High cholesterol is a metabolic alteration that can cause a whole series of unpleasant complications, including infarction, stroke and sudden death; for this reason it is necessary for EVERYONE to be able to recognize hypercholesterolemia and its dangers. But from this awareness comes a question:
"Does high cholesterol manifest itself with real symptoms or not?"
Brief introduction to cholesterol
Cholesterol is a steroid molecule normally present in all tissues (and food) of animal origin, where it performs numerous and essential metabolic and structural functions. These include: precursor of steroid hormones (eg testosterone and estrogen), vitamin precursor (of vitamin D), composition of cell membranes and bile (digestive juice-emulsifier produced by the liver and stored-freed by the gall bladder) etc.
Cholesterol moves between the various districts of the body thanks to the lymphatic stream and to the blood stream but, being a lipid, it is not able to dissolve in the hydrophilic liquid; for this reason, cholesterol uses as a solution and propagation medium (in the lymph and in the blood) certain large complex and soluble molecules called lipoproteins (LP).
All lipoproteins have a specific function (some carry it to the periphery - LDL or BAD - others carry it to the liver - HDL or GOOD) and for the health of the organism it is fundamental that they be quantitatively and qualitatively (molecular composition) in perfect balance. When the "carriers" increase, decrease, undergo oxidation or do not have the right interactions with the receptors (internal defect of the LPs or receptors with which they must interact at the level of the liver and tissues), a metabolic alteration called dyslipidemia.
There are different types of dyslipidemia, different for the type of lipid and LP involved (cholesterol and / or triglycerides), and for the respective etiopathological cause (primitive forms - hereditary and / or linked to environmental factors - and secondary, due to other pathologies) ; in the case of primitive forms, it is very important to divide the hereditary ones on the basis of the genetic defect responsible for the mutation.
High cholesterol
The cholesterol present in the human body has two distinct sources: endogenous (mainly hepatic) and exogenous (food intake through animal-type foods - to a lesser extent). When cholesterol is high, it increases the cardiovascular risk (ischemic heart disease and cerebral vascular syndrome), more or less significantly depending on the extent and other possible risk factors.
High cholesterol is assessed by measuring transport lipoproteins (LP) in the BLOOD; the respective evaluation criteria are: total cholesterol (with TOT) and bad cholesterol (with LDL). Leaving aside the secondary forms, the primary ones of high cholesterol affect genetics and / or lifestyle; the genetics may be of the type: familial hypercholesterolemia, polygenic hypercholesterolemia and hyperlipidemia with multiple phenotypes (with high cholesterol and high triglycerides). The secondary forms of high cholesterol triggered by an incorrect lifestyle have predisposing agents: a sedentary lifestyle, a diet rich in saturated fatty acids, a diet rich in hydrogenated fatty acids, a diet rich in cholesterol, hyperinsulinemia and / or type 2 diabetes mellitus.
These are very specific topics that are difficult to understand but absolutely decisive in understanding what will follow in the following paragraphs.
Does High Cholesterol Cause Symptoms?
High cholesterol does not prove real symptoms; however, the most severe forms determine the onset of some clinical signs. The difference between a symptom and a clinical sign is simply the point of view: while the symptom corresponds to the patient's perception (it is therefore subjective), the clinical sign is objectively recognized by the operating doctor. Those that affect the most severe forms of high cholesterol can be interpreted in either way as appropriate.
High cholesterol can lead to its storage in certain districts. In addition to promoting the formation of atherosclerotic plaques in blood vessels, with an increased cardiovascular risk (which is not a symptom but a complication), this accumulation can affect both the skin and the muscle tendons of the patient: we are talking about xanthomas. Xanthomas are clinical signs that, in many cases, to the touch are also distinctly perceived by the patient (although not causing painful sensations); moreover, those of the skin are also clearly visible. These characteristics would also place xanthomas among the symptoms of high cholesterol, and not only between clinical signs.
