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cardiovascular system
hypercholesterolemia
diagnoses

definition and etiology

definition:
an excess of cholesterol in the blood; generally defined as greater than 200 mg/dl, although many doctors are now citing 180 mg/dl as the maximum of the reference range

etiology:
• hyperlipoproteinemias: cholesterol may be slightly increased in types I and IV; moderately increased in type V (up to 250-500 mg/dl); markedly increased in types IIa, IIb and III (up to 300-1000 mg/dl)
• idiopathic
• biliary obstruction
• von Gierke's disease
• "sluggish" liver syndrome
• hypothyroidism
• pregnancy
• pancreatic dysfunction
• nephrosis
• diet: high intake levels of cholesterol, saturated and polyunsaturated fats, fried foods, hydrogenated oils, meat, sugar, coffee, alcohol; low intake of fiber
• nutrients: high zinc; low intake of vitamin C, calcium, chromium, copper, magnesium

Cholesterol levels have become the source of much national fear, even though cholesterol is one of the most valuable substances in the human body. Cholesterol is needed for strong cell walls, as a precursor for hormone production, and as a coating around nerves, to name just a few of its very important functions. Cholesterol is made in the liver in amounts up to 2000 mg/day. Cholesterol associated with high density lipoprotein, HDL (and Apolipoprotein A-1), is generally considered to be beneficial to the body, as it works to remove cholesterol from blood vessel walls and the the blood itself, bringing it to the liver for processing and excretion. Cholesterol associated with the low density lipoprotein, LDL (and Apolipoprotein B), is generally thought to be harmful to the body as it carries cholesterol into the bloodstream and can therefore place it into the intima of the arterial walls, promoting atherosclerotic processes. Very low density lipoproteins, VLDLs, become LDLs in the liver and are therefore also generally thought to be harmful.

For many years, this theory placed the effect of high cholesterol as the major etiologic agent in the epidemic of heart attacks and cardiovascular disease experienced in Western nations. However, recent evidence suggests other important factors: see atherosclerosis

signs and symptoms

signs and symptoms:
• high levels of total cholesterol, LDL, and VLDL cholesterol; of most concern when accompanied by low levels of HDL cholesterol
• history of poor eating habits, sedentary lifestyle, smoking, excessive drinking, etc.
• angina, hypertension, kidney disease
• no signs or symptoms may be present with life-threatening atherosclerotic disease

lab findings:
• based on Naturopathic Medical standards: total cholesterol = <180 mg/dl; HDL cholesterol = >60 mg/dl; LDL cholesterol =<100 mg/dl; VLDL = <35 mg/dl
• total cholesterol: HDL ratio
men: optimal = < 3.43; average = 4.97; 2x above average = 9.55
women: optimal = 3.27; average = 4.44; 2x above average = 7.05

course and prognosis

In industrial countries, people who are apparently symptom-free may suddenly have a massive MI. It may be the first indicator of disease. Therefore yearly cholesterol screens are highly recommended. Hypercholesterolemia in Western countries seems well-linked to significant morbidity (hypertension, angina) and mortality (MI, CVA). It is estimated that half the population will die from CHD and the results of atherosclerosis. Coronary bypass surgery is one of the most common operations now performed, even though it carries inherent risks and research has shown that its effect is generally transient, with patients often experiencing repeat symptoms only 2-3 years post-surgery. Chelation therapy offers some hope, but it remains controversial and the province of only a few physicians. New research suggests that prevention and natural treatment offer the healthiest, most lasting and least costly route to recovery.

differential diagnosis

• hypercholesterolemia is generally an incidental finding on blood screening, or identified following symptoms of complications
• classic lipidemias
• see primary causes as listed in the etiology


footnotes