Medication
This activity provides a practical approach to hypercholesterolemia and its management. [1][2][3] Etiology High cholesterol can be defined as a LDL-cholesterol greater than 190 mg/dL, greater than 160 mg/dL with one major risk factor, or greater than 130 mg/dL with two cardiovascular risk factors.
Self-care
Classically, hypercholesterolemia was categorized by lipoprotein electrophoresis and the Fredrickson classification. Newer methods, such as "lipoprotein subclass analysis", have offered significant improvements in understanding the connection with atherosclerosis progression and clinical consequences.
Nutrition
Treatment. Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.
Is there a practical approach to hypercholesterolemia?
The evaluation, diagnosis, and treatment of hypercholesterolemia (high blood lipids, high cholesterol), be it caused by genetics or poor lifestyle choices, is of paramount importance in managing cardiovascular disease's escalating development.[20]Nurses play a vital part in patient education.
How is hypercholesterolemia (high cholesterol) categorized?
What is the treatment for high cholesterol?
Why is it important for nurses to diagnose and treat hypercholesterolemia?
How do you treat high LDL cholesterol?
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What is LDL hypercholesterolemia?
Adults and children who have familial hypercholesterolemia have very high levels of low-density lipoprotein (LDL) cholesterol in their blood. LDL cholesterol is known as "bad" cholesterol because it can build up in the walls of the arteries, making them hard and narrow.
What effect does high cholesterol high levels of LDL have on the body?
When you have too much LDL cholesterol in your body it can build up in your arteries, clogging them and making them less flexible. Hardening of the arteries is called atherosclerosis. Blood doesn't flow as well through stiff arteries, so your heart has to work harder to push blood through them.
Is hypercholesterolemia the same as high cholesterol?
Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems. The medical term for high blood cholesterol is lipid disorder, hyperlipidemia, or hypercholesterolemia.
How does hypercholesterolemia affect the body?
With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
What causes hypercholesterolemia?
Genetics of Familial Hypercholesterolemia Familial hypercholesterolemia (FH) can be caused by inherited changes (mutations) in the LDLR, APOB, and PCSK9 genes, which affect how your body regulates and removes cholesterol from your blood. About 60-80% of people with FH have a mutation found in one of these three genes.
How do statins lower cholesterol?
Statin drugs lower LDL cholesterol by slowing down the liver's production of cholesterol. They also increase the liver's ability to remove LDL cholesterol that is already in the blood. The Food and Drug Administration (FDA) offers advice on the risks related to taking statins: Controlling Cholesterol with Statins.
What are the main functions of LDL?
Low-Density Lipoproteins (LDL) LDL is responsible for carrying cholesterol to cells that need it. Elevated LDL levels are associated with an increased risk of cardiovascular disease.
When does hypercholesterolemia arise?
Familial hypercholesterolemia is a genetic disorder. It is caused by a defect on chromosome 19. The defect makes the body unable to remove low density lipoprotein (LDL, or bad) cholesterol from the blood. This results in a high level of LDL in the blood.
What is considered hypercholesterolemia?
Hypercholesterolemia is defined as serum total cholesterol of 200 mg/dl or more, according to the National Cholesterol Education Program (NCEP) III guidelines.
What does the word hypercholesterolemia mean?
Hypercholesterolemia is a word for high levels of cholesterol in the blood. Some people have an inherited syndrome, which causes very high levels of cholesterol. Untreated high cholesterol raises the risk of heart disease and cardiovascular problems.
What is the role of a nurse in hypercholesterolemia?
The nurse is ideal for educating the patient about changes in lifestyle, eating a healthy diet, and resuming an active lifestyle.
What causes high cholesterol?
Low HDL-cholesterol levels (less than 40 mg/dl in male and less than 55 mg/dl in a female) . Modifiable high cholesterol causes include a diet high in saturated or trans fats, low fiber, physical inactivity, obesity, and smoking. [22] There are genetic and acquired causes of hypercholesterolemia.
What should a pharmacist do with statins?
The pharmacist should ensure compliance with the statin medications and offer antismoking aids. Further, the pharmacist should also be aware of statins' side effects like muscle pain and liver damage; and ensure that regular blood work is performed.
What is the best drug for LDL-C?
The drug class of choice is a statin that can lower LDL-C from 22% to 50%. Also, statins have been shown to reduce cardiovascular events in both primary and secondary prevention trials. The major side effects are elevated transaminases, myalgia, and myopathy, and new-onset diabetes.
How many people have high cholesterol?
Approximately 90 to 95% of those with high cholesterol have not yet been diagnosed [20]. According to the Center for Disease Control and Prevention (CDC), 73.5 million or 31.7%of adults in the United States have high LDL-C levels and are at twice the risk for heart disease than people with normal levels.
Can statins control LDL-C?
