Hypercholesterolemia

Overview

Hypercholesterolemia, commonly known as high cholesterol, is a condition characterized by elevated levels of cholesterol in the blood. This lipid disorder affects approximately 38% of adults worldwide and is a major modifiable risk factor for cardiovascular disease, including heart attacks and strokes. Cholesterol is a waxy, fat-like substance that is essential for many bodily functions, including cell membrane structure, hormone production, and bile acid synthesis. However, when cholesterol levels become elevated, particularly low-density lipoprotein (LDL) cholesterol, it can lead to atherosclerosis and significant cardiovascular complications.

The condition is often called a "silent killer" because it typically produces no symptoms until serious complications develop. Most people with hypercholesterolemia are unaware of their condition until routine blood testing reveals elevated levels or until they experience a cardiovascular event. The condition can be primary (genetic) or secondary (caused by other conditions or medications). Primary hypercholesterolemia includes familial hypercholesterolemia, a genetic disorder affecting the body's ability to remove LDL cholesterol from the blood, while secondary causes include diabetes, hypothyroidism, kidney disease, and certain medications.

Cholesterol is transported in the blood by lipoproteins, which are classified based on their density. Low-density lipoprotein (LDL) is often called "bad" cholesterol because it carries cholesterol from the liver to tissues and can contribute to plaque formation in arteries. High-density lipoprotein (HDL) is known as "good" cholesterol because it transports cholesterol from tissues back to the liver for disposal or recycling. The balance between these different types of cholesterol, along with triglycerides, determines overall cardiovascular risk.

The development of atherosclerosis begins when LDL cholesterol particles become trapped in artery walls and undergo oxidation, triggering an inflammatory response. This process leads to the formation of atherosclerotic plaques, which can narrow arteries and reduce blood flow to vital organs. Over time, these plaques can rupture, leading to blood clot formation and potentially causing heart attacks, strokes, or peripheral artery disease. Understanding and managing hypercholesterolemia is crucial for preventing these serious cardiovascular complications and maintaining long-term health.

Symptoms

Hypercholesterolemia is typically asymptomatic in its early stages, but some individuals may experience subtle symptoms or complications.

Associated Symptoms

Early Warning Signs

Most people with hypercholesterolemia have no symptoms, but some may notice:

• Fatigue or decreased energy
• Occasional chest discomfort
• Shortness of breath with exertion
• Cold hands and feet
• Leg cramps during walking

Physical Signs of Severe Hypercholesterolemia

Xanthomas

• Tendon xanthomas: Cholesterol deposits in tendons (especially Achilles)
• Eruptive xanthomas: Yellow bumps on skin, especially buttocks and elbows
• Palmar xanthomas: Yellow-orange deposits in palm creases
• Tuberous xanthomas: Large nodules on elbows, knees, or buttocks

Xanthelasma

• Yellowish cholesterol deposits around the eyelids
• Flat or slightly raised patches
• Usually painless and cosmetic concern
• May indicate familial hypercholesterolemia

Corneal Arcus

• Grayish-white ring around the cornea
• More significant if present before age 45
• May indicate severe hypercholesterolemia
• Common in elderly but concerning in young adults

Cardiovascular Complications

Coronary Artery Disease

• Chest pain or pressure (angina)
• Pain radiating to arms, neck, or jaw
• Shortness of breath
• Nausea or sweating
• Fatigue with minimal exertion

Peripheral Artery Disease

• Leg pain with walking (claudication)
• Cold feet or legs
• Weak pulses in feet
• Slow-healing wounds on legs or feet
• Hair loss on legs

Cerebrovascular Disease

• Transient ischemic attacks (mini-strokes)
• Sudden weakness or numbness
• Speech difficulties
• Vision changes
• Dizziness or balance problems

Metabolic Syndrome Symptoms

Hypercholesterolemia often occurs with other metabolic disorders:

