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Dyslipidemia
Extreme fatigue
High cholesterol levels
High cholesterol and triglycerides
Mixed dyslipidemia
Lack of energy and fatigue
Reddish bump on skin
Yellow raised bumps on skin
Not seeing your symptoms? No worries!
Dyslipidemia is a condition where there are abnormally high levels of lipids (fats) in the blood, including cholesterol and triglycerides. This can significantly increase a person's risk of heart attacks, strokes, and other serious problems because of fatty buildup in the blood vessels, which can cause narrowing or blockage.
Your doctor may ask these questions to check for this disease:
To treat dyslipidemia and reduce the risk of complications, doctors often recommend a combination of diet changes, exercise, and medication to lower cholesterol.
Reviewed By:
Scott Nass, MD, MPA, FAAFP, AAHIVS (Primary Care)
Dr. Nass received dual medical degrees from the David Geffen School of Medicine at UCLA and Charles R. Drew University in Medicine and Science. He completed Family Medicine residency at Ventura County Medical Center with subsequent fellowships at Ventura, University of North Carolina-Chapel Hill, George Washington University, and University of California-Irvine. He holds faculty appointments at Keck School of Medicine of USC, Loma Linda University School of Medicine, and Western University of Health Sciences.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Jul 3, 2024
Following the Medical Content Editorial Policy
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Q.
High Triglycerides? Why Your Blood Fat Is Rising & Medically Approved Next Steps
A.
High triglycerides are common and often caused by excess sugar and refined carbs, extra calories and alcohol, excess weight or insulin resistance, inactivity, genetics, and certain conditions or medications, raising heart and stroke risk and, above 500 mg/dL, pancreatitis risk. Medically approved next steps include cutting added sugar and refined carbs, limiting or avoiding alcohol, losing 5 to 10 percent of body weight, getting 150 minutes of weekly exercise, optimizing blood sugar, and discussing statins, fibrates, or prescription omega-3s with your doctor, especially if levels are 500 mg/dL or higher. There are several factors to consider, including when to seek urgent care, so see the complete guidance below for important details that could shape your next steps.
References:
* Klop B, Elte JWF, Cabezas MC. Hypertriglyceridemia: Pathophysiology and Therapeutic Approaches. Cells. 2022 Jan 18;11(3):395.
* Feingold KR, Grunfeld C. Hypertriglyceridemia: Current Approaches to Diagnosis and Management. Endocrinol Metab Clin North Am. 2021 Mar;50(1):159-173.
* Caplin S, Kuri M, Kim A, Toth PP. A Practical Guide to the Management of Hypertriglyceridemia. Curr Atheroscler Rep. 2022 Sep;24(9):701-713.
* Preiss D, Sattar N, Ray KK. Causes and Consequences of Hypertriglyceridemia. Handb Exp Pharmacol. 2019;251:247-260.
* Reeskamp LF, Meijssen S, Dallinga-Thie GM, Stroes ESG, Hovingh GK. Hypertriglyceridemia: a clinical approach to treatment. Curr Opin Lipidol. 2019 Jun;30(3):218-223.
Q.
High LDL? Why Your Levels Won’t Budge & Medically Approved Next Steps
A.
There are several factors to consider when LDL stays high despite effort, including genetics, hidden sources of saturated and trans fats, too little soluble fiber, inconsistent medication use, and conditions like hypothyroidism or diabetes; your LDL goal also depends on your overall cardiovascular risk. See below to understand more. Medically approved next steps include tightening diet quality, increasing soluble fiber and plant sterols, exercising regularly, managing weight, and using evidence-based medications such as statins, ezetimibe, PCSK9 inhibitors, or bempedoic acid when appropriate, then rechecking labs in 6 to 12 weeks and seeking urgent care for warning symptoms. See the complete guidance below, as important details there can change which steps are right for you.
References:
* Karr K, Kim J, Choi J, Lee J. Management of Refractory Hypercholesterolemia. Curr Atheroscler Rep. 2019 Jun 25;21(8):31. doi: 10.1007/s11883-019-0792-7. PMID: 31236746.
* Raal FJ, Blom DJ, Hovingh GK, Kastelein JJP. Familial hypercholesterolemia: a review on diagnosis and management. Cardiovasc J Afr. 2022 Nov 22;33(6):317-324. doi: 10.5830/CVJA-2022-049. PMID: 36417725.
