High cholesterol, in itself, does not cause any symptoms to the patient, except for the very rare cases of homozygous familial hypercholesterolemia, where - due to the very high levels of blood cholesterol (600 - 1200 mg / dL) - they are appreciated since childhood cholesterol deposits in the skin, tendons and around the cornea of the eye (horn arches), as well as lipid plates (xanthomas and xantelasmas) inside the skin on elbows, knees and buttocks.
Eyelid Xantelasm. From wikipedia.org
Although not apparently causing any symptoms or discomfort to the patient, high cholesterol is one of the main risk factors for cardiovascular diseases, which is recognized as the sad cause of being the leading cause of death in industrialized countries. In particular, high cholesterol is perhaps the most important etiological element in the appearance of atherosclerosis, a degenerative disease of large and medium caliber arteries, to which it progressively subtracts elasticity and extent.
In the internal walls of an artery affected by atherosclerosis there is the presence of inflammatory / cicatricial lesions, filled with lipid and immune cell deposits; due to these deposits, the artery becomes more prone to breakage and constitutes an obstacle to the normal circulation of the blood, reducing in a more or less important way the amount of oxygen and nutrients available for the tissues downstream of the obstruction.
Similar to high cholesterol, which - along with hypertension, overweight, insulin resistance, smoking, physical inactivity and eating disorders due to excess calories (species with surplus cholesterol, saturated fat, alcohol and sugar) - represents one of the main risk factors for its appearance, atherosclerosis is, in its early stages, absolutely asymptomatic. Today we know that in a large percentage of individuals the atherosclerotic processes begin already in the pediatric age or at the latest within 20 years of age; lipid deposits and histological changes at the level of the arteries therefore tend to worsen with the passage of time and to lose the characteristic of reversibility (fibrotic processes). Only decades later, approximately 50 years onwards, atherosclerotic plaques reach such dimensions as to give rise to fearsome complications, such as angina pectoris, ischemic heart disease, myocardial infarction, intermittent claudication, erectile dysfunction, stroke. Among the most alarming symptoms of these diseases we mention: chest pain with a strong sense of oppression or constriction (as if a boulder weighed on one's chest or was gripped by a vice), especially during severe psychophysical stress, lameness and cramps during a walk, confusion mental, headache.
In a distant study of 1953, conducted on the corpses of young US soldiers who died in the Korean war, Enos and his collaborators noted that - although these soldiers had no symptoms of cardiovascular disease - 35% of the sample had some visible but insignificant narrowing of one or more coronary vessels, 39% had a stenosis (narrowing due to thickening of the atherosclerotic plaque) between 10 and 90%, and 3% had a complete stenosis of one or more coronary vessels. Only 23% of soldiers boasted macroscopically normal coronary arteries.
Since 1953, many other studies have confirmed that the atherosclerotic process starts already in pediatric age and that its onset and evolution are related to cholesterol levels: the more these are elevated and the greater the risk. Furthermore, high cholesterol values in children are predictive of high values in adulthood.
What to do then?
While high cholesterol is an insidious enemy because it does not give direct signs or symptoms, on the other it is easily identifiable by a simple blood test. This is why periodic monitoring of cholesterol levels, starting at 20 years of age, is a wise and recommendable practice. In general, starting from the second decade of life it is recommended to repeat the exam every five years, even in the absence of symptoms, unless otherwise medically indicated; for example, in the case of high cholesterol or a predisposition to hypercholesterolemia, the doctor may recommend more frequent analyzes.
