systems is inhibited. Such a failure leads to the formation of a cholesterol deficiency in one place and their accumulation occurs where their excess is not needed.
• Structural changes affecting the tissue cell itself, leading to the loss of its contact with lipoproteins. Here we have a situation similar to point 1, but with the difference that the reason for the unsuccessful interaction does not come from the enzyme or the lipoprotein representatives, but on the other hand – from the “landing” cell.

Secondary hypercholesterolemia

Another, most frequently diagnosed type of causes is secondary hypercholesterolemia, which was not inherited, but acquired during one's life. The cause of the clinical picture under consideration can be alcohol, if the patient does not know the extent of its consumption, a sedentary lifestyle and many other factors that directly depend on the person himself.

The problem can also be provoked by disorders occurring in the endocrine system, pathological changes affecting the functioning of internal organs. After all, the body is a single mechanism and a failure in the functioning of one system invariably entails other changes.

Hyperlipidemia begins to progress if changes have affected the processes of transporting fatty structures from enterocytes to cells, or disturbances have activated the synthesis of lipoproteins, or their utilization has been inhibited.

Familial hypercholesterolemia

Autosomal dominant pathology, related to diseases of the monogenic group, i.e. determined by only one gene. A disorder affecting the malfunction of low-density lipids. In this case, the disorder occurs at the gene level and is inherited, being congenital.

A person can receive such a defective gene from one parent or from both, if they have a history of the disease in question.

Risk factors for high cholesterol include:

• Family history of this disorder.
• Diagnosis of early-onset heart attacks, both in the patient and in his relatives.
• High level of low-density lipoproteins in at least one of the parents. The burden of the anamnesis may consist in the resistance of the pathogenic situation to drug therapy.

Cholesterol is a natural enzymatic component of many biochemical processes and a necessary element of the cell membrane. Cholesterol deficiency leads to a failure in the synthesis of various hormones. Most of them enter the human body with animal fat, some is produced by the liver.

Cholesterol can be divided into those that contribute to the development of atherosclerosis - low-density lipoproteins (LDL), and those that control its amount, on the contrary, protecting against the onset and progression of the disease - high-density lipoproteins (HDL). It is high-density lipoproteins that reduce the likelihood of cardiovascular abnormalities.

Familial hypercholesterolemia

Familial malaise is considered a hereditary disease, which is one of its subtypes. Today, it is responsible for 10% of defects affecting the coronary arteries, which are diagnosed in young people under 55 years of age. The source of such disorders is a mutated gene. This pathology is quite common, especially in families living in polluted industrial megacities. For every 200-300 healthy genes, there is one mutated one.

Familial hypercholesterolemia according to Fredrickson classification refers to type 2. The essence of this disease is that due to a failure in genetics, lipoproteins lose the ability to bind with cholesterol and transport it to the desired organ. In parallel with this, there is an increase in the number of synthesized cholesterol plaques, which is also a disorder.

And as a result, plaques begin to accumulate in places where they should not be, which leads to the development of cardiovascular diseases, coronary disorders. This is one of the reasons for diagnosing "early" heart attacks.

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Homozygous familial hypercholesterolemia

If, during diagnosis, two mutated alleles of low-density lipoprotein genes are detected and this disease is hereditary, then doctors state that it is a hereditary disease, designated by the term.

This mutation provokes a rapid disruption of lipid breakdown, as well as a complete absence of receptors. As sad as it sounds, mutational changes of this kind are quite common, one clinical manifestation per hundred thousand people.

The frequency of the pathology encountered is also divided by the type of “destruction”:

• In patients with a complete absence of receptors, such activity is shown to be only 2% of normal work, and the level of low-density lipoproteins increases sharply.
• In case of receptor defect, their activity falls within the range of 2-25% of the normal value, the amount of low-density lipoproteins is slightly below the norm.

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Heterozygous familial hypercholesterolemia

One of the most common varieties of the disease in question, the frequency of which is diagnosed as one clinical picture per five hundred healthy cases.

The essence of the pathology is a mutation of one gene, leading to its defective damage. The symptoms of this manifestation of the disease are:

• Increase in total cholesterol levels.
• Increased LDL levels.
• Triglyceride levels are close to normal.
• Diagnosis of early heart disease.
• Burdened family history.
• The presence of tendon xanthomas, although their absence in the body is not evidence of health. This is especially true for a child's body. These samples are taken in the area of the Achilles tendons. Visually, this situation is manifested in swelling and lumpy formations. Another area of the appearance of thickenings and tubercles is the back of the palms of the upper limbs and the flexor tendons of the phalanges.

