What is ?Statistics on Risk Factors for Progression of Symptoms of Clinical Examination of How is Diagnosed?Prognosis of How is Treated? ReferencesWhat is ?
is defined as elevated amounts of cholesterol in the blood. Cholesterol is a waxy, fat-like substance that is naturally found in the walls of cells. It is used by the body to produce certain hormones, vitamin D, and bile acids that help to digest fat. If the amounts of cholesterol in the blood are excessive, cholesterol can build up in arteries, which can lead to coronary heart disease and many other serious conditions.
Statistics on Nonfamilial (non-inherited) is the most common form of . It occurs in occurs in people with a susceptible genotype which is aggravated by excessive intake of saturated fats and cholesterol.
Familial hypercholesterolemia is an inherited genetic disorder. The children of people with familial hypercholesterolemia may inherit either the normal gene or the defective gene, so the prevalence within that family will be approximately 50%. It is the most common potentially fatal genetic disorder and affects somewhere between 1/200 to 1/500 Australians.
Risk Factors for
Predisposing factors for high cholesterol levels () include:
Family historyDiets high in saturated fats and cholesterolLiver diseaseUnderactive thyroidPoorly controlled diabetes Overactive pituitary glandNephrotic syndrome Anorexia nervosaObesity Smoking Low levels of physical activity Polycystic ovarian syndromeInsulin resistance Alcohol use Kidney failure Stress PregnancyLupus Multiple myelomaLymphoma
While some factors cannot be altered by changes in lifestyle, many can be changed. The most important risk factors related to high cholesterol are:
In most cases, elevated cholesterol levels are associated with an overly fatty diet coupled with an inactive lifestyle.
A number of complications may occur if high cholesterol is left untreated. These include:
Heart disease: One of the leading cause of death in Australia. Elevated cholesterol levels more than doubles the risk of heart attack. StrokeInsulin resistance: Many people diagnosed as being insulin resistant then go on to develop diabetes.Symptoms of
is often an asymptomatic condition (meaning it displays no symptoms) and is usually discovered during routine screening. In some cases it can be a genetic disorder, so your doctor will ask you several questions about the health of other members of your family. A history of stroke, heart attack or sudden death in your immediate family will point towards a genetic condition, namely familial . Your doctor may draw a family tree so other at-risk members can be identified and followed up, although some family members can be reluctant to be involved due to confidentiality issues.
General Cardiovascular Disease 10-Year Risk Calculator
This risk assessment tool is based on data from the Framingham Heart Study to estimate 10-year risk for general cardiovascular disease outcomes (coronary death, myocardial infarction, coronary insufficiency, angina, ischaemic stroke, haemorrhagic stroke, transient ischaemic attack, peripheral artery disease, heart failure). This tool is designed to estimate risk in adults aged 30-74 years of age without CVD at baseline examination. Use the calculator below to estimate 10-year risk.
PredictorsAge years MaleFemaleGender YesNoHave you been diagnosed with Type II diabetes?Are you a smoker?*Are you prescribed medication to lower your blood pressure? If you do not know the following blood pressure and cholesterol parameters ask your General Practitioner on your next visit.Systolic blood pressure** mmHg Total cholesterol*** mmol/L OR mg/dl HDL cholesterol**** mmol/L OR mg/dl ResultsSignificant (> 20%)Elevated (10–20%)
Mild risk (< 10%)
You have a significant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, your sugar levels should be well controlled.Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have an elevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a mild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.*For these purposes "smoker" means any cigarette smoking in the past month.
**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.
***Total cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
****HDL cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
References:D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.Stancoven A, McGuire DK. Preventing macrovascular complications in Type 2 Diabetes Mellitus: glucose control and beyond. American Journal of Cardiology 2007; 99: 5H-11H.
This tool needs javascript enabled to work.
Male risk estimatePointsAgeHDLTotal CholesterolSBP Not TreatedSBP TreatedSmokerDiabetic-2 60+ PointsCVD riskHeart age (years)-3 or lessBelow 1% 8018 +> 30%> 80
Female risk estimatePointsAgeHDLTotal CholesterolSBP Not TreatedSBP TreatedSmokerDiabeticPointsCVD riskHeart age (years)-2 or less801615.9%>801718.5%>801821.5%>801924.8%>802028.5%>8021+>30%>80
More than 20 pointsSignificant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, your sugar levels should be well controlled.Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.10 to 20 pointsElevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.Less than 10 pointsMild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.
This information will be collected for educational purposes, however it will remain anonymous.Clinical Examination of
In its advanced state, high cholesterol may result in any of the following:
How is Diagnosed?
As symptoms of high cholesterol won't become evident until it is possibly too late, blood screening is essential for early diagnosis. An initial blood test is done to check a "random" measurement of total and HDL cholesterols, meaning that the test is performed at any time during the day, regardless of what has been eaten.
Those with abnormal levels will go on to have a fasting lipid profile test (in which the person being tested refrains from eating for 8-12 hours, usually overnight, prior to the test). The fasting test will indicate whether or not total cholesterol levels fall within the normal range, are moderately high, or if they are in the very high range.
Prognosis ofThe risk of complications of can be significantly reduced by therapies that lower serum cholesterol levels.
Lowering cholesterol by 1% reduces the risk of coronary artery disease by 2%.
The treatment of other modifiable risk factors such as smoking, high blood pressure and diabetes will further decreases the risk of complications of .
Maintaining an appropriate weight, eating a low fat diet and exercising can also have a significant impact on cholesterol levels and improve long-term outcomes.
