Hypercholesterolemia facts for kids

Hypercholesterolemia means having too much cholesterol in your blood. It's like having too much of a certain fat-like substance floating around inside you.

What is Cholesterol?

Cholesterol is a tiny molecule found in the walls of all your cells. It's a type of lipid, which is a fancy word for a fat or something similar to fat. Cholesterol is a special kind of lipid called a steroid. Steroids have a unique chemical shape made of four rings of carbon atoms.

Other steroids you might have heard of are hormones like cortisol, estrogen, and testosterone. Fun fact: all these steroid hormones are actually made by changing the basic shape of cholesterol! When scientists talk about making one molecule from simpler ones, they call it synthesis.

Where Does Cholesterol Come From?

Cholesterol is usually found in the walls of animal cells. It's only in animals; plants don't make it. So, any cholesterol you eat in food comes from animal products. But even vegans, who only eat plant foods, can still have cholesterol in their bodies. This is because most of the cholesterol in our bodies is made by our own bodies!

What Does Cholesterol Do?

Cholesterol has many important jobs in your cells. Its main role is to help build and keep cell membranes strong. It's also the starting material for things like bile acids (which help you digest fats) and steroid hormones.

However, cholesterol is best known for something not-so-good it can do. High levels of cholesterol can lead to a condition called atherosclerosis. This is a disease where white blood cells and cholesterol build up inside the walls of your arterys (blood vessels that carry blood from your heart). These fatty areas can slowly block a blood vessel or even break open, causing a blood clot.

Types of Cholesterol

Not all cholesterol is bad! There are different kinds of cholesterol in your blood. Doctors often measure these types to see if someone has hypercholesterolemia.

• HDL (High-Density Lipoprotein) is often called 'good cholesterol'. People with high levels of HDL cholesterol tend to have less atherosclerosis.
• LDL (Low-Density Lipoprotein) is sometimes called 'bad cholesterol'. People with high levels of LDL cholesterol tend to have more atherosclerosis.
• VLDL (Very Low-Density Lipoprotein) also causes more atherosclerosis when its levels are high. Measuring VLDL is expensive, so doctors often check triglycerides instead. Triglycerides are a type of fat, and high levels usually mean high VLDL.

Why is Atherosclerosis Bad?

When atherosclerosis gets serious, it can block blood flow in your arteries. This can harm whatever organ or tissue the artery was supplying blood to. If the organ or tissue doesn't get enough blood, it can even die. Doctors call this an infarction. If it's just hurt from low blood flow, but not enough to die, it's called ischemia.

• If the blocked artery goes to your heart, you could have angina or a heart attack. A heart attack is also called a myocardial infarction. Myocardial means related to the heart muscle, and infarction means tissue death. So, a heart attack is when part of your heart muscle dies because blood flow stopped. Angina is when blood flow is low but not completely blocked.
• If the blocked artery goes to your brain, you could have a stroke.
• If it goes to your kidneys, it can cause kidney failure.
• If it goes to an arm or leg, that limb might also die. If this happens, the arm or leg might need to be amputated (cut off) if doctors can't fix the blood vessel.

How is Atherosclerosis Treated?

The best way to deal with atherosclerosis is to try not to get it in the first place! Some people develop it faster than others. Many things cause these differences. Some you can change, and some you can't.

• Things you can't change:

* Genetics: Whether you get good or bad genes from your parents. * Sex: Men tend to get atherosclerosis earlier than women.

• Things you can change:

* Smoking * Controlling diabetes and high blood pressure * Exercise * Diet: Eating healthy foods (low cholesterol, low fat, and more fruits and vegetables is better).

If someone has hypercholesterolemia (high blood cholesterol), doctors will treat them. The first step is usually to exercise more, stop smoking, and eat healthier. If these changes work and cholesterol levels become normal, no more treatment might be needed. If not, sometimes medicines are also needed. But even with medicine, it's still important to keep up with healthy habits.

