Hypercholesterolemia often does not present with symptoms, yet a raised blood cholesterol level increases the risk of atherosclerosis and cardiovascular events such as stroke or heart attack.

When a physician is assessing whether a patient is at a low, moderate or high risk of cardiovascular disease, the following are taken into consideration:

• A blood test is performed and hypercholesterolemia is indicated if the level of low-density lipoproteins (LDLs) or triglyceride is raised or the level of high-density lipoproteins (HDLs) is too low.
• The presence of other cardiovascular risk factors are assessed such as diabetes, high blood pressure and obesity. Patients with additional risk factors require more aggressive treatment, even if their blood cholesterol is not particularly high. On the other hand, those with few or no risk factors can often be managed using lifestyle and dietary changes alone, without the need for medication.

Treatment approach

An outline of how hypercholesterolemia is managed is given below.

• A healthy, balanced diet rich in wholegrains, fibre, fruits and vegetables is recommended. The diet should also be low in saturated fats, which can be replaced by unsaturated fats. Such a diet can reduce cholesterol levels by up to 15%, which may be sufficient to treat mild cases of hypercholesterolemia.
• Engaging in physical activity for at least 120 minutes a week can significantly improve lipid levels.
• Quitting smoking can improve levels of HDL cholesterol, as well as decreasing blood pressure and lowering the risk of heart attack. After just one year of quitting, the risk of heart disease falls to half that of a smoker and after 15 years, the risk of heart disease is similar to that of a non-smoker.

Cholesterol-lowering drugs

Medications that can be taken to lower the blood cholesterol level include:

• A statin such as atorvastatin, simvastatin, or rosuvastatin is used to inhibit the liver enzyme that helps to produce cholesterol.
• Niacin is a B vitamin that is given in high doses to reduce triglycerides and also raise HDL cholesterol.
• Ezetimibe helps reduce the absorption of dietary cholesterol from the gut. This drug is not as effective as statins, but is associated with fewer adverse side effects.