LDL Cholesterol Levels CalculatorThis risk assessment tool is based on data from the National Cholesterol Education Program and the findings of the Adult Treatment Panel III to classify your LDL, HDL, total cholesterol and triglyceride levels.PREDICTORSRESPONSEAgeyearsGenderMaleFemale Do you have any of the following?YesNoCoronary heart diseaseCarotid artery disease (symptomatic)Peripheral arterial diseaseAbdominal aortic aneurysmDiabetesDo you have a family history of premature coronary heart disease (males <55yrs; female <65yrs) in a first degree relative?Are you a smoker?*Is your blood pressure > 140/90 or are you prescribed medication to lower your blood pressure?**What is your LDL cholesterol***mg/dlHDL cholesterol***mg/dlTotal cholesterol***mg/dlTriglycerides***mg/dl*For these purposes "smoker" means any cigarette smoking in the past month**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.***Cholesterol and triglyceride values should be the average of at least two measurements obtained from lipoprotein analysisResultsWe have identified that you have one or more risk factor/s for developing cardiovascular disease. It may be advisable to talk with your General Practitioner to further assess your risk and optimal cholesterol levels to aim for.
LDL Cholesterol
your LDL level falls within the optimal range. No specific intervention is required, just maintain a healthy lifestyle.your LDL levels are slightly above optimal. You should discuss appropriate lifestyle changes with your General Practitioner.your LDL level is higher than what is considered optimal. You should consult your General Practitioner to discuss methods of lowering this level. This may include lifestyle changes and/or medication.please enter your LDL Cholesterol level.
HDL Cholesterol
your HDL level falls within the optimal range. No specific intervention is required, just maintain a healthy lifestyle.Your HDL cholesterol is in the normal range.your HDL level is lower than what is considered optimal. You should consult your General Practitioner to discuss methods of raising this level. This may include lifestyle changes and/or medication.please enter your HDL cholesterol level.
Total Cholesterol
your total cholesterol level is appropriate for your age and gender. However more important than the total level is the individual components, LDL and HDL. Optimally, your LDL should be low and your HDL high, check above to see that your level for these is optimal.your total cholesterol level is higher than what is considered optimal. You may like to discuss this with your General Practitioner and also assess the level of the individual components, LDL and HDL.please enter your total cholesterol level.
Triglycerides
your level of triglycerides falls within the optimal range. No specific intervention is required, just maintain a healthy lifestyle.your triglyceride level is higher than what is considered optimal. You may like to discuss these results with your General Practitioner.please enter your triglyceride level.Reference
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.
This information will be collected for educational purposes, however it will remain anonymous.
The primary concern in treatment is to reduce the risk of cardiovascular diseases, such as heart disease and stroke, by lowering blood cholesterol levels. If you are thought to have a genetic form of this disorder, treatment may be started at a very young age. In addition, genetic counselling and family screening may be considered in your treatment plan. People who benefit most from lowering their cholesterol are those who already have heart disease or who have multiple risk factors for the disease.
In addition to lifestyle changes, specific cholesterol-lowering medications are often prescribed.
LDL Cholesterol Levels to Aim for ToolThis risk assessment tool is based on data from the National Cholesterol Education Program and the findings of the Adult Treatment Panel III, to estimate LDL cholesterol levels to aim for.PredictorsAge years MaleFemaleGenderDo you have any of the following?YesNoCoronary heart diseaseCarotid artery disease (symptomatic)Peripheral arterial diseaseAbdominal aortic aneurysmDiabetes Do you have a family history of premature coronary heart disease (males <55yrs; female <65yrs) in a first degree relative? Are you a smoker?* Is your blood pressure > 140 / 90 or are you prescribed medication to lower your blood pressure?** What is your HDL cholesterol*** mmol/L OR mg/dl Total cholesterol**** mmol/L OR mg/dl ResultsCategory 1LDL goal: <2.56 mmol/L (100 mg/dL)
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.Category 2aLDL goal: <3.33 mmol/L (130 mg/dL)
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.Category 2bLDL goal: <3.33 mmol/L (130 mg/dL)
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.Category 3LDL goal: <4.10 mmol/L (160 mg/dL)
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.*For these purposes smoker means any cigarette smoking in the past month.
**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.
***HDL cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis. HDL cholesterol > 60 mg/dL counts as a negative risk factor; its presence removes one risk factor from the total count.
****Total cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
Reference:National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.
This tool needs javascript enabled to work.
PointsCHD or CHD risk equivalent:
- Coronary heart disease
- Carotid artery disease (symptomatic)
- Peripheral arterial disease
- Abdominal aortic aneurysm
- DiabetesSmokerBP >140/90 or on antihypertensivesHDLFamily historyAge (yrs)-1 >60mg/dL 0nonono noYounger than 45 for men or 55 for women.1 yesyes
For more information on cholesterol, including the health effects of high cholesterol and ways to lower cholesterol levels, as well as some useful tools, see Cholesterol.
For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition. References
Citkowitz E. Hypercholesterolemia, familial [online]. Omaha, NE: WebMD eMedicine; 2006 [cited 23 August 2006]. Available from: URL linkKumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book] Grundy SM, Bilheimer D, Chait A, et al. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA. 1993;269(23):3015-23. [Abstract]Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336(8708):129-33. [Abstract]Guidelines for the diagnosis and management of familial [online]. Sydney, NSW: Cardiac Society of Australia and New Zealand; 2005 [cited 23 August 2006]. Available from: URL linkWoodhouse S. A Common but Nearly Forgotten Life Threatening Disorder. Brisbane, QLD: University of Queensland; 2005.
Drugs/Products Used in the Treatment of This Disease:Crestor (Rosuvastatin calcium)Ezetrol (Ezetimibe)Gemfibrozil-BC (Gemfibrozil)Lipitor (Atorvastatin calcium)Nicotinic Acid (Nicotinic acid)Pravachol (Pravastatin sodium)Vytorin (Ezetimibe/ Simvastatin)Zocor (Simvastatin)
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