• Increased abdominal weight
• High blood pressure symptoms
• Frequent urination (diabetes)
• Increased thirst
• Blurred vision
• Slow wound healing

Symptoms in Familial Hypercholesterolemia

Heterozygous Form

• Usually asymptomatic until adulthood
• Early coronary artery disease (before age 55 in men, 65 in women)
• Tendon xanthomas in 75% of patients
• Family history of early heart disease

Homozygous Form (Rare)

• Severe symptoms in childhood
• Extensive xanthomas
• Corneal arcus in children
• Heart disease before age 10-20
• Aortic stenosis

Emergency Symptoms

Seek immediate medical attention for:

• Severe chest pain or pressure
• Pain radiating down left arm
• Sudden shortness of breath
• Sudden weakness on one side
• Sudden speech difficulties
• Loss of vision
• Severe leg pain with exercise

Long-term Complications

• Progressive atherosclerosis
• Increased risk of blood clots
• Kidney disease from vascular damage
• Erectile dysfunction in men
• Memory problems from reduced brain circulation
• Reduced exercise tolerance

Causes

Hypercholesterolemia results from a complex interplay of genetic, lifestyle, and medical factors that affect cholesterol production and metabolism.

Primary Causes (Genetic)

Familial Hypercholesterolemia

• LDL receptor defects: Mutations affecting cholesterol uptake
• ApoB mutations: Defective protein for LDL binding
• PCSK9 gain-of-function: Increased LDL receptor degradation
• Inheritance pattern: Autosomal dominant
• Prevalence: 1 in 200-500 people

Polygenic Hypercholesterolemia

• Multiple genetic variants with small effects
• More common than familial hypercholesterolemia
• Interactive effects with lifestyle factors
• Variable penetrance and expression

Secondary Causes

Endocrine Disorders

• Hypothyroidism: Reduced cholesterol clearance
• Diabetes mellitus: Altered lipid metabolism
• Cushing's syndrome: Excess cortisol effects
• Growth hormone deficiency: Metabolic alterations
• Polycystic ovary syndrome: Insulin resistance

Kidney Disease

• Nephrotic syndrome
• Chronic kidney disease
• Uremia
• Protein loss affecting metabolism

Liver Disease

• Primary biliary cholangitis
• Cholestasis
• Hepatitis
• Fatty liver disease

Lifestyle Factors

Dietary Causes

• Saturated fat intake: Increases LDL cholesterol
• Trans fat consumption: Raises LDL, lowers HDL
• Dietary cholesterol: Modest effect on blood levels
• Excess calories: Weight gain and metabolic changes
• Refined carbohydrates: Increased triglycerides
• Low fiber intake: Reduced cholesterol excretion

Physical Activity

• Sedentary lifestyle
• Lack of aerobic exercise
• Reduced muscle mass
• Poor metabolic fitness
• Insulin resistance development

Other Lifestyle Factors

• Obesity: Especially abdominal obesity
• Smoking: Lowers HDL cholesterol
• Excessive alcohol: Raises triglycerides
• Chronic stress: Affects hormone levels
• Sleep deprivation: Alters metabolism

Medications

Drugs That Raise Cholesterol

• Corticosteroids: Long-term use
• Anabolic steroids: Lower HDL cholesterol
• Progestins: Some formulations
• Thiazide diuretics: May increase LDL
• Beta-blockers: Some types affect lipids
• Immunosuppressants: Cyclosporine, tacrolimus
• Protease inhibitors: HIV medications
• Isotretinoin: Acne medication

Age and Gender Factors

Age-Related Changes

• Gradual increase in cholesterol with age
• Reduced metabolic rate
• Decreased physical activity
• Hormonal changes
• Accumulated lifestyle effects

Gender Differences

• Premenopausal women: Protected by estrogen
• Postmenopausal women: Rapid increase in LDL
• Men: Earlier onset of elevated cholesterol
• Pregnancy: Temporary physiological increase

