High Cholesterol

High cholesterol is in our population relatively widespread disease. The cholesterol itself is a vitally important substance, which is needed by our organism to build stable cell membranes and hormones. In high concentrations, however, it may be dangerous by accelerating the process of atherosclerosis. This process can be very simply described as gradual deposition of cholesterol into arterial walls that gradually narrow.


The cholesterol is partially absorbed from food in the small intestine and partially produced by our metabolism. In a very simplified way, we can distinguish three main values of cholesterol in the blood.

Total cholesterol

This is the total value of cholesterol in blood. It is considered abnormal when it is higher than 5.2 mmols per liter (of course, this value may be variable in different countries). However, before stating any diagnosis, we should also know the other values named below.

LDL cholesterol

This is a component of the total cholesterol. It is called “bad cholesterol” as it is exactly this cholesterol subtype that contributes to the atherosclerosis. Its blood level is considered abnormal when it is higher than three mmols per liter.

HDL cholesterol

This is a component of the total cholesterol, which is known as the “good cholesterol”. Its value shows the ability of our body to transport the cholesterol into the liver where it is further processed and excreted. Abnormal level is lower than 1.2 mmols per liter in men and 1.0 mmols per liter in women.


Triglycerides are non-cholesterol fats. They are composed of glycerol and fatty acids. Their high concentration also contributes to accelerated process of atherosclerosis and to cardiovascular diseases. In addition, people with very high level of triglycerides have increased risk of acute pancreatitis.


High cholesterol (or high triglycerides) is usually caused by a combination of genetic predisposition and lifestyle including unhealthy diet, lack of physical exercise and chronic alcoholism. Some congenital forms are caused by known genetic disorders such as the familial hypercholesterolemia.


High cholesterol has no symptoms, but when unsolved for a long time, it may manifest by cardiovascular complications of atherosclerosis including angina pectoris, heart attack, ischemic stroke, peripheral artery disease, etc.


The value of cholesterol can be easily evaluated from a sample of venous blood. However, it is necessary to take the blood on an empty stomach and examine not only the total value of cholesterol, but also of both its main subtypes and also the level of triglycerides. In a patient with very high cholesterol, it is advisable to check his or her personal history to rule out familial occurrence and when there is a suspicion of any form of congenital hypercholesterolemia, it is possible to perform genetic testing.


The treatment should always include change of the lifestyle, physical exercise, healthy diet with reduced intake of animal fats and increase intake of vegetables, fruit and seafood. Obesity should be prevented or treated. It is reported that loss of 10% of weight in an obese patient has a significantly positive impact on the health reducing risk of cardiovascular diseases. This means that a patient with 120 kilograms should lose approximately 12 kilograms.


It is appropriate to introduce the lifestyle changes and then check the cholesterol level again. When the values are still abnormally high, it is advisable to begin with pharmacotherapy. There are many hypolipidemic drugs and their effects are usually satisfactory. Probably the most commonly used are statins. The medications either block the synthesis of cholesterol molecules in our body or they reduce its intestinal absorption (or both). The goal is to decrease the level of LDL cholesterol (and triglycerides) and increase the HDL cholesterol.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources