What is cholesterol?

Cholesterol is a water-insoluble lipid molecule that plays a fundamental role for the human and animal organism as it represents an important constituent of plasma membranes, myelin sheath of nerves and even embryonic development. Furthermore, it is a precursor of Vitamin D and bile acids.

In humans, cholesterol has endogenous origin for 70% of the total, while the exogenous share, coming almost exclusively from the intake of fatty foods of animal origin, corresponds to 30% of the total.

The level of cholesterol in the blood is called “cholesterolemia” and can only be detected through specific blood tests, since a deficiency or an excess of cholesterol in blood is not associated with any particular symptoms.

The situation characterized by high levels of cholesterol in the blood is called “hypercholesterolemia”, while a low concentration of cholesterol in the blood is called “hypocholesterolemia”. Both conditions are considered potentially harmful to health.

In order to circulate in blood, cholesterol is carried by plasma lipoproteins. These can be LDL (Low Density Lipoproteins) or HDL (High Density Lipoproteins).

LDLs are also called “bad cholesterol” because a high LDL level leads to a buildup of cholesterol in the arteries that can be detrimental.

HDLs, on the other hand, are commonly referred to as “good cholesterol”, because they remove excess cholesterol from the blood.

High levels of LDL cholesterol and low levels of HDL cholesterol are both considered as cardiovascular risk factors, since they can favor the formation of atheromas, ie lesions in the artery walls, in a process called atherosclerosis. This can lead to a narrowing of the vessel and consequent nefarious events such as heart attack or stroke.

Types of cholesterol

Cholesterol levels: when they are good and when not

As described before, cholesterol is divided into “good” or “bad”. Therefore, acceptable or unacceptable levels were established depending on the type of cholesterol we are referring to.

In detail, total cholesterol to be considered normal and corresponding to low risk must be <200 mg/dL. This is considerable as the desirable condition.

Within the total cholesterol, however, the individual levels of LDL and HDL cholesterol must be evaluated:

  • LDL (bad) cholesterol is defined as normal when it has a value <130 mg/dL
  • HDL (good) cholesterol is optimal when it has a value >60 mg/dL.

It can therefore be seen how the total cholesterol value is indeed important, but also how the decisive difference lies finally in the level of the two types of cholesterol present in it: for HDL a low value is desirable while for LDL a high value is certainly preferable.

High cholesterol can be due to several causes. Since most of cholesterol is synthesized at an endogenous level, for example by the liver itself, the genesis of the problem cannot be traced only in diet. In fact, there are people who are genetically predisposed to the development of hypercholesterolemia, a condition called “familial hypercholesterolemia”.

On the other hand, there are other conditions associated with the development of high cholesterol, such as eating unhealthy food (excess of butter, cheese and other fats especially from animal sources), overweight and poor physical exercise.

In order to control high cholesterol levels and to lower LDL cholesterol values, it is often recommended to modify the diet and intensify physical activity, introduce the use of drugs such as statins that block the production of LDL and the use of nutraceuticals that act both as monotherapy (in the case of borderline values) and as add-on to pharmacological treatments.

The issue of cholesterol treatment was also addressed in an Inter-Company Position Paper, in which it was concluded that a therapy including a change in lifestyle, the use of drugs and nutraceuticals must be modulated and therefore personalized according to the patient.

High cholesterol: what to do?


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