Pathophysiology

Cholesterol Synthesis

• Hepatic production (75% of body cholesterol)
• HMG-CoA reductase enzyme regulation
• Feedback inhibition mechanisms
• Circadian rhythm effects

Cholesterol Metabolism

• LDL receptor pathway
• Reverse cholesterol transport
• Bile acid synthesis
• Intestinal absorption
• Lipoprotein metabolism

Environmental Factors

• Air pollution exposure
• Socioeconomic status
• Access to healthy foods
• Cultural dietary patterns
• Occupational factors
• Geographic location

Risk Factors

Multiple factors can increase the likelihood of developing hypercholesterolemia and its cardiovascular complications:

Non-Modifiable Risk Factors

Genetic Factors

• Family history: First-degree relatives with high cholesterol
• Familial hypercholesterolemia: Inherited genetic mutations
• Ethnicity: Some populations have higher risk
• Gender: Men at earlier risk, women after menopause
• Genetic polymorphisms: Variations in cholesterol metabolism genes

Age

• Men: Risk increases after age 45
• Women: Risk increases after age 55 or menopause
• Children: Risk if familial hypercholesterolemia
• Elderly: Highest prevalence in those over 65

Modifiable Lifestyle Risk Factors

Diet

• High saturated fat intake (>10% of calories)
• Trans fat consumption
• Excessive dietary cholesterol
• Low fiber diet
• High refined carbohydrate intake
• Frequent processed food consumption
• Large portion sizes
• Irregular eating patterns

Physical Activity

• Sedentary lifestyle
• Less than 150 minutes moderate exercise per week
• Lack of strength training
• Prolonged sitting time
• Low cardiorespiratory fitness

Weight and Body Composition

• Obesity (BMI ≥30 kg/m²)
• Overweight (BMI 25-29.9 kg/m²)
• Abdominal obesity (waist circumference >40" men, >35" women)
• High body fat percentage
• Recent weight gain

Substance Use

• Tobacco smoking (lowers HDL)
• Excessive alcohol consumption
• Recreational drug use
• Secondhand smoke exposure

Medical Risk Factors

Metabolic Conditions

• Diabetes mellitus: Type 1 and Type 2
• Metabolic syndrome: Cluster of risk factors
• Insulin resistance: Prediabetic state
• Hypothyroidism: Underactive thyroid
• Polycystic ovary syndrome: Hormonal disorder

Cardiovascular Conditions

• Hypertension
• Previous heart attack
• Stroke
• Peripheral artery disease
• Coronary artery disease

Other Medical Conditions

• Chronic kidney disease
• Liver disease
• Autoimmune disorders
• HIV infection
• Sleep apnea
• Chronic inflammatory conditions

Medication-Related Risk Factors

• Long-term corticosteroid use
• Immunosuppressive medications
• Certain blood pressure medications
• Hormone replacement therapy
• Antipsychotic medications
• Some seizure medications

Psychosocial Risk Factors

• Chronic stress
• Depression
• Social isolation
• Low socioeconomic status
• Limited education
• Work-related stress
• Poor sleep quality

Environmental Risk Factors

• Air pollution exposure
• Limited access to healthy foods
• Unsafe neighborhoods for exercise
• Chemical exposures
• Seasonal variations

Reproductive and Hormonal Factors

Women-Specific

• Menopause and hormonal changes
• Pregnancy complications (gestational diabetes)
• Polycystic ovary syndrome
• Certain contraceptive methods
• Early menopause

Men-Specific

• Low testosterone levels
• Andropause
• Anabolic steroid use

Risk Factor Combinations

Multiple risk factors have synergistic effects:

• Diabetes + hypertension + obesity
• Smoking + family history + sedentary lifestyle
• Age + gender + multiple metabolic factors
• Genetic predisposition + poor lifestyle choices

Population-Specific Risks

High-Risk Ethnic Groups

• South Asian populations
• African Americans
• Hispanic/Latino populations
• Native Americans
• Pacific Islanders

Diagnosis

Diagnosis of hypercholesterolemia relies primarily on blood tests that measure various lipid components and assess cardiovascular risk.

