Iunia Mihu
editorial staff
Without cholesterol nothing would work in the body – we depend on this fat-like substance because it fulfills many important functions. For example, cholesterol is required for the formation of certain hormones and for the production of vitamin D. In addition, the building material is an important part of the cell membrane – without it, body cells would have no shell at all and the cell contents would literally melt away. Cholesterol also plays a central role in digestion, as it produces bile acid, which is important for fat digestion. However, too much cholesterol in the blood, also known as hypercholesterolemia, can increase the risk of cardiovascular disease.
“Good” and “bad” cholesterol
The body produces most of the cholesterol it needs itself, in the liver – only a small part, around ten percent, is ingested through food. Due to its nature, cholesterol is not soluble in water – and therefore also in blood – which is why the body has come up with a clever transport system: Cholesterol is packed into small packages primarily with proteins (proteins) and fats (lipids). These are called “lipoproteins” after their main components and are divided into two different groups according to their density: the so-called LDL cholesterol and HDL cholesterol. “LDL” stands for “low-density lipoprotein”, in German: low-density lipoprotein. This LDL packet transports cholesterol from the liver to the body. If the cholesterol supply is greater than the absorption capacity of the cell, the LDL release their cholesterol load into the blood. As a result, the vessels narrow over time and so-called atherosclerosis develops, also known as “hardening of the arteries”. The deposits, known as plaques, can eventually detach and burst. Platelets then try to repair the defect. The result: a local thrombosis, i.e. a blockage of smaller blood vessels. Both changes, the constriction and the “bursting” of the deposit, can lead to a heart attack or stroke. Elevated LDL cholesterol is therefore associated with an increased risk of cardiovascular disease and is therefore also known as “bad” cholesterol.
“HDL”, on the other hand, stands for “high-density lipoprotein”, i.e. high-density lipoprotein. This type of packet transports excess cholesterol from the body’s cells and blood back to the liver, where it is metabolized. HDL cholesterol is also referred to as “good” cholesterol because it can do even more: “HDL can also release cholesterol that is already bound to the vessel walls. It thus makes a decisive contribution to preventing vascular calcification. Therefore, the following applies: the more HDL, the better,” writes the German Society for Combating Lipid Metabolism Disorders and Their Complications DGFF (Lipid-Liga). Normal to high HDL values therefore offer a protective effect against arteriosclerosis (hardening of the blood vessels) and reduce the risk of diseases of the cardiovascular system.
cause in heredity
So high LDL cholesterol is a recognized risk factor for cardiovascular disease, but the levels alone say little about the benefit of treatments. According to the Health Knowledge Foundation, the cause of high cholesterol levels is usually a hereditary predisposition in combination with an unhealthy lifestyle. Common triggers are poor nutrition, lack of exercise, overweight (especially on the abdomen) or obesity. Elevated cholesterol levels can go unnoticed for many years. Those affected often do not even notice their illness, the values that are too high can also come out by chance, for example during a regular check-up at the family doctor or when another examination is carried out. In addition to determining blood values, your own history of illness and that of your family is also important. How high the LDL cholesterol value may be depends on the individual overall risk of developing cardiovascular diseases. In general, according to the guideline, the more risk factors there are for cardiovascular disease, the lower the LDL cholesterol levels should be.
Therapy of hypercholesterolemia
It is usually treated with medication, for example with so-called statins, which lower the high LDL cholesterol in the blood. They work, but the side effects are not without them. A new drug has been on the market for a number of years for patients who are at high risk or who have already had a heart attack. The antibody PCKS9 (“Proprotein Convertase Subtilisin/Kexin Type 9”) is still a young therapeutic approach that lowers blood lipids better and has hardly any side effects. However, this drug can only be used as a therapy if other lipid-lowering drugs are ineffective or if statin therapy has to be stopped due to side effects, including muscle cramps. This is prescribed by the statutory health insurance companies because the new active ingredient is very expensive. Antibody therapy can also be combined with a statin. The PCSK9 antibody is injected into the skin of the abdomen, upper arm or thigh using a pre-filled syringe every 14 days. The side effects should be minimal. According to studies, flu-like symptoms can occur in less than ten percent of patients.