Dr Thapelo Motshudi
22 August 2022
4 min read

What is cholesterol?

Cholesterol is a substance produced by the liver and also found in certain foods. Cholesterol is used to make some vitamins, hormones, build cell walls and create some bile salts.

Even though we routinely talk about cholesterol as if it’s one entity, there are in fact a number of different types of cholesterol molecules produced in the body. All of us have cholesterol in our bodies, what varies is the amount and the fraction of the different types. Cholesterol is a molecule of fat that has multiple functions, including being one of the components of the walls of our cells, and it is active in a number of chemical reactions. This means that we need it to survive, saying that someone “has cholesterol” only means that she has more of the undesirable type in her blood than is recommended, not that she shouldn’t have it at all. Even though this is too simplistic, generally the broad categories spoken about are LDL (low density) and HDL (high density) cholesterol. It is preferable to have more HDL and less LDL.

High-density lipoprotein (”good” cholesterol)

It helps prevent heart disease and has a protective effect on your blood vessels.

Low-density lipoprotein (”bad” cholesterol)

It may build up in your arteries and form plaque. Plaque narrows your arteries and may eventually lead to strokes and heart attacks.

How does high cholesterol show itself?

The symptoms of high cholesterol depend on the type of hypercholesterolemia, i.e. familial or acquired, and how high it actually is. What is common, is that one is likely to develop heart disease, strokes, and other problems related to the amount of blood going to different parts of the body. This is because cholesterol lines the inner layer of blood vessels and narrows them, thus decreasing the amount of blood going to a number of organs, which can result in heart attacks and strokes. In the severe form of familial hypercholesterolemia, children will have deposits of cholesterol in the tendons of their muscles, causing joint pain and skin lesions.

What causes high cholesterol?

High or elevated cholesterol is called hypercholesterolemia. One can be born with a gene that causes the disease, called familial hypercholesterolemia or it can be acquired throughout life. The familial type also has subdivisions and manifests much earlier in life. Acquired hypercholesterolemia is generally diet and lifestyle related.

How is high cholesterol diagnosed?

Doctors use blood tests to diagnose hypercholesterolemia. This test is normally performed after one has fasted for a prescribed period of time, to avoid measuring the cholesterol from food. However, sometimes hypercholesterolemia is found when one has blood tested for unrelated conditions, and elevated cholesterol is found as an incidental finding. In young patients with familial hypercholesterolemia, the disease is actively sought when a child presents with a stroke or other features of high cholesterol described above. It is also commonly tested for in occupational health screening tests. It is very important to note that the value given for the upper limit of total cholesterol as being normal will vary depending on the laboratory used. It is important that you do not compare your blood results, analysed at one laboratory, to those of a friend or a colleague analysed at a different lab. Your doctor will help interpret your individual results.

How is hypercholesterolemia treated?

The goal of treatment for familial and acquired hypercholesterolemia is the same, which is to reduce the fraction of LDL and thus increase the ratio of HDL. This is done firstly with what is called lifestyle modification, which includes a reduction in dietary fat, loss of weight if overweight, exercise, and stopping smoking if you are a smoker. There are also specific drugs/tablets that are used to lower LDL and improve one's total cholesterol profile. In addition, treatment is also directed to specific complications one might have already developed.

The content in this communication is for information purposes only and is not intended to be detailed advice. You should seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.


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