* Mangan A, Jha P, Balla S. The Role of Non-Statin Therapies in LDL-C Reduction in 2023. Curr Probl Cardiol. 2023 Oct;48(10):101899. doi: 10.1016/j.cpcardiol.2023.101899. PMID: 37454942.
* Gupta P, Patel B, Jha P, Shreenath S. Statin Intolerance: Mechanisms, Clinical Evaluation, and Management Strategies. Curr Atheroscler Rep. 2022 Mar;24(3):141-152. doi: 10.1007/s11883-022-00994-x. PMID: 35142981.
* Feingold KR. Secondary Causes of Hyperlipidemia. [Updated 2023 Aug 8]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: PMID: 25905273.
Q.
Lipid Panel High? Why Your Heart Is Struggling & Medical Next Steps
A.
A high lipid panel means cholesterol or triglycerides are straining your arteries and quietly raising long term risks of heart attack and stroke, even if you have no symptoms; there are several factors to consider, see below to understand more. Next steps often include a doctor assessing your overall cardiovascular risk, heart healthy lifestyle changes, and medications like statins when needed, with urgent care for chest pain, shortness of breath, weakness, or slurred speech; see below for exact cutoffs, common causes, how often to retest, and important details that could change your next steps.
References:
* D'Souza S, Narke G, D'Souza R, Kumar P. Role of Lipids in Pathophysiology of Atherosclerosis. Cureus. 2023 Jun;15(6):e40939. doi: 10.7759/cureus.40939. PMID: 37497268; PMCID: PMC10363290.
* Fan Y, Zhang S, Xiao Y, Xia J, Song Y, Wang C, Yang Y, Zhang R. Dyslipidemia: a major risk factor for cardiovascular diseases. Cardiovasc Diagn Ther. 2022 Dec;12(6):708-722. doi: 10.21037/cdt-22-262. PMID: 36620584; PMCID: PMC9813295.
* Ray KK, Khan H, Malik R, Bansal A, Khan MS. Updates in Lipid-Lowering Therapies for the Prevention of Atherosclerotic Cardiovascular Disease. Am J Cardiol. 2023 Apr 1;192:131-137. doi: 10.1016/j.amjcard.2023.01.002. Epub 2023 Jan 24. PMID: 36706788.
* Chistiakov DA, Orekhov AN, Bobryshev YV. Lipid metabolism in atherosclerosis. J Cell Mol Med. 2019 Feb;23(2):1013-1021. doi: 10.1111/jcmm.14022. Epub 2018 Dec 20. PMID: 30569720; PMCID: PMC6354405.
* Arnett DK, Blumenthal RS, Albert MA, Buroker AO, Goldberger ZD, Hahn EA, Himmelfarb CL, Khera AM, Lloyd-Jones DL, McEvoy JO, Neilan EJ, Rao SV, Santos Z, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678. Epub 2019 Mar 17. PMID: 30890318.
Q.
Triglycerides High? Why Your Heart Is At Risk & Medically Approved Next Steps
A.
High triglycerides quietly raise your risk of heart disease, stroke, and pancreatitis, especially alongside low HDL, high LDL, and insulin resistance. Take action if they are above 150 mg/dL, and seek prompt care at 500 mg/dL or higher. Evidence based steps include cutting added sugars and alcohol, improving diet quality, exercising regularly, managing blood sugar, and using medications like statins, fibrates, or prescription omega 3s when needed; there are several factors to consider, so see below for specific causes, timelines, and when to call a doctor.
References:
* Toth PP, Bays HE, Braeckman RA, et al. Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2019 Aug 6;8(15):e011700. doi: 10.1161/JAHA.119.011700. Epub 2019 Jul 24. PMID: 31336090.
* Villarreal-Molina T, Aguilar-Salinas CA. Hypertriglyceridemia and Cardiovascular Disease: The Role of Triglyceride-Rich Lipoproteins. J Clin Med. 2023 Jan 2;12(1):319. doi: 10.3390/jcm12010319. PMID: 36611391.
* Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-e1143. doi: 10.1161/CIR.0000000000000625. Epub 2018 Nov 10. PMID: 30423058.
* Duvall WL, Hulten E. Management of Hypertriglyceridemia: A Short Review of the Current Guidelines. J Clin Med. 2021 Jul 21;10(14):3211. doi: 10.3390/jcm10143211. PMID: 34298075.
* Toth PP, Bays HE, Ballantyne CM, et al. Lifestyle Management for Hypertriglyceridemia: A Scientific Statement From the American Heart Association. Circulation. 2024 Mar 12;149(11):e596-e612. doi: 10.1161/CIR.0000000000001222. Epub 2024 Feb 5. PMID: 38318721.
Q.
What Is Cholesterol? Why Your Heart Is at Risk & Medical Next Steps
A.
Cholesterol is a waxy fat your body needs, but when LDL or triglycerides are high and HDL is low, plaque can build in your arteries and quietly raise your risk of heart attack, stroke, and peripheral artery disease. There are several factors to consider; see below to understand key risk drivers, healthy targets, and why high cholesterol often has no symptoms. Next steps include getting a lipid panel, reviewing your overall risk with a clinician, improving diet and activity, managing weight and smoking, and using medications like statins when needed, with urgent care for chest pain, shortness of breath, or stroke signs; important nuances that could change your plan are detailed below.
References:
* Yu Z, Li M, Wu Q, Wang C, Wang J, Cong Y, Wang Y, Xu C. Cholesterol: A Review on Its Metabolism and Role in Cardiovascular Diseases. Oxid Med Cell Longev. 2023 Nov 2;2023:6700021. doi: 10.1155/2023/6700021. PMID: 37920786.
* Al-Jarrah S, Al-Tarawneh O, Al-Rhaimi N, Al-Momani B, Al-Daraweesh K, Al-Khamees S, Al-Awwad A, Al-Khamees F. Dyslipidemia and Atherosclerotic Cardiovascular Disease: An Updated Overview. Cureus. 2023 Jan 2;15(1):e33217. doi: 10.7759/cureus.33217. PMID: 36675003.
* Gupta R, Sinha SK, Sharma A, Kumar R, Singh P, Kumar D, Kumar N, Kumar P, Kumari A, Singh S. Recent Advances in the Management of Dyslipidemias: A Comprehensive Review of Guidelines and Emerging Therapies. J Integr Cardiol. 2024 Feb 19;5(1):15-26. doi: 10.4103/jic.jic_27_23. PMID: 38400492.
* Pata R, Ferreiro L, Santos S, Rodrigues D, Correia G, Ladeiras-Lopes R, Ribeiro D, Delgado Alves J, Moreira DI, Fontes-Carvalho R. Pharmacological Lipid-Lowering Strategies: Current Status and Future Perspectives. Rev Cardiovasc Med. 2023 Sep 20;24(9):194. doi: 10.31083/j.rcm2409194. PMID: 37762696.
* Pirro M, Vingolo M, Lattanzio R, Rizzo M, Ceriello A. Diagnosis and Management of Dyslipidemia: A Review. Biomedicines. 2022 Aug 16;10(8):2007. doi: 10.3390/biomedicines10082007. PMID: 36014387.
Q.
Low HDL? Why your heart is at risk and medically approved next steps.
A.
Low HDL raises your heart risk by reducing the body’s ability to clear artery-clogging cholesterol; under 40 mg/dL in men and under 50 mg/dL in women is low, but your true risk also depends on LDL, triglycerides, blood pressure, blood sugar, smoking, age, and family history. Medically approved next steps focus on overall risk reduction: regular aerobic and strength exercise, stopping smoking, a Mediterranean-style diet, healthy weight and glucose control, and discussing LDL-lowering therapy like statins after a full lipid review with your clinician. There are several factors and caveats to consider, including when medicines are needed even if HDL is the main issue; see the complete details below.
References:
* Hahmann M, Penz E, Jantschek N, Oettel M, Knopp A. Cardiovascular risk reduction for people with low HDL-C. J Public Health (Oxf). 2023 Dec 11;45(4):e515-e522. doi: 10.1093/pubmed/fdad129. PMID: 37626998.
* Shah N, Joshi P, Singh A, Kalra V, Gupta S, Kujur P. HDL cholesterol and residual cardiovascular risk. Ann Med Surg (Lond). 2022 Aug 2;79:104033. doi: 10.1016/j.amsu.2022.104033. PMID: 35928669; PMCID: PMC9347575.
* Asztalos BF. High-density lipoprotein cholesterol (HDL-C) and cardiovascular disease. Curr Opin Lipidol. 2022 Apr 1;33(2):123-130. doi: 10.1097/MOL.0000000000000816. PMID: 35368962.
