What is hypercholesterolemia, and how is it diagnosed?
Hypercholesterolemia refers to an abnormally high level of total cholesterol or LDL cholesterol in the blood, a major cardiovascular risk factor. It is diagnosed through a lipid panel (EAL—evaluation of a lipid abnormality) performed on an empty stomach, as prescribed by a doctor. Supplements for cardiovascular health are available in the store’s cholesterol and cardiovascular health section.
- Reference lipid values (to be interpreted by a doctor based on the overall risk profile): Desirable total cholesterol < 2 g/L (5.2 mmol/L) — LDL cholesterol: target based on cardiovascular risk (< 1.9 g/L for low-risk individuals — < 1.0 g/L for secondary prevention after a heart attack) — HDL cholesterol: protective factor (> 0.60 g/L = protection) — triglycerides < 1.5 g/L when fasting
- Clinical forms: pure hypercholesterolemia (elevated LDL, normal triglycerides) — isolated hypertriglyceridemia — mixed hyperlipidemia (elevated LDL and triglycerides) — familial hypercholesterolemia (rare genetic form — very high LDL levels beginning in childhood — specialized care)
- Main causes: a diet high in saturated and trans fats, a sedentary lifestyle, being overweight, smoking, diabetes, hypothyroidism — genetic factors — certain medications (thiazide diuretics, beta-blockers, corticosteroids)
What is the cardiovascular impact, and what lifestyle changes are recommended?
Hypercholesterolemia contributes to atherosclerosis (deposition of lipid plaques in arterial walls)—vulnerable plaque → rupture → arterial thrombosis → myocardial infarction or stroke. Overall cardiovascular risk takes into account not only cholesterol but also blood pressure, diabetes, smoking, and family history—its assessment is the responsibility of the physician.
- Cholesterol-lowering diet: reduce saturated fats (fatty meats, processed meats, whole-fat dairy products, palm oil, and coconut oil) and trans fats (processed) — increase soluble fiber (oats, barley, legumes, apples, psyllium), which trap cholesterol in the digestive tract— omega-3 EPA-DHA (fatty fish 2–3 times per week)—extra virgin olive oil and nuts (omega-9 and polyphenols)
- Physical activity: 150 minutes per week of moderate-intensity activity increases HDL and reduces triglycerides — resistance training (weight training) also improves the lipid profile
- Smoking cessation (Tabac Info Service: 3989): Smoking lowers HDL and damages blood vessel walls
- Medication: statins (first-linetreatment —reduces LDL by 30–55% depending on the compound and dose)—ezetimibe (in combination or as monotherapy) — PCSK9 inhibitors (for severe or resistant cases, by specialized prescription) — fibrates (hypertriglyceridemia) — by prescription only, never for self-medication
What dietary supplements can support your diet and lifestyle?
These supplements support a healthy lifestyle—they are not a substitute for statins or prescribed medications. Consult a doctor and pharmacist before taking any supplements if you are currently on lipid-lowering treatment (potential interactions).
- Red yeast rice: contains monacolin K (a natural statin) — documented reduction in LDL — same side effects and interactions as pharmaceutical statins (risk of myopathy; contraindicated during statin therapy, pregnancy, or liver or kidney failure) — self-medication not recommended without medical advice — ANSES note: monitor muscle tolerance
- Omega-3 EPA-DHA: 20–30% reduction in triglycerides at 3–4 g/day — EFSA-validated claim — on LDL levels: neutral to slightly favorable effect
- Artichoke (Cynara scolymus): cynarin and luteolin — mild inhibition of hepatic cholesterol synthesis — limited clinical data — as a standardized extract, well-established traditional use recognized by the EMA
- Plant phytosterols and stanols: 2 g/day incorporated into the diet reduces LDL by 7–10% in 3 weeks (EFSA) — in margarine or fortified supplements — do not use in pregnant women, children under 5 years of age, or patients taking statins without medical advice
