Cholesterol is a waxy substance found in your blood.

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Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease.

With high cholesterol, you can develop fatty deposits (atherosclerotic plaques) in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, the deposits can break suddenly and form a clot that causes a heart attack or stroke.

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Symptoms:

high cholesterol has no symptoms of it's own. 

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Risk factors:

Factors that can increase your risk of bad cholesterol include:

• Poor diet. 

  • Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers and microwave popcorn, can raise your cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase your cholesterol.

• Obesity. 

  • Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.

• Lack of exercise. 

  • Exercise helps boost your body's HDL, or "good," cholesterol while increasing the size of the particles that make up your LDL, or "bad," cholesterol, which makes it less harmful.

• Smoking. 

  • Cigarette smoking damages the walls of your blood vessels, making them more prone to accumulate fatty deposits. Smoking might also lower your level of HDL, or "good," cholesterol.

• Age. 

  • Because your body's chemistry changes as you age, your risk of high cholesterol climbs. For instance, as you age, your liver becomes less able to remove LDL cholesterol.

• Diabetes. 

  • High blood sugar contributes to higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.

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Treatment:

Depends on your “cardiovascular risk” ie. risk of having a heart attack or stroke in the next 10 years."

There are many factors that determine a person’s cardiovascular risk, such as age, sex, smoking history, blood pressure, family history, etc. Cholesterol levels are another factor.

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Your physician will use the Framingham Risk Calculator to determine your risk 

 

Patients are then categorized as “Low”, “Medium”, or “High” risk of having a heart attack or stroke in the next 10 years.

• LOW RISK = less that 10% risk

• MEDIUM RISK = between 10% to 20% risk

• HIGH RISK = more than 20% risk

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Depending on the patients risk category, different prevention and treatment options may recommended.

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Simplified recommendation for cholestrol medications

Regardless of a person’s cholesterol level, the following is recommended for heart and stroke prevention:

• LOW risk   –>    a statin is not recommended - treat with lifestyle management

• MEDIUM risk   –> medium dose statin

• HIGH risk   –> high dose statin

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Lifestyle and home remedies:

Lifestyle changes are essential to improve your cholesterol levels. To bring your numbers down, try the following:

• Lose extra pounds. Losing even 5 to 10 pounds can help lower cholesterol levels.

• Eat a heart-healthy diet. Focus on plant-based foods, including fruits, vegetables and whole grains. Limit saturated fats, found in red meat and full-fat dairy products, and trans fats, found in many processed foods.

  Monounsaturated fat — found in olive and canola oils — is a healthier option. Avocados, nuts and oily fish are other sources of healthy fat.

• Exercise regularly. Work up to at least 30 minutes of moderate intensity exercise five times a week or vigorous exercise five times a week.

• Don't smoke. If you smoke, find a way to quit.

 

If you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.

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Medications:

The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects. Common choices include:

• Statins - these are first line medications. 

  • Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Statins can also help your body reabsorb cholesterol from built-up deposits on your artery walls, potentially reversing coronary artery disease.

    Choices include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

• Bile-acid-binding resins. 

  • Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (lodalis) 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. 

  • Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Ezetrol) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.

• Injectable medications. 

  • A newer class of drugs, known as PCSK9 inhibitors, can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.

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clinic this link to see the Canadian Cardiovascular Society lipid guidelines