Lipid Panel Testing

Fasting Lipid Profile

• Total cholesterol: Sum of all cholesterol types
• LDL cholesterol: "Bad" cholesterol
• HDL cholesterol: "Good" cholesterol
• Triglycerides: Another type of blood fat
• Fasting requirement: 9-12 hours without food

Non-Fasting Lipid Testing

• Total cholesterol and HDL can be measured anytime
• LDL calculated may be less accurate
• Triglycerides significantly affected by recent meals
• Useful for initial screening

Cholesterol Level Classifications

Total Cholesterol (mg/dL)

• Desirable: Less than 200
• Borderline high: 200-239
• High: 240 and above

LDL Cholesterol (mg/dL)

• Optimal: Less than 100
• Near optimal: 100-129
• Borderline high: 130-159
• High: 160-189
• Very high: 190 and above

HDL Cholesterol (mg/dL)

• Low (men): Less than 40
• Low (women): Less than 50
• High: 60 and above (protective)

Triglycerides (mg/dL)

• Normal: Less than 150
• Borderline high: 150-199
• High: 200-499
• Very high: 500 and above

Advanced Lipid Testing

Additional Measurements

• Apolipoprotein B (ApoB): Better predictor than LDL
• Apolipoprotein A1 (ApoA1): Major HDL protein
• Lipoprotein(a): Genetic risk factor
• LDL particle number: More precise risk assessment
• Small dense LDL: More atherogenic particles

Inflammatory Markers

• C-reactive protein (CRP)
• Interleukin-6
• Tumor necrosis factor
• Myeloperoxidase

Screening Guidelines

Age-Based Recommendations

• Adults 20-39: Every 4-6 years if low risk
• Adults 40-75: Every 1-2 years
• Adults 76+: Individualized based on health status
• Children 9-11: One-time screening
• Adolescents 17-21: One-time screening

High-Risk Population Screening

• Family history of early heart disease
• Diabetes or prediabetes
• Hypertension
• Smoking
• Obesity
• Metabolic syndrome

Cardiovascular Risk Assessment

Risk Calculators

• ASCVD Risk Calculator: 10-year cardiovascular risk
• Framingham Risk Score: Traditional risk assessment
• Reynolds Risk Score: Includes family history and CRP
• QRISK: UK-based calculator

Risk Categories

• Low risk: <5% 10-year ASCVD risk
• Intermediate risk: 5-20% 10-year ASCVD risk
• High risk: >20% 10-year ASCVD risk
• Very high risk: Established cardiovascular disease

Genetic Testing

Indications for Testing

• Very high cholesterol levels (>300 mg/dL)
• Strong family history of early heart disease
• Physical signs of familial hypercholesterolemia
• Tendon xanthomas
• Corneal arcus in young adults

Genetic Mutations Tested

• LDL receptor gene mutations
• Apolipoprotein B gene mutations
• PCSK9 gene mutations
• Polygenic risk scores

Additional Diagnostic Tests

To Rule Out Secondary Causes

• Thyroid function tests: TSH, T4
• Liver function tests: ALT, AST, bilirubin
• Kidney function: Creatinine, BUN
• Diabetes screening: Glucose, HbA1c
• Protein levels: Albumin, total protein

Cardiovascular Imaging

• Coronary artery calcium scoring
• Carotid intima-media thickness
• Ankle-brachial index
• Echocardiogram
• Stress testing

Monitoring and Follow-up

• Repeat testing 6-8 weeks after lifestyle changes
• Monitor every 3-6 months when starting medications
• Annual monitoring once stable
• Liver enzymes monitoring with statin therapy
• Muscle symptoms assessment

Treatment Options

Treatment of hypercholesterolemia involves a comprehensive approach combining lifestyle modifications and, when necessary, medications to reduce cardiovascular risk.