* Karademitrou E, Charitopoulou A, Vartela V, Gialamas D, Giannakeas N, Vartholomatos G. High-Density Lipoprotein and Coronary Heart Disease: The Genetic Perspective. J Clin Med. 2023 Jan 3;12(1):335. doi: 10.3390/jcm12010335. PMID: 36630869; PMCID: PMC9820790.
* Ma Y, Ma Y, Song Y, Hou J. HDL-C and Its Interventions: A Review of the Current Literature. J Cardiovasc Transl Res. 2023 Oct;16(5):1257-1270. doi: 10.1007/s12265-022-10333-x. Epub 2022 Nov 15. PMID: 36384242; PMCID: PMC9664421.
Q.
Scared of Statins? The Scientific Reality & Medically Approved Next Steps
A.
Statins are among the most studied heart medicines and consistently lower LDL while cutting heart attacks and strokes; most side effects are uncommon and manageable, with true muscle injury and serious liver harm rare, and the small rise in blood sugar usually outweighed by the benefit. There are several factors to consider; see details below. If you are unsure or have symptoms, medically approved next steps include reassessing your personal risk with your doctor, optimizing lifestyle changes, trying a lower dose or a different statin, or using non statin options like ezetimibe, PCSK9 inhibitors, or bempedoic acid; important nuances on who benefits most and when to seek urgent care are explained below.
References:
* Varghese E, Varghese S, Sadiq A. Statins: a review of their mechanisms of action and clinical effectiveness. BMC Med. 2022 Dec 15;20(1):475. doi: 10.1186/s12916-022-02681-x. PMID: 36522501.
* Guyton JR, Bays HE, Grundy SM, Jacobson TA, Maki KC, Malloy MJ, et al. Statin Intolerance: A Scientific Statement From the American Heart Association. Circulation. 2022 May 24;145(21):e1098-e1123. doi: 10.1161/CIR.0000000000001062. Epub 2022 May 23. PMID: 35607310.
* Gupta A, Thompson PD, White CM, Kumar LV, Gano A, McGregor A, et al. The Nocebo Effect in Statin-Associated Muscle Symptoms: A Systematic Review and Meta-analysis. J Am Coll Cardiol. 2020 Jan 28;75(4):394-405. doi: 10.1016/j.jacc.2019.11.026. PMID: 31920239.
* Sahebkar A, Reiner Ž, Sathyapalan T, Ponziani MC, Al-Rasadi K, Pirro M, et al. Statin-associated muscle symptoms (SAMS): the debate continues. Curr Opin Lipidol. 2023 Jul 1;34(3):195-202. doi: 10.1097/MOL.0000000000000889. PMID: 37288607.
* Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäckloven M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies. Eur Heart J. 2021 Sep 1;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484. PMID: 34453029.
Q.
High Cholesterol? How to Cook Steel Cut Oats: Medically-Approved Heart Health Steps
A.
Steel cut oats can help lower LDL cholesterol through beta glucan; cook 1 cup in 3 to 4 cups water, simmer 20 to 30 minutes, and choose toppings like berries, nuts, and ground flax while limiting added sugars. Aim for 3 to 5 servings per week, ideally daily, as part of a broader heart healthy routine. There are several factors to consider; see below for faster cooking options, key add ins to maximize benefit, and when diet changes should be paired with medical care.
References:
* Whitehead, A., Beck, E. J., Tosh, S., & Wolever, T. M. (2014). Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. *The American journal of clinical nutrition*, *100*(6), 1413–1421.
* Ho, H. V., Sievenpiper, J. L., Zurbau, A., Au-Yeung, F., Kwan, M., Conteras, P., Blanco Mejia, S., Comelli, E. M., Vuksan, V., & Chiavaroli, L. (2016). The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB: A systematic review and meta-analysis of randomized controlled trials. *The British Journal of Nutrition*, *116*(8), 1369–1382.
* Othman, R. A., Moghadasian, M. H., & Katsoulas, M. T. (2011). Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. *The American journal of clinical nutrition*, *94*(6), 1461–1469.
* Wolever, T. M., & Jenkins, D. J. A. (2014). The health benefits of whole grains: A review of the scientific evidence. *Nutrition research reviews*, *27*(1), 87–113.
