High cholesterol: what to do in case of hypercholesterolaemia

By Cristiano Antonino On Apr 4, 2023

Cholesterol is a molecule belonging to the lipid class, present in the blood, partly self-produced by the liver and partly introduced through food intake

Its consistency is very similar to wax, which makes it, when present in above-average amounts (hypercholesterolaemia), capable of literally ‘sticking’ to the walls of blood vessels, obstructing them and preventing the passage of blood.

Statistics show that at least one Italian in three suffers from hypercholesterolaemia (but 40% do not know they suffer from it as they are asymptomatic).

However, high cholesterol is a condition not to be underestimated and not to be taken lightly, as it can have serious consequences on cardiovascular health.

In fact, there are a growing number of cases of heart attacks and strokes due to high levels of LDL or bad cholesterol in the blood, caused by a poor diet or high sedentary activity.

What is cholesterol and when is high cholesterol?

Cholesterol is an important component of cells and is indispensable for their functioning. If present in excess in the blood, it becomes one of the main risk factors for the development of cardiovascular disease.

The excess amounts, no longer useful to the cells, are in fact deposited on the walls of the blood vessels and clog them by forming atherosclerotic plaques, which thus obstruct the free passage of blood.

The arteries therefore lose their elasticity, leading to an increased risk of developing strokes and heart attacks.

Cholesterol is transported in the blood by special protein structures called lipoproteins, of which there are several types, which make up what is known as ‘total cholesterol’ (the names of the different types of cholesterol depend directly on the lipoprotein to which they bind and how they are transported in the body).

HDL (High Density Lipoprotein) cholesterol, better known as ‘good cholesterol’, when present in the blood in adequate amounts, helps cleanse the blood vessels of bad cholesterol.

The latter is carried back from the vessels to the liver.

Good HDL cholesterol levels protect the heart and cardiovascular system.

In all cases, it should never be less than 30% of the total.

LDL (Low Density Lipoprotein) cholesterol is the ‘bad’ cholesterol, which is transported from the liver to the arteries, where it is deposited in the form of plaques that can obstruct normal blood flow.

Total blood cholesterol arises from the combination of its HDL and LDL components and a further, special type called VLDL (Very Low Density Lipoprotein).

This is a lipoprotein that has more triglycerides than the amount of cholesterol transported.

The following table is intended to summarise and relate the amounts of cholesterol in the blood and the degrees of cholesterolaemia in order to help the patient in understanding his or her condition.

Mg of cholesterol in one dl of blood (mg/dl) Cholesterolaemia grade

<200 mg/dl Normal cholesterolemia – ideal situation

200 – 249 mg/dl Mild hypercholesterolaemia

250 – 299 mg/dl Moderate hypercholesterolaemia

> 299 mg/dl Severe hypercholesterolaemia

Main causes of hypercholesterolaemia

For years, experts have emphasised that the major causes of hypercholesterolaemia are associated with an unhealthy and mainly sedentary lifestyle.

The main risk factors predisposing an individual to this condition are:

overweight, with a BMI (Body Mass Index) of 30 or more
obesity, especially abdominal obesity (excessive waistline)
poor diet. Following an unbalanced diet rich in fat and sugar raises cholesterol levels
lack of physical activity. Being sedentary raises LDL levels and lowers HDL levels
smoking. It damages blood vessels by itself, making it easier to accumulate fat in already damaged vessels.

To the risk factors just described, others can be added, including the presence of pathological conditions (type 2 diabetes mellitus, hypertension) or heredity and genetics (hereditary or familial hypercholesterolaemia).

In the latter case, mutations may be present at the level of the LDL-receptor gene which, by not functioning properly, makes it difficult to eliminate LDL-cholesterol.

Symptoms of hypercholesterolaemia

Being affected by hypercholesterolaemia does not presuppose the presence of unambiguous and specific symptoms.

Most of the time, high cholesterolaemia values are only noticed as a result of routine blood tests.

What high cholesterol can lead to: all the consequences

Excessive levels of LDL-cholesterol in the blood lead to the formation of plaques that clog the blood vessels, with more or less serious consequences for the entire organism, which finds itself irreparably deprived of the most important means of transport for the flow of oxygen and nutrients necessary for its functioning.

The consequences of hypercholesterolaemia are mainly of a cardiovascular nature.