Lifestyle Modifications

Dietary Changes

• Reduce saturated fat: <7% of total calories
• Eliminate trans fats: Read food labels carefully
• Increase soluble fiber: 10-25 grams daily
• Plant stanols/sterols: 2 grams daily
• Omega-3 fatty acids: Fish twice weekly
• Mediterranean diet pattern: Proven cardiovascular benefits
• DASH diet: Emphasizes fruits, vegetables, whole grains
• Portion control: Maintain healthy weight

Physical Activity

• Aerobic exercise: 150 minutes moderate intensity weekly
• Resistance training: 2-3 sessions per week
• High-intensity interval training: For experienced exercisers
• Daily walking: 10,000 steps goal
• Reduce sedentary time: Break up prolonged sitting

Weight Management

• Achieve and maintain healthy BMI (18.5-24.9)
• Reduce waist circumference
• Gradual weight loss (1-2 pounds per week)
• Behavioral modification techniques
• Regular monitoring and support

Other Lifestyle Changes

• Smoking cessation: Improves HDL cholesterol
• Moderate alcohol consumption: If appropriate
• Stress management: Meditation, yoga, counseling
• Adequate sleep: 7-9 hours nightly

Pharmacological Treatment

Statin Medications (First-line)

• Atorvastatin (Lipitor): 10-80 mg daily
• Rosuvastatin (Crestor): 5-40 mg daily
• Simvastatin (Zocor): 10-40 mg daily
• Pravastatin (Pravachol): 10-80 mg daily
• Lovastatin (Mevacor): 20-80 mg daily
• Fluvastatin (Lescol): 20-80 mg daily
• Pitavastatin (Livalo): 1-4 mg daily

Non-Statin Medications

• Ezetimibe (Zetia): Cholesterol absorption inhibitor
• PCSK9 inhibitors: Evolocumab, alirocumab
• Bile acid sequestrants: Cholestyramine, colesevelam
• Fibrates: For high triglycerides
• Niacin: Limited use due to side effects
• Omega-3 fatty acids: Prescription formulations

Combination Therapy

• Statin + ezetimibe
• Statin + PCSK9 inhibitor
• Multiple agents for severe cases
• Tailored to individual response

Treatment Goals

LDL Cholesterol Targets

• Very high risk: <70 mg/dL
• High risk: <100 mg/dL
• Moderate risk: <130 mg/dL
• Low risk: <160 mg/dL

Additional Targets

• Non-HDL cholesterol: 30 mg/dL higher than LDL target
• HDL cholesterol: >40 mg/dL (men), >50 mg/dL (women)
• Triglycerides: <150 mg/dL
• Apolipoprotein B: <80 mg/dL (high risk)

Special Populations

Familial Hypercholesterolemia

• Aggressive LDL reduction (>50%)
• High-intensity statin therapy
• Often requires combination therapy
• PCSK9 inhibitors frequently needed
• LDL apheresis for severe cases

Diabetes

• Statin therapy for most patients >40 years
• Aggressive LDL targets
• Address multiple risk factors
• Monitor for drug interactions

Elderly Patients

• Consider life expectancy and quality of life
• Start with lower doses
• Monitor for drug interactions
• Assess cognitive function

Children and Adolescents

• Lifestyle modifications first-line
• Medications if severe familial hypercholesterolemia
• Statin therapy >10 years old if indicated
• Family-based interventions

Alternative and Complementary Therapies

Supplements

• Red yeast rice: Contains natural statins
• Plant stanols/sterols: Reduce cholesterol absorption
• Psyllium: Soluble fiber supplement
• Berberine: May lower cholesterol
• Coenzyme Q10: May help with statin side effects

Mind-Body Therapies

• Meditation and mindfulness
• Yoga and tai chi
• Biofeedback
• Stress reduction programs

Monitoring and Side Effects

Statin Monitoring

• Liver enzymes at baseline and follow-up
• Muscle symptoms assessment
• Creatine kinase if muscle symptoms
• Diabetes risk monitoring
• Drug interaction screening