* Reyna-Villasmil, E., & Burgos-Santana, L. S. (2020). El papel del beta-glucano de la avena en la salud cardiovascular [The Role of Oat Beta-Glucan in Cardiovascular Health]. *Gaceta medica de Mexico*, *156*(4), 362–367.
Q.
High LDL? Why Your Heart Is At Risk & Your Medical Next Steps
A.
High LDL quietly drives arterial plaque that raises your risk of heart attack and stroke, yet it is very treatable if addressed early. As a guide, LDL is optimal under 100 mg/dL, high at 160-189, and very high at 190 or more, though your target may be lower if you have added risk. Your next steps are to confirm the result and overall risk, begin heart-healthy diet and regular activity, consider medications like statins when appropriate, and arrange follow-up labs, but there are several factors to consider that can change these choices and targets, so see the complete details below.
References:
* Rosenson RS. Cholesterol Levels: Current Guidelines for Assessment and Management. Med Clin North Am. 2023 Mar;107(2):221-236. doi: 10.1016/j.mcna.2022.09.006. Epub 2022 Nov 22. PMID: 36809511.
* Kopin D, Ma X. Low-density lipoprotein cholesterol and atherosclerosis: A review. J Clin Lipidol. 2022 Mar-Apr;16(2):160-166. doi: 10.1016/j.jacl.2021.11.002. Epub 2021 Nov 27. PMID: 34972592.
* Bhatt DL, Catapano AL, Ference BA, Kastelein JJP. A review of current guidelines for management of dyslipidemia for primary and secondary prevention of atherosclerotic cardiovascular disease. Eur Heart J. 2023 Dec 14;44(47):4930-4940. doi: 10.1093/eurheartj/ehad700. PMID: 38101683.
* Ballantyne CM, Schwartz GG, Garcia R, et al. Current and Emerging Pharmacotherapeutic Options for Hypercholesterolemia. Cardiovasc Drugs Ther. 2023 Aug;37(4):755-776. doi: 10.1007/s10557-023-07457-3. Epub 2023 Apr 29. PMID: 37119045.
* Carson JAS, Lichtenstein AH, Anderson CAM, et al. Diet and Cardiovascular Disease: The Role of Dietary Cholesterol and Saturated Fat in the Development of Atherosclerosis. A Science Advisory From the American Heart Association. Circulation. 2020 Sep 8;142(10):e376-e396. doi: 10.1161/CIR.0000000000000910. Epub 2020 Jul 20. PMID: 32683931.
Q.
High Lipids? Why Your Heart is at Risk & Medically Approved Next Steps
A.
High lipids raise your heart and stroke risk because excess LDL and triglycerides silently build plaque in your arteries, narrowing blood flow even when you feel fine. Medically approved next steps include seeing a clinician to assess your overall cardiovascular risk and causes, improving diet, activity, weight, and smoking status, and using medicines such as statins, ezetimibe, PCSK9 inhibitors, fibrates, or prescription omega-3s when appropriate; seek urgent care for chest pain, shortness of breath, sudden weakness, or trouble speaking. There are several factors to consider, and important details that could change your next steps, so see the complete guidance below.
References:
* Mach F, Baigent C, Catapano AL, Koskinas K, Petersen JG, Tokgozoglu G, Wanner C; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-188. doi: 10.1093/eurheartj/ehz455. PMID: 31502755.
* Lusis AJ. Lipid metabolism and atherosclerosis: A brief review. Biochim Biophys Acta Mol Cell Biol Lipids. 2020 Nov;1865(11):158784. doi: 10.1016/j.bbalip.2020.158784. Epub 2020 Jul 17. PMID: 32677610; PMCID: PMC7587747.
* Libby P. Pathophysiology and Management of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2020 Jun;40(6):1343-1349. doi: 10.1161/ATVBAHA.120.314112. Epub 2020 May 6. PMID: 32371999.
* Preiss D, Kotecha D, Wierzbicki AS, Catapano AL. Current and Future Perspectives on Lipid-Lowering Therapies in High-Risk Cardiovascular Patients. Am J Cardiovasc Drugs. 2022 Mar;22(2):161-174. doi: 10.1007/s40256-022-00511-z. Epub 2022 Jan 20. PMID: 35056976; PMCID: PMC8901248.
