Know your cholesterol level to avert potential complications

Cholesterol is a lay term used to describe lipid molecules that deposit on the arterial wall and slowly cause narrowing, distortion or blockage of the vessel. Lipid particles are manufactured in the liver, upon absorption of fatty globules from the intestines. Once manufactured in the liver, they are released into the blood where they are responsible for a variety of biological functions. The lipid particles exist in different forms, each with different properties. Generally small particles, such as low density lipoprotein (LDL) are more likely to percolate the wall of the blood vessel, where they get deposited and cause inflammation, a process known as atherosclerosis. The progressive inflammation, causes narrowing of the vessel and rupture of the atherosclerotic plaque and clot formation that causes heart attacks, stroke and blockage of arteries. The deformation of the blood vessaels also causes aneurysms of the aorta for example, which could rupture with serious consequences including death.

 Is cholesterol synonymous with body fat that causes obesity?

No. Indeed, many people are surprised when told the BMI is normal yet the blood cholesterol is high. On the other hand, some obese people may have normal blood cholesterol. The two differ in that the body fat that causes obesity are fat globules stored under the skin when the body cannot process excess fat; whereas blood cholesterol are lipoprotein particles that circulate in the blood and contribute to the development of plaque build-up in the arteries.

How common are lipid disorders in Kenya?

According to data from the Kenya Ministry of Health (2015) the prevalence of cholesterol for adults was 7.3% for men and 12.8% for women.  These figures are on the rise with the cities carrying most of the burden.

Recent data is showing rising obesity levels in the village communities and in children as well. A survey conducted in 2014 showed that nationally 5% of Kenyan children aged 0–59 months are overweight (5.5% male vs. 3.8% female). The highest prevalence in overweight among children was found in Central region (6.9%) and lowest in North Eastern (3.1%).

Is it true that elevated cholesterol causes heart attacks and stroke?

Multiple studies conducted have consistently shown a clear correlation between the level of cholesterol and the likelihood of developing a heart attack or stroke. There is a clear correlation between the level of blood cholesterol and the extend of plaque build-up in the arteries.

In addition, treatment of lipid disorders has been shown to lower possibility of heart attack and stroke.

The likelihood of developing heat attack increases in those who smoke, have hypertension or diabetes and those with family history of heart attack.

What causes lipid disorders?

Lipid disorders arise from a multiplicity of conditions. These include liver disease, excessive alcohol consumption, diabetes, thyroid disease, pancreatic disorders and genetic abnormalities. These are compounded by unhealthy dietary habits and sedentary lifestyles.

Genetic abnormalities are particularly important because these patients have elevated cholesterol early in their lives as this leads to early plaque build-up in the arteries and premature heart attack and stroke. Genetic abnormalities commonly run in families and patients are particularly advised to have their cholesterol checked if heart attack has affected a first degree relative who is younger than 40 years for men and 50 years for women.

How do I know my cholesterol is elevated?

Many patients with elevated cholesterol are discovered for the first time after coming to the hospital with a heart attack or stroke. This is because lipid abnormalities can stay dormant for many years without causing harm. It is therefore imperative for one to measure their lipid levels in advance to determine if they are risk. This is recommended annually for those with hypertension, diabetes and family history of heart disease or stroke. Some patients with very high cholesterol may show some skin abnormalities around the eye or around the Achilles tendon.

The Kenya Ministry of Health recommends that all adults undergo cholesterol screening at least once every two years, with more frequent checks for individuals at higher risk or with pre-existing health conditions.

Are lipid disorders treatable?

Yes. The first line treatment for lipid disorders are lifestyle measures. These include exercise of at least 45 minutes 5 days a week, and diet modification to avoid foods rich in saturated and trans-fats, fats such as ham, bacon and deep fried fast foods. Recommended foods that could help reduce cholesterol include fruits and vegetables (avocado, olives), nuts, legumes such as beans and lentils and white meat such as fish. Patients are advised to limit alcohol and avoid salt.

Physicians will commonly perform a risk stratification to determine the risk to the patient. Risk refers the likelihood of developing a complication (heart attack, stroke, blocked artery) over the next 10 years. If the risk is high, then drug therapy is beneficial.

How long is medication for cholesterol required?

Once someone has been diagnosed with a lipid disorder, the treatment is usually life-long.  This means applying lifestyle measures and lifestyle modification. It is therefore imperative for the patient and physician to have a candid discussion about first line of therapy (lifestyle modification) and goals of therapy before medication is started. Once medication is withdrawn, the lipid levels rise to premedication levels and process of plaque build-up continues.

Does cholesterol medication cause side effects?

As with any other medication treatment, there are side effects though minimal and vary from one patient to another. These tend to occur within days to weeks of starting the medication. The commonest side effect is muscle pains and weakness. Muscle pains commonly affected are the large muscles on the thigh or upper arms. Other lesser likely side effects that the physician will look out for are liver enzyme abnormalities. It is recommended that patients discuss with their physicians their symptoms before assuming they are caused by the medication.

What happens if the medication is giving side effects?

A diagnostic assessment is performed that includes stopping the medication to assess resolution of symptoms and sometimes re-challenging the patient with the same medication.

Aga Khan University Hospital has introduced a cholesterol disorders clinic to manage patients at risk of associated complications.

Patients referred to this clinic will benefit from;

• Assessment of their cholesterol to determine the specific lipid abnormality

• Genetic tests to determine the underlying genetic defect.

• Analysis of the results by an experienced team of Cardiologists and Family physicians for patient-centered management.

• Appropriate dietary advice

• Education on how to maintain cholesterol at acceptable levels

This service is available in the following medical centres;

• ​Peponi Specialty and Executive Clinic on 6^th Peponi Road, Westlands

• Valley Arcade Medical Centre at Valley Arcade Mall

• Capital Medical Centre at Capital Centre Mall

• Karen Specialty and Executive Clinic at Binaa Complex 2nd Floor along Lang'ata Road

By Dr Mzee Ngunga, Consultant Interventional Cardiologist at Aga Khan University Hospital, Nairobi.