Common Side Effects

• Muscle aches and weakness
• Liver enzyme elevation
• Digestive issues
• Memory concerns (rare)
• Diabetes risk (small increase)

Surgical Interventions

LDL Apheresis

• For severe familial hypercholesterolemia
• When medications insufficient
• Weekly or biweekly treatments
• Removes LDL from blood

Liver Transplantation

• Extreme cases of homozygous familial hypercholesterolemia
• Last resort option
• Replaces defective cholesterol metabolism

Prevention

Prevention of hypercholesterolemia focuses on maintaining healthy lifestyle habits throughout life and early identification of risk factors.

Primary Prevention

Dietary Strategies

• Heart-healthy eating patterns: Mediterranean, DASH, or plant-based diets
• Limit saturated fats: Choose lean proteins and low-fat dairy
• Increase fiber intake: Whole grains, fruits, and vegetables
• Choose healthy fats: Olive oil, nuts, avocados, fatty fish
• Limit processed foods: Reduce sodium and added sugars
• Control portions: Use smaller plates, measure servings
• Cook at home: Better control over ingredients

Physical Activity Guidelines

• Regular aerobic exercise: 150 minutes moderate or 75 minutes vigorous weekly
• Strength training: 2+ days per week
• Daily movement: Take stairs, walk meetings, active hobbies
• Reduce sitting time: Stand and move every hour
• Find enjoyable activities: Dancing, hiking, sports
• Progressive increase: Gradually build activity levels

Weight Management

• Maintain healthy BMI (18.5-24.9 kg/m²)
• Monitor weight regularly
• Address weight gain early
• Focus on sustainable habits
• Seek professional help when needed

Lifestyle Factors

Smoking Prevention and Cessation

• Never start smoking
• Quit smoking programs
• Avoid secondhand smoke
• Nicotine replacement therapy
• Behavioral counseling
• Support groups

Stress Management

• Develop healthy coping strategies
• Regular relaxation practices
• Maintain social connections
• Work-life balance
• Professional counseling when needed
• Time management skills

Sleep Hygiene

• 7-9 hours of sleep nightly
• Consistent sleep schedule
• Good sleep environment
• Limit screen time before bed
• Address sleep disorders

Early Detection and Screening

Regular Health Checkups

• Annual physical examinations
• Blood pressure monitoring
• Lipid screening per guidelines
• Diabetes screening
• Weight and BMI assessment

Family History Assessment

• Document family cardiovascular history
• Earlier screening if family history positive
• Genetic counseling if indicated
• Share information with healthcare providers

Age-Specific Prevention

Children and Adolescents

• Healthy eating habits: Limit fast food and sugary drinks
• Active lifestyle: 60 minutes daily activity
• Screen time limits: <2 hours recreational screen time
• Family meals: Regular eating together
• Education: Teach about nutrition and exercise
• Screening: If family history or risk factors

Young Adults

• Establish healthy habits early
• Regular exercise routine
• Avoid excessive alcohol
• Don't start smoking
• Begin cholesterol screening
• Stress management skills

Middle Age

• Regular health screenings
• Address risk factors promptly
• Maintain physical activity
• Weight management
• Hormone changes awareness

Older Adults

• Continue healthy lifestyle habits
• Regular medical monitoring
• Medication compliance
• Social engagement
• Fall prevention

Community and Environmental Prevention

Policy Level

• Trans fat bans
• Menu labeling requirements
• Safe walking and biking infrastructure
• School nutrition programs
• Workplace wellness programs

Community Resources

• Farmers markets and healthy food access
• Community gardens
• Recreation centers and parks
• Walking groups and fitness classes
• Health education programs

High-Risk Population Prevention

Genetic Risk

• Earlier and more frequent screening
• Aggressive lifestyle modifications
• Family cascade screening
• Genetic counseling
• Preventive medications when appropriate

Comorbid Conditions

• Optimal diabetes management
• Blood pressure control
• Thyroid function optimization
• Kidney disease management
• Medication review and adjustment

Technology and Tools

• Fitness trackers and apps
• Nutrition tracking applications
• Telemedicine and remote monitoring
• Online education resources
• Virtual support groups
• Home cholesterol testing kits

When to See a Doctor

Regular medical evaluation is essential for early detection and management of hypercholesterolemia, as the condition is typically asymptomatic.

