Hypercholesterolemia (high cholesterol)

Cholesterol is a fatty substance produced by the liver and obtained from food, essential for building cell membranes, producing hormones, and synthesising vitamin D. It travels through the bloodstream carried by proteins called lipoproteins. The balance between different lipoprotein types determines cardiovascular risk.

The main lipid markers are:

• LDL cholesterol (low-density lipoprotein) carries cholesterol from the liver to tissues. Excess LDL deposits in artery walls, forming plaques that narrow and harden the arteries over time. It is the primary driver of atherosclerosis and cardiovascular disease.

• HDL cholesterol (high-density lipoprotein) carries cholesterol back to the liver for removal. Higher HDL is protective against cardiovascular disease.

• Triglycerides are fats carried in the blood, and levels can rise after meals. Persistently elevated triglycerides contribute independently to cardiovascular risk and are closely linked to metabolic syndrome.

• Apolipoprotein B (ApoB) reflects the number of atherogenic (plaque-forming) lipoprotein particles in the blood. It is a more precise cardiovascular risk marker than LDL alone.

• Lipoprotein(a) or Lp(a) is a genetically determined lipoprotein that independently raises cardiovascular risk and does not respond to standard lifestyle or statin treatment.

High cholesterol causes no symptoms. It accumulates silently in artery walls over years, causing progressive narrowing and stiffening before any clinical event occurs.

In rare cases of familial hypercholesterolaemia, physical signs may include:

• Xanthelasma, yellowish deposits around the eyes

• Xanthomas, fatty deposits over tendons particularly the Achilles and hand tendons

• Corneal arcus, a pale ring around the iris, particularly in younger people

These are physical signs of severe longstanding hypercholesterolaemia rather than early warning signs, and their absence does not exclude significant lipid abnormality.

High cholesterol develops through a combination of genetic, dietary, metabolic, and hormonal factors. Contributing causes include:

• Diet high in saturated and trans fats raises LDL cholesterol by reducing hepatic LDL receptor activity, increasing circulating LDL levels.

• Physical inactivity can worsen the overall lipid profile and is associated with higher triglycerides and lower HDL cholesterol.

• Obesity particularly excess visceral fat increases triglyceride production and reduces HDL.

• Familial hypercholesterolaemia is an inherited condition caused by genetic changes affecting the body's ability to clear LDL from the bloodstream. It can result in markedly elevated LDL cholesterol from an early age and affects approximately 1 in 250 people.

• Hypothyroidism can increase LDL cholesterol and may contribute to secondary hypercholesterolaemia. Treating the thyroid disorder can improve the lipid profile.

• Type 2 diabetes and insulin resistance raise triglycerides and lower HDL, producing a characteristic dyslipidaemic pattern.

• Chronic kidney disease impairs lipid metabolism and raises cardiovascular risk through multiple mechanisms.

• Medications including corticosteroids, certain antihypertensives, and antipsychotics can raise cholesterol as a side effect.

High cholesterol is directly and definitively detected through blood testing. Because total cholesterol alone doesn't tell the whole story, a comprehensive profile is essential to understand your true cardiovascular health.

Blood tests Elfcare's panel includes a comprehensive lipid and cardiovascular risk profile:

• Total cholesterol: a general overview that serves as a starting point for risk assessment.

• LDL cholesterol: the bad cholesterol and the primary target for treatment to prevent artery blockages.

• HDL cholesterol: the good cholesterol; low levels can increase cardiovascular risk.

• Triglycerides: reflects how your body processes fats and sugars. High levels signal metabolic strain.

• ApoB: a precise count of plaque-forming particles, often more accurate than LDL for those with diabetes.

• Lipoprotein(a): a genetic risk marker that everyone should check at least once, as it doesn't respond to standard lifestyle changes.

• Non-HDL cholesterol: a summary marker of all bad cholesterol types in your blood.

• TSH: screens for an underactive thyroid, a common and treatable cause of high cholesterol.

• HbA1c and glucose: checks for insulin resistance, which creates a specific, high-risk pattern of blood fats.

• CRP: measures inflammation in the blood vessels that can speed up plaque buildup.

• Creatinine and eGFR: assesses kidney health, as kidney function directly impacts how your body handles fats.

Why early detection matters

Atherosclerosis begins in early adulthood and progresses silently over decades before causing a clinical event. A heart attack or stroke is frequently the first indication that cholesterol has been elevated for years. Identifying high cholesterol early, including Lp(a) elevation and familial hypercholesterolaemia, allows for treatment that stabilises plaques, reduces cardiovascular events, and in some cases reverses arterial damage. For every 1 mmol/L reduction in LDL, the risk of major cardiovascular events falls by approximately 20 to 25%. The earlier the intervention, the greater the cumulative benefit over a lifetime.

How Elfcare can help

Elfcare's blood panel provides one of the most comprehensive lipid profiles available in a preventive health check, covering total cholesterol, LDL, HDL, triglycerides, ApoB, Lp(a), and non-HDL cholesterol alongside thyroid function, metabolic markers, and CRP.

ApoB and Lp(a) in particular are markers that standard GP cholesterol tests frequently omit, yet they provide critical additional information about cardiovascular risk that LDL alone misses.

If our blood tests identify significant lipid abnormalities or related cardiovascular risk markers, we take care of further diagnostics or refer you to the appropriate specialist.