Diagnosis significantly increases the likelihood of a patient developing cardiovascular diseases (for example, coronary heart disease) at a young age.

It is desirable to recognize such a clinical picture in infancy, this will allow targeted control of the indicator parameter, preventing pathological changes in the body.

Pure hypercholesterolemia

It is caused by an increase in the quantitative component of cholesterol in the blood. Such a diagnosis is given to a patient if this criterion is determined by a figure of more than 5.18 mmol/l. This is already a pathology, which is a dominant symptom of the development of atherosclerosis.

Medical statistics say that about 120 million of the world's population have serum cholesterol levels of about 5.18 mmol/l and above, and for 60 million this level is already determined to be 6.22 mmol/l and above.

Diagnosis of hypercholesterolemia

If the doctor, based on some signs, begins to suspect that his patient has the disease in question, he prescribes a more detailed targeted examination, since it is impossible to make a correct diagnosis visually. Diagnostics includes several mandatory points

1. Analysis of patient complaints.
2. Clarification of the time period of occurrence of xanthelasma, xanthoma, lipoid corneal arcus.
3. Collecting the patient's medical history. Whether the patient or his close blood relatives have such diseases as a history of heart attack or stroke. Does any of the relatives have the disease in question?
4. A physical examination is mandatory.
5. The main diagnostic indicator of the disease is the result of the analysis of the specific lipid profile of blood plasma - lipidogram. On its basis, the amount of various lipids (cholesterol, triglycerides, high-density and low-density lipoproteins) is determined. They are directly the criterion for the presence or absence of pathological changes. The atherogenicity coefficient is determined.
6. A general urine and blood test is prescribed. Inflammations, other failures and deviations are detected.
7. A biochemical analysis of plasma is also required, which allows one to determine quantitative indicators of protein, uric acid, creatinine levels, sugar and other components of the blood.
8. An immunological blood test allows us to determine the presence of antibodies to chlamydia and cytomegalovirus, and also determines the level of C-reactive protein.
9. Modern medical equipment makes it possible to conduct genetic studies that allow us to identify a defective gene that carries information related to lipid metabolism. Such a gene is responsible for the hereditary form of the disease.
10. Blood pressure measurement.

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Nutrition and diet for hypercholesterolemia

This is a very important "brick" in the measures that are used to stop the problem that has arisen. By reviewing their addictions, the patient can significantly change the situation for the better, significantly reducing the volume of cholesterol plaques in the blood.

If the disease has not gone too far. Sometimes it is enough to remove "bad" products from your diet and this minor step will allow you to maintain this indicator at acceptable normal values.

The first thing a patient needs to do is to eliminate fatty foods of animal origin from their diet. They can be replaced with plant analogues. This can significantly reduce the amount of excess cholesterol plaques. Fatty fish and fish oil, on the contrary, are desirable in the diet of such a patient.

You should not give up meat and meat products, but they should not be fatty. A more serious restriction concerns offal (liver, brain structure, kidneys). You should minimize smoked foods and egg (yolk) intake. The cholesterol in such products is "off the charts".

The diet for hypercholesterolemia allows the consumption of low-fat dairy products (no more than 1-2%); fermented milk products are welcome.

You should remove butter, fast food products, and baked goods from your diet. When buying bakery products, you should make sure that they are made from bran and wholemeal flour.

The patient's diet should include all kinds of cereals cooked in water or low-fat milk. Green tea and nuts cleanse blood vessels well. But you shouldn't eat a lot of nuts, because they are a high-calorie product.

As strange as it may sound, but in moderate doses alcohol helps slow down the development of atherosclerosis. But the "therapeutic dosage" should not be higher than the daily norm, corresponding to 20 ml of pure alcohol, which is approximately equal to 40 ml of vodka, 150 ml of wine, 330 ml of beer. Such dosages are suitable for a man's body, for women these figures should be halved. We are talking about a quality product, not a surrogate. At the same time, we should not forget that if there is a history of cardiovascular pathology, alcohol is contraindicated.

It is worth eliminating coffee from your consumption. Research has shown that when you give up this drink, your cholesterol level in the body decreases by 17%.

The diet of such a patient must include the required amount of legumes, fruits and vegetables so that the body does not feel a lack of vitamins and minerals.

If a person loves seafood, then scallops, mussels and other seafood can significantly diversify the patient’s diet.

For such patients, all foods should be steamed, boiled or baked.