Routine Screening Schedule

Adults Without Risk Factors

• Ages 20-39: Every 4-6 years
• Ages 40-75: Every 1-2 years
• Ages 76+: Discuss with healthcare provider

High-Risk Individuals

• Family history: Earlier and more frequent screening
• Diabetes: Annual screening
• Hypertension: Annual screening
• Smoking: Annual screening
• Obesity: Annual screening

Immediate Medical Attention

Cardiovascular Emergency Symptoms

• Chest pain: Severe, crushing, or persistent
• Heart attack symptoms: Pain radiating to arm, neck, jaw
• Stroke symptoms: Sudden weakness, speech problems, vision loss
• Severe shortness of breath: Especially at rest
• Loss of consciousness: Fainting or near-fainting
• Severe leg pain: With walking, may indicate peripheral artery disease

Schedule Appointment Soon

New or Worsening Symptoms

• Chest discomfort with exertion
• Unusual fatigue or weakness
• Shortness of breath with minimal activity
• Leg pain or cramping when walking
• Cold hands or feet
• Erectile dysfunction (men)
• Memory problems or confusion

Physical Signs

• Yellow deposits around eyes (xanthelasma)
• Yellow bumps on skin (xanthomas)
• White or gray ring around cornea (corneal arcus) if under 45
• Swelling in legs or feet
• Significant weight gain

Follow-up Appointments

After Starting Treatment

• 6-8 weeks: After lifestyle changes
• 6-12 weeks: After starting medications
• Every 3-6 months: Until goals achieved
• Every 6-12 months: Once stable

Medication Monitoring

• Liver function tests
• Muscle symptom assessment
• Drug interaction review
• Side effect evaluation
• Dose adjustment if needed

Special Circumstances

Family History of Early Heart Disease

• Male relatives with heart disease before age 55
• Female relatives with heart disease before age 65
• Family history of familial hypercholesterolemia
• Multiple family members with high cholesterol
• Family history of sudden cardiac death

Pregnancy and Cholesterol

• Pre-pregnancy cholesterol assessment
• Discontinue statins if pregnant
• Post-pregnancy reassessment
• Breastfeeding medication safety

Children and Adolescents

• Screen if: Family history of early heart disease
• Screen if: Family history of high cholesterol
• Screen if: Overweight or obese
• Screen if: Diabetes or other risk factors
• Routine screening: Once between ages 9-11 and 17-21

What to Discuss with Your Doctor

Medical History

• Family history of heart disease, stroke, or high cholesterol
• Personal history of cardiovascular events
• Current medications and supplements
• Other medical conditions
• Smoking history
• Diet and exercise habits

Current Symptoms

• Chest pain or discomfort
• Shortness of breath
• Fatigue or weakness
• Leg pain with walking
• Any new or changing symptoms

Lifestyle Factors

• Current diet patterns
• Exercise routine
• Weight changes
• Stress levels
• Sleep quality
• Alcohol consumption

Preparing for Your Appointment

• List all medications, including over-the-counter and supplements
• Document family health history
• Note any symptoms or concerns
• Bring previous test results
• Prepare questions about treatment options
• Consider bringing a family member for support

Questions to Ask Your Doctor

• What are my cholesterol numbers and what do they mean?
• What is my cardiovascular risk level?
• Do I need medication or can lifestyle changes be enough?
• How often should I have my cholesterol checked?
• What side effects should I watch for with medications?
• Should my family members be tested?
• What diet and exercise plan do you recommend?

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Frequently Asked Questions