However, some patients cannot achieve adequate control of their LDL-C levels, even with high-dose statin therapy , and require additional drugs. Cholesterol absorption inhibitors (ezetimibe) and/or bile acid sequestrants are the next line of drugs, given their safety combined with statins.
Can statins cause myopathy?
If transaminases exceed three times the upper limit of normal, the statin dose should be reduced, or a lower dose of another statin should be used. Myopathy is a serious problem since it can result in rhabdomyolysis and acute renal failure. Certain drugs, in combination with statins, increase this risk.
When was the cholesterol guideline published?
In the UK, the National Institute for Health and Clinical Excellence has made recommendations for the treatment of elevated cholesterol levels, published in 2008, and a new guideline appeared in 2014 that covers the prevention of cardiovascular disease in general.
Why is my LDL elevated?
Elevated levels of non-HDL cholesterol and LDL in the blood may be a consequence of diet, obesity, inherited (genetic) diseases (such as LDL receptor mutations in familial hypercholesterolemia ), or the presence of other diseases such as type 2 diabetes and an underactive thyroid.
What is the term for high levels of lipids in the blood?
It is a form of hyperlipidemia (high levels of lipids in the blood), hyperlipoproteinemia (high levels of lipoproteins in the blood), and dyslipidemia (any abnormalities of lipid and lipoprotein levels in the blood). Elevated levels of non-HDL cholesterol and LDL in the blood may be a consequence of diet, obesity, ...
What is the mutation in familial hypercholesterolemia?
In familial hypercholesterolemia, mutations may be present in the APOB gene ( autosomal dominant ), the autosomal recessive LDLRAP1 gene, autosomal dominant familial hypercholesterolemia ( HCHOLA3) variant of the PCSK9 gene, or the LDL receptor gene. Familial hypercholesterolemia affects about one in 250 individuals.
How do statins help with cholesterol?
In people without cardiovascular disease, statins have been shown to reduce all-cause mortality, fatal and non-fatal coronary heart disease, and strokes. Greater benefit is observed with the use of high-intensity statin therapy . Statins may improve quality of life when used in people without existing cardiovascular disease (i.e. for primary prevention). Statins decrease cholesterol in children with hypercholesterolemia, but no studies as of 2010 show improved outcomes and diet is the mainstay of therapy in childhood.
How much cholesterol is considered high?
In the United States, the National Heart, Lung, and Blood Institute within the National Institutes of Health classifies total cholesterol of less than 200 mg/dL as “desirable,” 200 to 239 mg/dL as “borderline high,” and 240 mg/dL or more as “high”.
Why do people with type 2 diabetes need statins?
Statins should be used for primary prevention against macrovascular complications in adults with type 2 diabetes and other cardiovascular risk factors. Once lipid-lowering therapy is initiated, people with type 2 diabetes mellitus should be taking at least moderate doses of a statin.
How to treat high cholesterol?
Treatment. Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.
What is the best treatment for high cholesterol in children?
Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. Children age 10 and older who have extremely high cholesterol levels might be prescribed cholesterol-lowering drugs, such as statins.
How is cholesterol measured?
In the United States, cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. In Canada and many European countries, cholesterol levels are measured in millimoles per liter (mmol/L). To interpret your test results, use these general guidelines.
How old do you have to be to get a cholesterol test?
For most children, the National Heart, Lung, and Blood Institute recommends one cholesterol screening test between the ages of 9 and 11, and another cholesterol screening test between the ages of 17 and 21.
What is the best medicine for high triglycerides?
If you also have high triglycerides, your doctor might prescribe: Fibrates. The medications fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid) reduce your liver's production of very-low-density lipoprotein (VLDL) cholesterol and speed the removal of triglycerides from your blood.
What medications lower cholesterol?
The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood. Cholesterol absorption inhibitors.
How long before a blood test can you drink water?
A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports: For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.
What is the goal of LDL?
The main goal of treatment is to lower, or control, your LDL level to minimize your personal risk for heart attack or cardiovascular disease, based on your cholesterol numbers and other risk factors, such as a history of cardiovascular disease. Lifestyle changes are recommended for anyone with high cholesterol. These include: Diet upgrades.
What happens when you have high cholesterol?
Here’s what happens in your body when you have high cholesterol: The waxy cholesterol builds up in artery walls and contributes to plaque, a hard deposit that narrows and clogs the arteries. (You may hear this referred to as atherosclerosis, or “hardening of the arteries.”)
What foods raise cholesterol?
Stick to a healthy diet. Saturated fats, trans fats and dietary cholesterol can all raise cholesterol levels. Foods thought to keep cholesterol low include monounsaturated fats (such as nuts and olive oil), polyunsaturated fats (such as fish and canola oil) and water-soluble fiber (such as oats, beans and lentils).
How to lower triglycerides?