Diet menu for hypercholesterolemia

As the recommendations show, the diet for this disease is simple and quite varied. Therefore, there should not be any major difficulties in compiling a menu for hypercholesterolemia. And if the patient loves meat, let it be included in his dish, you should only make sure that the product is not fatty and is prepared in one of the permitted ways.

A one-day menu for such a patient could, for example, be as follows:

• Breakfast: casserole – 150 g, green tea.
• Lunch: orange.
• Lunch: Lenten borscht – 200 g, fish baked with vegetables – 150 g, apple juice – 200 ml.
• Afternoon snack: rosehip infusion – 200 ml, apple.
• Dinner: pearl barley porridge in water with boiled meat – 150 g, fresh carrot salad – 50 g, tea with milk.
• Before bed – a glass of kefir.

Total daily amount of bread – 120g.

Treatment of hypercholesterolemia

Therapy for the pathology in question includes both drug and non-drug methods. Non-drug treatment of hypercholesterolemia includes several recommendations:

• Weight control.
• Moderate physical activity, individually calculated for each patient. Physical therapy, morning jogging, swimming pool and other components of active recreation.
• A balanced diet with compliance with all dietary requirements for the disease in question.
• Giving up bad habits. This especially concerns alcohol and nicotine.

If the above methods are “not enough” to maintain cholesterol levels within normal limits, the doctor prescribes drug therapy.

Medicines for hypercholesterolemia

First, having analyzed the clinical picture of the disease, the attending physician prescribes a diet for such a patient, gives recommendations on lifestyle changes, and prescribes therapeutic physical exercises. And if such a set of changes does not lead to the desired result, the specialist is forced to resort to pharmacology.

Patients with this diagnosis are mainly prescribed statins (for example, atorvastatin), which effectively reduce the level of cholesterol in the patient's body by inhibiting the enzyme that activates its production.

Atorvastatin is administered orally at any time of the day, with food. The starting daily dosage is from 10 mg to 80 mg. The corresponding figure is prescribed by the doctor individually for each patient. During the treatment, after two to four weeks, the patient's blood cholesterol levels should be monitored, adjusting the dosage accordingly.

In parallel with statins, fibratams can be prescribed, which reduce the level of lipids and triglycerides while simultaneously increasing the concentration of high-density lipoproteins, as well as bile acid sequestrants, which enhance the process of breaking down excess cholesterol.

A specialist can introduce omega-3 polyunsaturated fatty acids into the treatment protocol, which regulate the number of triglycerides and also have a beneficial effect on the functioning of the heart. Triglycerides are introduced, for example, ezetimibe, which blocks the absorption of cholesterol by the small intestine.

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Treatment of hypercholesterolemia with folk remedies

To relieve the problem, folk remedies are often used. There are many such recipes. Here are some:

• Crushed milk thistle seeds are taken one teaspoon at a time with food.
• An infusion of celandine, which is prepared from a gram of dry plant and a glass of boiling water, has proven itself well. After infusion, strain the liquid and take a dessert spoon three times a day.

Prevention of hypercholesterolemia

Everyone knows that it is easier to maintain your body at a “healthy” level than to put in a lot of effort to get rid of the disease and regain your former health. Prevention of hypercholesterolemia is not overly complicated, but by following the recommendations given, you can significantly protect your body from disorders that invariably occur against the background of high cholesterol.

• You need to watch your weight.
• Avoid high-calorie foods.
• Eliminate baked goods, fatty, smoked and spicy foods from your diet.
• Increase your intake of fruits and vegetables, which are rich in vitamins, minerals and fiber.
• Eliminate bad habits: alcohol, nicotine.
• Sports activities with individually selected loads.
• Avoid stress and heavy emotional loads.
• Periodic monitoring of the amount of cholesterol plaques in the blood is necessary.
• Blood pressure control.
• Mandatory complete treatment of diagnosed diseases that can provoke high cholesterol levels.
• When the first pathological signs appear, consult a specialist and, if necessary, undergo medication treatment.

Hypercholesterolemia - this term is used by doctors not to denote a disease, but a symptom that can lead to quite serious disorders in the patient's body. Therefore, even a minor violation of its level in the blood should not be ignored. In the early stages of development, this pathology can be easily kept within the norm by a corrected diet and a recommended diet. If this stage of therapy was ignored, then a person risks getting more complex and sometimes irreversible diseases in the future, such as atherosclerosis, heart attack, stroke and others. Only a person can save his health by timely contacting a doctor. Therefore, be more attentive to your body and do not brush off its signals for help. After all, a piece of fatty meat eaten is not worth the spoiled quality of the rest of your life!