It increases the risk of developing

atherosclerosis: accumulation and deposition of fat on the walls of the arteries. The blood vessels are obstructed, the blood does not flow properly, the muscles and organs of the body are not adequately oxygenated
angina pectoris: chest pain that appears when the heart is not sufficiently oxygenated. Blood flow through the coronary arteries gradually decreases until, in severe cases, it no longer flows at all
infarction: death of tissue, usually cardiac, caused by stopping blood flow
stroke: brain damage that occurs due to severe and sudden lack of blood flow to the brain.

How hypercholesterolaemia is diagnosed

In general, the diagnosis is made following blood tests.

The values are expressed in mg/dl, i.e. how many milligrams of this fat are present in one decilitre of blood.

Total cholesterol

It is considered low and average when values are below 200 mg/dl.

Between 200-239 mg/dl is considered moderate cardiovascular risk.

Above 240 mg/dl the values and risk are high.

LDL-cholesterol

It is considered optimal when values are below 130 mg/dl (although it should remain between 70-100 mg/dl).

Between 130-159 mg/dl is considered moderate cardiovascular risk.

Above 160 mg/dl the values and risk are high.

HDL cholesterol

Above 60 mg/dl is the desired value as it helps protect the body against cardiovascular diseases.

Between 50-59 mg/dl the cardiovascular risk becomes medium to low.

Below 40 mg/dl in men and 50 mg/dl in women, the situation becomes problematic and the risk high.

Hypercholesterolaemia: treatment and prevention

After blood tests have shown higher-than-normal cholesterol values, it is good to know that they can easily return to normal by following the right treatment and prevention protocol, which certainly involves a healthy lifestyle, consisting of a proper diet and adequate exercise.

When suffering from high cholesterol, sport is essential to maintain a normal weight.

Regular exercise, especially aerobic exercise with high intensity intervals (HIIT), helps to act on atherosclerotic plaques by eliminating them.

It is important that, once blood tests show satisfactory and no longer harmful cholesterol levels, one continues to maintain the new habits.

If lifestyle changes do not yield significant results and blood tests still show high LDL values, it will be up to the doctor to decide whether to prescribe drug therapy.

The most commonly used active ingredients of which are:

Statins: they block the production of LDL, help the liver eliminate the already present and excess LDL in the blood, and increase the synthesis of HDL. They can lead to pain and discomfort in the muscles and are contraindicated for those suffering from serious liver disease and dysfunction.
Bile sequestrants: these bind to bile salts that contain cholesterol to be eliminated and prevent it from being absorbed by the intestine. They can give rise to side effects such as halitosis, belching, meteorism and constipation.
Niacin or nicotinic acid: lowers total and LDL cholesterol, raising HDL values in the blood. Side effects include itching, headache and reddening of the skin.
Fibrates: in addition to treating high triglycerides, they are also useful in lowering cholesterol levels.
Ezetimibe: hinders the absorption of cholesterol and bile salts by the intestine as with statins.

Hypercholesterolaemia: what diet to follow

If the tests show high LDL-cholesterol levels, a first step towards solving the problem is to change your eating habits by following a healthy, balanced diet.

The Mediterranean diet, because of the wide range of foods it offers, is certainly a great ally in this battle.

One can freely eat cereals and pulses, which, together with fruit and vegetables, contain no fat and help reduce excess cholesterol.

Fibre, which reduces the absorption of this type of lipid, is very important in plant-based foods.

Cereals (bread, pasta, rice, barley, spelt, oats) are preferably whole grain and should not be overly seasoned, preferably with oil rather than unsaturated fats such as butter, lard and cream.

Meat and fish can be eaten freely

The former is preferred in lean cuts, but can be eaten either red or white.

Fish, rich in Omega 3, is ideal for combating cholesterol, but it is recommended to avoid frying and limit the intake of shellfish and crustaceans because, on the contrary, they are very rich in fat.

Eliminating fat altogether is not good, as our bodies need it for growth, cellular functioning and daily energy.

It is good to limit intake during the week, always preferring unsaturated fats to saturated fats (foods of animal origin).

For the same reason, it is advisable to limit cold meats, meat offal, cheese and eggs (even egg pasta and sweets containing them) and to consume skimmed and not whole milk products (milk, yoghurt).

Absolutely eliminate junk food, precooked and packaged foods, and alcohol intake. Limit intake of sweets to 1-2 times a week.

Prefer simple and wholesome cooking methods such as boiling, steaming and grilling. Avoid frying.

Finally, it is recommended not to follow drastic, do-it-yourself diets, but always rely on expert advice.

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