WARNING! Xanthomas occur predominantly in genetic forms (familial hypercholesterolemia and combined familial hypercholesterolemia) because these diseases cause blood cholesterol levels so high that they also cause peripheral deposition; however this does not mean that in the absence of xanthomas the cardiovascular risk is to be considered always moderate! Hypercholesterolemia, although less severe than the cases mentioned above, therefore WITHOUT xanthomas, is however an extremely important risk factor.
skin. There is a certain distinction that affects the correlation of the different types of accumulation with the respective causes and possible complications of high cholesterol. Xanthomas are formed by the incorporation of cholesterol by macrophages that mutate into large frothy cells, which also indicates a significant level of inflammation (hence the correlation with the risk of ischemic heart disease and cerebral vascular syndrome). Palpation is often necessary to identify tendon xanthomas, in particular: Achilles or calcaneal tendons, patellar tendons and tendons of the extensor muscles of the fingers. On the contrary, the cutaneous ones are clearly visible and are distributed between: eyelids, folds of the face and palms of the hands; limbs and buttocks; on the joints.
At this point, the kind readers will ask themselves:
"When high cholesterol is primary, caused ONLY by environmental factors or by association with polygenic forms (generally less serious), are there any clinical signs or symptoms that are equally visible and important? "
The answer is not well defined; the onset of xanthomas is related to abnormal cholesterol levels which, fortunately, are not so frequent. On the other hand, the formation of atherosclerotic plaques (in addition to being almost silent) can occur, in the long term, even with significantly lower levels of cholesterol. This difference is essential because most of the subjects with high cholesterol do NOT perceive any symptoms and DO NOT see any clinical signs, which is why sometimes they do NOT intervene to moderate their blood concentrations, thus suffering a slow but inexorably increasing risk of complications. When these last manifest themselves with their characteristic symptoms it is now too late to prevent serious health consequences.
Possible complications of high cholesterol | Characteristic symptoms |
Angina Pectoris | Strong sense of oppression, as if the chest were clamped tightly; the pain symptoms can radiate up to the neck, the left arm, the shoulder, the jaw and the central part of the upper half of the abdomen. In general, this symptomatology is aggravated by physical activity, cold air, stress and all other situations in which the energy demands of the heart increase considerably compared to the rest condition. |
Heart attack | Chest pain (such as a weight or a clamp in the center of the chest), typically located behind the sternum, which can radiate to the chest, neck, left arm, shoulder, mandible and central part of the upper half of the abdomen and to the shoulder blades. It can be accompanied by cold sweats, nausea, vomiting, weakness and dizziness. |
Cerebral infarction (stroke) | Sudden onset of vertigo, with loss of balance and coordination of movements; difficulty in expressing oneself with words or understanding what we are told; paralysis or numbness, weakness, tingling or paralysis on one side of the body; vision disorders, blindness of the eye, blurred vision or double vision; violent headache. |
Intermittent claudication | Occurrence of a cramping pain that assails a lower limb during a physical effort, regresses with rest and recurs on the occasion of a new prolonged use of the limb. With the perpetuation of the effort, the pain, classically located in the calf, gradually intensifies to the point of making the movement impossible. |
In conclusion, the only way to ensure that you do not suffer from high cholesterol is to periodically carry out the respective blood tests. In practice, in the general population, cholesterol (col) can be defined as HIGH when: the plasma TOT is higher than 199-239mg / dl and the plasma LDL col is greater than 129-159mg / dl. Then, in addition to high TOT and high LDL cholesterol, the cardiovascular insufficiency also significantly increases the HDL or GOOD colonic insufficiency (<40mg / dl in men / women in menopause and <50mg / dl in fertile woman) and the unfavorable ratio between the with LDL or BAD and the with HDL or GOOD (if> 3).
Ensuring that one's own blood parameters are within the norm can significantly reduce the overall cardiovascular risk.