If someone already has atherosclerosis that's causing problems like heart attacks or strokes, just a better diet, exercise, and quitting smoking may not be enough. Medicine is almost always needed in these cases.

People with atherosclerosis need to be checked by doctors to make sure they don't get ischemia or infarction. Since they are more likely to have a heart attack or stroke, they must watch for signs. Sometimes, doctors might do tests to find atherosclerosis before it causes symptoms. But if you ever feel symptoms of these problems, it's important to see a doctor immediately.

For these serious problems, doctors can try to reopen the blocked artery. This might be done with surgery or with strong medicines that make the blood less likely to form clots. If this isn't done fast enough, the affected tissue or organ might be too damaged to save.

Medicines to Treat Hypercholesterolemia

The most common type of medicine for hypercholesterolemia are 'statin' drugs. They are called 'statins' because their names usually end in -statin. They work by inhibiting an enzyme called HMG-CoA Reductase. Inhibiting an enzyme means making it work less well.

The HMG-CoA Reductase enzyme helps your body make more cholesterol. If it's inhibited, your body makes less cholesterol. So, statin drugs lower the amount of LDL (bad) cholesterol in your blood, which stops atherosclerosis from getting worse. Statins can even help make atherosclerosis better. However, statins aren't as good at increasing HDL (good) cholesterol. Low HDL is hard to treat with medicines, but it goes up with more exercise!

There are two main problems that can happen when taking statins: Liver problems and 'Rhabdomyolysis'.

Rhabdomyolysis means a disease where muscle cells are damaged and die. Statins can sometimes cause muscle cell damage, leading to weakness and muscle pain. The bigger problem is that when muscle cells die, they release proteins into the blood. Your kidneys remove these proteins. If your kidneys take up too much protein, they can get hurt, sometimes leading to kidney failure. So, if you take statins and get muscle pain or weakness, stop the medicine and see a doctor.

Statins can also cause liver problems. They might cause mild irritation of the liver and, rarely, very bad liver damage. Because of this, doctors usually check liver blood tests after you start taking a statin. Doctors also tell patients to watch for signs of liver damage: pain on the right side of the stomach, nausea, vomiting, and jaundice (yellow skin or eyes).

However, both of these problems are rare. For someone with hypercholesterolemia, the benefits of statins are usually much greater than the risks. This means you are more likely to prevent problems than cause them by taking statins. Many big scientific studies show the same thing: if people have hypercholesterolemia and take statins, they are more likely to live longer and be healthier.

There are other kinds of medicines to treat hypercholesterolemia, but statins are usually the most effective.

• Fibrates are medicines that lower cholesterol levels. They can also help people with Type II Diabetes. This is good because diabetes and hypercholesterolemia can cause similar problems. If someone has both, the problems can be much worse. Fibrates can cause rhabdomyolysis, like statins, and also upset stomach. Taking fibrates and statins at the same time makes rhabdomyolysis happen much more often.
• Niacin is a vitamin that lowers cholesterol levels. It's also called Vitamin B3. A severe lack of niacin can cause a disease called Pellagra, which is rare today. However, less severe niacin deficiency can cause high blood pressure, weight gain, and hypercholesterolemia. So, sometimes Niacin is used to treat high cholesterol. Niacin is one of the medicines that might help increase HDL (good) cholesterol. The biggest problem with taking enough Niacin to help cholesterol is that it causes severe flushing (hot, red, sometimes itchy skin). This side effect is so uncomfortable that some people stop taking the medicine.
• Bile Acid Resins are medicines that make your body absorb less bile when you digest food. This also causes you to take up less cholesterol, which lowers blood cholesterol levels.

Images for kids

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  Xanthelasma palpebrarum, yellowish patches of cholesterol deposits above the eyelids. These are more common in people with familial hypercholesterolemia.

See also

In Spanish: Hipercolesterolemia para niños