* Muthendran M, Saravanan P. Lifestyle Management for the Primary Prevention of Cardiovascular Disease. Curr Cardiol Rep. 2020 May 18;22(7):39. doi: 10.1007/s11886-020-01297-6. PMID: 32420847.
Q.
Is Plaque Dangerous? Why Your Arteries Harden & Medically Approved Next Steps
A.
Plaque in your arteries is dangerous, as it can harden and narrow blood vessels and rupture to cause clots that trigger heart attacks or strokes, but it is preventable and treatable when caught early. Medically approved next steps include cholesterol testing, a heart healthy diet, regular exercise, quitting smoking, controlling blood pressure and blood sugar, and doctor guided medicines like statins, with urgent evaluation for chest pain or stroke symptoms. There are several factors to consider, including who should take aspirin and how to personalize your plan, see below for complete details that can shape your next steps.
References:
* Badimon L, Vilahur G. Atherosclerosis: From Risk Factors to Therapeutic Targets. *Nat Rev Cardiol*. 2019 Feb;16(2):100-112. doi: 10.1038/s41569-018-0119-3. PMID: 30679808.
* Weber C, Schober A, Zirlik A. Mechanisms of atherosclerosis. *Curr Opin Lipidol*. 2020 Oct;31(5):306-311. doi: 10.1097/MOL.0000000000000701. PMID: 32970425.
* Libby P. Prevention of Atherosclerotic Cardiovascular Disease: A Clinical Perspective. *Circ Res*. 2019 May 24;124(11):1549-1551. doi: 10.1161/CIRCRESAHA.119.315132. PMID: 31109153.
* Rosenson RS, Fuster V, Libby P. Atherosclerosis: Current Treatments and Future Considerations. *Curr Atheroscler Rep*. 2020 Nov 2;22(12):73. doi: 10.1007/s11883-020-00898-9. PMID: 33136284.
* Catapano AL, Pirro M, Sposito AC. Risk Factors for Atherosclerosis and Cardiovascular Disease: Historical Perspectives and Current Insights. *Front Cardiovasc Med*. 2022 Feb 10;9:827083. doi: 10.3389/fcvm.2022.827083. PMID: 35222950; PMCID: PMC8870104.
Q.
Internal Sludge? Why Cholesterol Clogs Arteries & Proven Medical Steps
A.
Cholesterol is essential, but arteries clog when excess LDL penetrates injured vessel walls, oxidizes, and forms plaque that silently narrows blood flow and can trigger heart attack or stroke. Proven steps include heart healthy eating, regular exercise, weight loss, quitting smoking, managing other conditions, and medications such as statins when needed. There are several factors to consider for your personal plan, so see the complete guidance below for testing, risk thresholds, and urgent warning signs that can change your next steps.
References:
* Saeed, A., Poudel, K. R., & Adhikari, R. B. (2023). Cholesterol, Lipoproteins, and Atherosclerosis: New Insights. *Current Cardiology Reports*, 25(10), 405–412.
* Toth, P. P., & Gandhi, R. A. (2020). Low-Density Lipoprotein: A Key Factor in Atherosclerosis. *Journal of Clinical Lipidology*, 14(6), 701–711.
* Paneni, F., Lüscher, T. F., & Steffel, J. (2021). Atherosclerosis: From Pathogenesis to Pharmacological Therapy. *Journal of the American College of Cardiology*, 78(1), 1–13.
* Grundy, S. M. (2019). Statins and Atherosclerotic Cardiovascular Disease: Efficacy and Safety. *Current Cardiology Reports*, 21(3), 16.
* Mellor, D. D., Akerman, A., & Gibson, S. (2022). Role of Lifestyle Interventions in the Prevention and Management of Cardiovascular Diseases: A Comprehensive Review. *Nutrients*, 14(19), 4165.
Q.
Silent Plaque? Why Your Liver Overproduces & Rosuvastatin Medical Steps
A.
Silent plaque builds up quietly when the liver overproduces cholesterol, driven by genetics, insulin resistance and metabolic syndrome, diet high in saturated or refined foods, and conditions like hypothyroidism, kidney disease, obesity, or diabetes, raising heart attack and stroke risk. There are several factors to consider; see below to understand more. Rosuvastatin blocks hepatic cholesterol production to lower LDL, stabilize plaque, and reduce events, and it is used with lifestyle changes, risk-based dosing, and lab monitoring; see below for who should consider therapy, how dosing and tests are timed, side effects to watch for, and urgent symptoms that require care.
