Cholesterol plays a critical role in women’s heart health, yet it often goes undetected until a serious problem occurs. According to Dr. Walid Hmissa, a board-certified internal medicine physician at Northside Primary Care Lawrenceville, high cholesterol (hyperlipidemia) rarely causes symptoms.
“About 99% of the time, patients have elevated cholesterol and they can’t tell if they’ve never had lab work,” Dr. Hmissa said. “They can’t tell until, unfortunately, the day comes … and they have some sort of major cardiac event that ends up altering the rest of their life.”
Types of cholesterol explained
A standard cholesterol panel measures three main components:
- LDL (low-density lipoprotein), often called “lousy” cholesterol
- HDL (high-density lipoprotein), known as “happy,” or good, cholesterol
- Triglycerides, another type of fat in the blood
“Your LDL starts with an L — that’s your lousy cholesterol,” Dr. Hmissa said. “Your HDL starts with an H — that’s your happy cholesterol.”
LDL cholesterol contributes to plaque buildup inside blood vessels. Over time, these deposits narrow arteries and reduce blood flow, leading to atherosclerotic cardiovascular disease, or ASCVD.
ASCVD is the leading cause of death in the United States. According to the Centers for Disease Control and Prevention, approximately 86 million adults aged 20+ have total cholesterol levels of more than 200 mg/dL. Yet, only about 54.5% of patients who could benefit from medications are on cholesterol-lowering therapy.
“If there’s no blood going through, there’s no oxygen going into your cardiac tissue, and that’s how you get a heart attack,” Dr. Hmissa said.
What causes high cholesterol
High cholesterol may be genetic or lifestyle-related. Primary hyperlipidemia is inherited.
“In these cases, you’re out of luck because you were just born with it,” Dr. Hmissa said.
However, secondary hyperlipidemia, which is more common, is usually acquired. “It is mostly due to diet,” he added.
Obesity, sedentary behavior, diabetes, high blood pressure and chronic inflammation often contribute.
How cholesterol is screened
Cholesterol is checked using a fasting lipid panel.
“It’s very important that you’re fasted about 9 to 12 hours before,” Dr. Hmissa said, noting that eating beforehand can raise triglycerides and affect results.
Providers also evaluate related risk factors such as blood pressure and blood sugar.
“High cholesterol and diabetes tend to go hand in hand.”
Treatment goals and medications
The primary goal of treatment is to lower LDL cholesterol.
“Lifestyle modification is foundational for all patients,” Dr. Hmissa said. “The lower your LDL is, the less likely that you will have some sort of cardiac event in the future.”
Statins remain the cornerstone of treatment. Dr. Hmissa called them “perhaps one of the greatest inventions in medicine.” Treatment decisions are individualized and often guided by a patient’s ASCVD risk score.
“Using statins plus the lifestyle modifications really does make the biggest difference,” Dr. Hmissa said.
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