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What high cholesterol means, how to read a lipid profile, what the atherogenic index is, and when statins are necessary. Explained by Dr. Anna Vitaliivna Sharhorodska.
When a person first sees elevated cholesterol in their test results, it almost always causes concern. In popular medical information, cholesterol is often associated with atherosclerosis, heart attack, and stroke, so any increase seems dangerous.
In reality, the situation is more complex. Cholesterol is not just a risk factor for cardiovascular disease, but also a vital molecule without which the body could not function normally.
Modern medicine views cholesterol not as a single indicator, but as part of a complex lipid metabolism system where the ratios of different cholesterol fractions, genetic factors, and individual cardiovascular risk all matter.
What is cholesterol and why does the body need it?
Cholesterol is an essential structural component of cell membranes. It ensures the stability of the cell envelope and regulates its permeability.
In addition, cholesterol performs several key functions:
- Participates in the synthesis of steroid hormones (estrogens, progesterone, testosterone, and cortisol);
- Is a component of the myelin sheath of nerve fibers;
- Is necessary for the synthesis of bile acids;
- Participates in the synthesis of vitamin D;
- Enables the transport of fat-soluble vitamins.
That is why the body produces cholesterol on its own. About 80% of cholesterol is synthesized by the liver and intestines, and only a small portion comes from food.
What a lipid profile shows
A blood test that evaluates fat metabolism is called a lipid profile (or lipid panel).
It includes several indicators:
- Total cholesterol
- High-density lipoproteins (HDL)
- Low-density lipoproteins (LDL)
- Triglycerides
- Sometimes lipoprotein (a) and apolipoproteins.
It is the ratio of these fractions that determines the risk of developing atherosclerosis.
Good and Bad Cholesterol
High-density lipoproteins (HDL) are often called “good” cholesterol. They transport excess cholesterol from the tissues back to the liver, where it is processed and excreted.
Low-density lipoproteins (LDL) are responsible for delivering cholesterol to cells. It is an excess of this fraction that can accumulate in the vessel walls and contribute to the formation of atherosclerotic plaques.
What is lipoprotein(a) and why is it important in cholesterol assessment?
Lipoprotein(a), or Lp(a), is a special type of lipoprotein that is similar in structure to LDL cholesterol (“bad cholesterol”) but has an additional protein—apolipoprotein(a). This specific feature makes Lp(a) significantly more atherogenic than regular LDL.
High levels of lipoprotein(a) are associated with an increased risk of developing atherosclerosis, myocardial infarction, stroke, and aortic valve calcification. It promotes cholesterol accumulation in the vascular wall, causes endothelial inflammation, and can enhance blood clot formation. As a result, atherosclerotic plaques form faster and become more unstable.
The peculiarity of Lp(a) is that its level is almost entirely genetically determined and depends little on diet or lifestyle. This is why cardiovascular events can occur in some people even when other lipid profile indicators are within the normal range.
Current recommendations from European cardiovascular societies suggest measuring Lp(a) levels at least once in a lifetime, especially if there is a family history of early heart attacks or strokes.
What is the atherogenic index?
One of the important indicators for assessing cardiovascular disease risk is the atherogenic index (AI). It reflects the ratio between atherogenic (harmful) and anti-atherogenic cholesterol fractions.
Calculation formula:
AI = (Total Cholesterol – HDL) / HDL
This indicator helps to understand how high the risk of atherosclerotic plaque formation is.
Interpretation of atherogenic index values:
- Up to 3.0 — low risk
- 3.0–4.0 — moderate risk
- Over 4.0 — high risk of atherosclerosis
Even with normal total cholesterol, a high atherogenic index may indicate an increased cardiovascular risk.
Symptoms of high cholesterol (which don’t actually exist)
One of the most common misconceptions is the expectation that high cholesterol has obvious symptoms. In most cases, high cholesterol causes no symptoms at all. This is why it is sometimes called the “silent risk factor.” A person may feel perfectly healthy while atherosclerosis gradually develops in the vessels.
Sometimes indirect signs may include:
- Xanthomas (fatty deposits on the skin)
- Xanthelasmas on the eyelids
- Early cardiovascular events in relatives
- Appearance of lipomas on the body, or as ultrasound findings
- Increased blood pressure
- Decreased memory sharpness (the brain is very sensitive to impaired blood supply)
- Decreased visual acuity (the retina is sensitive to the state of the vessels and pressure changes)
However, in most cases, the only way to detect a disorder is through a lipid profile blood test.Cholesterol Norms
Normal values depend not only on age but also on individual cardiovascular risk.
Approximate indicators for adults:
- Total cholesterol up to 5.0 mmol/L
- LDL (low-density lipoproteins / bad cholesterol) up to 3.0 mmol/L
- HDL (high-density lipoproteins / good cholesterol) more than 1.0 mmol/L in men, more than 1.2 mmol/L in women
- Triglycerides up to 1.7 mmol/L
In patients with high cardiovascular risk (ischemic heart disease, diabetes mellitus, history of heart attack or stroke), the target LDL level may be significantly lower—1.8 or even 1.4 mmol/L.
Can cholesterol be lowered without medication?
For people with low or moderate risk, lifestyle changes are sometimes sufficient.
The greatest impact comes from:
- A balanced diet
- Reducing excess weight
- Regular physical activity
- Control of insulin resistance (sugar and alcohol are direct causes of increased cholesterol levels).
However, in cases of high cardiovascular risk, drug therapy may be necessary to prevent heart attack and stroke.
Conclusion
Frequently Asked Questions (FAQ)
Can cholesterol increase without an obvious reason?
Should high cholesterol always be treated?
Can cholesterol be lowered by diet alone?
Does stress affect cholesterol levels?
Can high cholesterol be determined without tests?
How often should cholesterol be checked?
Does excess weight affect cholesterol levels?
Is it necessary to monitor cholesterol after age 40?
Can cholesterol be high in people with normal weight?
Can you get rid of atherosclerosis completely?
Is high cholesterol dangerous?
What is the atherogenic index?
Can cholesterol be high in young people?
Does homocysteine affect cholesterol?
It:
- Damages the vascular endothelium
- Promotes the oxidation of LDL
- Activates vascular wall inflammation
- Increases the risk of thrombosis
In combination with high cholesterol, this sharply increases the risk of heart attack, stroke, and atherosclerosis.
Is it necessary to give up eggs completely?
Does alcohol affect cholesterol levels?
Yes, alcohol can affect the lipid profile, but the effect depends on the dose and regularity of consumption. Small doses of alcohol (e.g., a glass of dry wine) are sometimes associated with an increase in HDL—”good” cholesterol. However, regular or excessive alcohol consumption has the opposite effect:
- Increases triglycerides
- Can increase LDL (“bad” cholesterol)
- Increases the risk of fatty liver disease
- Promotes insulin resistance
Consequently, this increases overall cardiovascular risk. Current cardiology recommendations do not advise using alcohol as a way to “improve cholesterol.”
Which alcohol increases cholesterol the most?
The most negative effects on the lipid profile come from:
- Hard spirits
- Sugary cocktails
- Beer in large quantities
They contribute to increased triglycerides and the accumulation of visceral fat, which is directly linked to dyslipidemia. Dry red wine in small quantities has a less pronounced effect, but even it is not a recommended method for preventing atherosclerosis.