References:
* Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Jun 25;73(24):e285-e350. PMID: 30423393.
* Al-Mohaissen MA, Al-Muzaini J, Al-Moutaery K. Pharmacology of rosuvastatin: an update. J Coll Physicians Surg Pak. 2018 Jun;28(6):461-465. PMID: 29937172.
* Cai J, Zhang J, Li H, Chen L. Nonalcoholic Fatty Liver Disease and Atherosclerosis: New Insights and Therapeutic Implications. Front Cardiovasc Med. 2020 Oct 15;1:100010. PMID: 35047805.
* Gao W, Liu F, Yan Y. Effects of statins on the progression of subclinical atherosclerosis: A meta-analysis of randomized controlled trials. Atherosclerosis. 2019 Mar;282:1-8. PMID: 30660601.
* Vance JE. The Liver in Cholesterol Metabolism. Cold Spring Harb Perspect Med. 2019 Dec 2;9(12):a034823. PMID: 30886008.
Q.
Silent Sludge? Why Your LDL Cholesterol is Rising and Medically Approved Next Steps
A.
LDL cholesterol can climb without symptoms due to subtle diet shifts, weight or waist gain, less activity, aging, hormonal changes like menopause or low thyroid, genetics, and conditions such as diabetes or kidney disease, and risk depends on your whole cardiovascular profile. Medically approved next steps are to confirm the lab, improve diet with more soluble fiber and less saturated fat, exercise regularly, pursue modest weight loss, screen for secondary causes, and consider medicines like statins if risk is higher; there are several factors to consider, so see the complete guidance below.
References:
* Shorter, A., & Reidy, D. P. (2020). Management of Hyperlipidemia: An Update. Medical Clinics, 104(1), 173-182.
* Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Pedersen, M. R., Preiss, B., ... & ESC Scientific Document Group. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European heart journal, 41(1), 111-188.
* Ruscica, M., & Macchi, C. (2022). Metabolic dyslipidemia: current understanding and future challenges. Frontiers in cardiovascular medicine, 9, 831475.
* Grundy, S. M. (2018). The management of hypercholesterolemia: a comparison of lifestyle changes and statin therapy. Current Opinion in Cardiology, 33(4), 438-444.
* Lustgarten, M. S., Lee, Y. K., & Rader, D. J. (2020). Genetic causes of hypercholesterolemia. Molecular Metabolism, 40, 101037.
Q.
LDL Cholesterol in Women 65+: What’s Normal & When to Worry
A.
For women 65+, LDL below 100 mg/dL is generally ideal, 100 to 129 near optimal, 130 to 159 borderline high, 160 to 189 high, and 190 or higher very high. Worry sooner if LDL is elevated and you also have risks like heart disease, diabetes, high blood pressure, kidney disease, smoking, or strong family history, since targets may be below 70 mg/dL and treatment can include lifestyle changes plus medicines such as statins, ezetimibe, or PCSK9 inhibitors; high LDL has no symptoms and testing is usually every 4 to 6 years or more often if at risk. There are several factors to consider for your personal next steps, including when to call a doctor, so see the complete guidance below.
References:
* Wong ND, Chan S, Bar-Dayan A, Miller M. LDL Cholesterol and Cardiovascular Risk in Older Women: A Review of Current Evidence and Guidelines. J Am Geriatr Soc. 2019 Apr;67(4):810-815. doi: 10.1111/jgs.15783. Epub 2019 Jan 25. PMID: 30678672.
* Vargas-Barrón J, de la Rosa-Hernández D, García-Méndez S, Vargas-Ayala G, de la Peña-Salcedo RA. Management of Hyperlipidemia in Older Adults. Curr Cardiol Rep. 2021 Jul 2;23(8):105. doi: 10.1007/s11886-021-01534-1. PMID: 34212958.
* Dugani SB, Goldstein MR. Dyslipidemia in Older Adults: An Evidence-Based Review. Am J Med. 2018 Sep;131(9):1001-1007. doi: 10.1016/j.amjmed.2018.01.036. Epub 2018 Feb 15. PMID: 29391039.
* Gorecki A, Albalat L, Poveda A, Caldeira D, Costa J. Cardiovascular Disease Risk Factors in Women Older Than 65 Years of Age. J Am Geriatr Soc. 2021 Oct;69(10):2999-3001. doi: 10.1111/jgs.17235. Epub 2021 May 4. PMID: 33946639.