Alcohol can raise triglycerides, so you may be advised to cut back. Regular exercise . Aim for at least 30 minutes of exercise a day, most days.
How to keep cholesterol levels in a healthy range?
Adults over age 20 should have their cholesterol measured at least every five years. That gives you and your doctor a chance to intervene early if your numbers start to rise. Stick to a healthy diet.
How to improve cardiovascular health?
Get practical ideas to on eating for cardiovascular health. Exercise and manage your weight. Along with a healthy diet, staying fit and maintaining a normal weight for your height lower your cardiovascular risks by minimizing the odds of other contributing health problems like obesity and diabetes.
Is cholesterol a natural component?
Cholesterol is a natural component in everyone’s blood, and supports normal function of cell membranes, hormone levels and more. However, having too much, is considered hyperlipidemia, hypercholesterolemia or high blood cholesterol — a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.
What is the definition of hypercholesterolemia?
Definition. Hypercholesterolemia can be defined as the presence of high plasma cholesterol levels, with normal plasma triglycerides, as a consequence of the rise of cholesterol and apolipoprotein B (apoB)-rich lipoproteins, called low-density lipoprotein (LDL). According to the WHO definition ...
What is the non-HDL cholesterol goal?
The goals for non-HDL cholesterol are generally 30 mg/dL higher than those for LDL cholesterol (Box 41-1 ). For example, in patients with coronary heart disease and coronary heart disease risk equivalents, the LDL goal is less than 100 mg/dL and the non-HDL goal is less than 130 mg/dL. 13.
What are the factors that contribute to liver transplants?
About 40% have hypertriglyceridemia.27–29 Contributing factors are likely to include increased dietary intake of saturated fats secondary to corticosteroid-induced appetite stimulation and corticosteroid-induced increase in low-density lipoprotein (LDL) production. CNIs reduce cholesterol secretion into bile and increase LDL production. There is evidence that hyperlipidemia occurs more frequently with cyclosporine than with tacrolimus. Hyperlipidemia is a specific side effect of sirolimus. Pretransplant serum cholesterol levels have also been found to be an independent predictor of posttransplant hypercholesterolemia on multivariate analysis in one study. 30
What to do if LDL is not achieved?
If adequate LDL is still not achieved, either a bile acid sequestrant, fibrate, or nicotinic acid should be added . Note that patients may need to be followed more carefully for side effects, such as liver function test (LFT) elevation and myopathy, with certain combination therapies.
What is the LDL-like particle that contains apolipoprotein B?
Lipoprotein (a), often represented as Lp (a), is an LDL-like particle that contains apolipoprotein B (apo B). It has independently been correlated with an increased risk of adverse cardiovascular event in certain patient populations.
What is the term for the presence of an excess of the complex particles that transport lipids in the blood?
Hypercholesterolemia is one of a group of diseases known as hyperlipidemias or dyslipidemias, which are characterized by the presence of an excess of the complex particles that transport lipid in the blood, known as plasma lipoproteins.
Is autosomal recessive hypercholesterolemia the same as HoFH?
Autosomal recessive hypercholesterolemia (ARH) has a clinical presentation closely resembling HoFH, with some key differences. For instance, while most physical signs are quite similar, aortic valve stenosis is less common, and aortic root disease shows slower progression [109 ]. Age of diagnosis can vary between the first and fifth decades of life, meaning ARH is a potential diagnosis in both pediatric and adult populations. In reported patients, total plasma cholesterol levels have varied between 9.6 and 27.1 mmol/L (370 and 1050 mg/dL), while LDL cholesterol levels have varied between 8.6 and 22.9 mmol/L (330 and 890 mg/dL) [ 110 ]. Despite the large variability, these parameters are sufficiently abnormal in ARH patients to satisfy the SBR criteria for HeFH diagnosis; in the context of a severe pediatric clinical presentation, ARH closely resembles HoFH [ 55 ].
Overview
Treatment
Signs and symptoms
Causes
Specialist to consult
Diagnosis
Screening method
Treatment recommendations have been based on four risk levels for heart disease. For each risk level, LDL cholesterol levels representing goals and thresholds for treatment and other action are made. The higher the risk category, the lower the cholesterol thresholds.
For those at high risk, a combination of lifestyle modification and statins has been shown to decrease mortality.
Epidemiology
Although hypercholesterolemia itself is asymptomatic, longstanding elevation of serum cholesterol can lead to atherosclerosis (hardening of arteries). Over a period of decades, elevated serum cholesterol contributes to formation of atheromatous plaques in the arteries. This can lead to progressive narrowing of the involved arteries. Alternatively smaller plaques may rupture and cause a cl…
Research directions
Hypercholesterolemia is typically due to a combination of environmental and genetic factors. Environmental factors include weight, diet, and stress. Loneliness is also a risk factor.
Diet has an effect on blood cholesterol, but the size of this effect varies between individuals.