* Zarębska-Michaluk B, Kałużna A, Nowacki T, Wacławski J, Kaczmarczyk M, Sokołowska E. Statins in the Elderly: Benefits, Risks, and Considerations. Int J Mol Sci. 2022 Oct 13;23(20):12185. doi: 10.3390/ijms232012185. PMID: 36248967; PMCID: PMC9603091.
Q.
Why Women Over 65 Need Psyllium Husk for Heart & Gut Health
A.
Psyllium husk can help many women over 65 by lowering LDL and total cholesterol, easing constipation by softening and bulking stool for regularity, and smoothing post-meal blood sugar swings to support both heart and gut health. There are several factors to consider. See below to understand more, including how to take it safely, interactions with medicines, who should avoid it, warning signs that need urgent care, and when to talk with a clinician about your personal plan.
References:
* Abellán Ruiz MS, Gomis P, Herrero-Pomares R, Cadenas B, Olivares-Durán V, Marín F. Effect of psyllium consumption on blood lipid levels: a meta-analysis of randomized controlled trials. J Diet Suppl. 2017 Jul 4;14(4):423-437. doi: 10.1080/19390211.2016.1264215. Epub 2017 Mar 29. PMID: 28355938.
* Ma J, Zhang L, Li Y, Meng H, Niu H, Sun J, Zhang S, Sun S, Han T, Feng Y. Effect of psyllium on stool characteristics, gut microbiota, and fermentation products in healthy elderly individuals. Food Sci Nutr. 2021 Jun 2;9(7):3585-3595. doi: 10.1002/fsn3.2323. PMID: 34221415; PMCID: PMC8170289.
* Saeed MK, Mehmood T, Anjum S, Ullah N, Nazir N, Bashir S, Ali B. A comprehensive review on the impact of psyllium on gut microbiota. Food Res Int. 2024 Jan;175:113702. doi: 10.1016/j.foodres.2023.113702. Epub 2023 Nov 2. PMID: 38086968.
* Dajani A, Dajani S. The effect of psyllium on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2018 Jan;36(1):19-27. doi: 10.1097/HJH.0000000000001550. PMID: 28915017.
* Ma X, Ma W, Xu H, Hu Y. Psyllium for Human Health: Recent Advances in Its Chemical Composition and Health Benefits. Foods. 2023 Feb 24;12(5):953. doi: 10.3390/foods12050953. PMID: 36900732; PMCID: PMC10002166.
Q.
Can I eat grapefruit while taking statins?
A.
Grapefruit can interact with some statins, making them work too strongly and possibly causing side effects. It's best to talk to your doctor about whether you should avoid grapefruit while taking your specific statin. See below to understand more.
References:
Lee JW, Morris JK, & Wald NJ. (2016). Grapefruit Juice and Statins. The American journal of medicine, 26299317.
https://pubmed.ncbi.nlm.nih.gov/26299317/
de Andrés S, Lucena A, & de Juana P. (2004). [Interactions between foodstuffs and statins]. Nutricion hospitalaria, 15315110.
https://pubmed.ncbi.nlm.nih.gov/15315110/
Stump AL, Mayo T, & Blum A. (2006). Management of grapefruit-drug interactions. American family physician, 16939181.
Q.
Can omega-3 supplements replace statins?
A.
Omega-3 supplements cannot replace statins, as they work differently and are not as effective in lowering cholesterol levels. See below to understand more.
References:
Hoang T, & Kim J. (2020). Comparative Effect of Statins and Omega-3 .... Nutrients, 32722395.
https://pubmed.ncbi.nlm.nih.gov/32722395/
Ong HT, & Cheah JS. (2008). an objective review of omega-3, red yeast rice and garlic in .... Chinese medical journal, 18982874.
https://pubmed.ncbi.nlm.nih.gov/18982874/
Bradberry JC, & Hilleman DE. (2013). Overview of omega-3 Fatty Acid therapies. P & T : a peer-reviewed journal for formulary management, 24391388.
Q.
Do statins really cause muscle pain?
A.
Yes, statins can cause muscle pain in some people, but not everyone who takes them will have this problem. See below to understand more.
References:
Pedroso AF, Barreto SM, Telles RW, Machado LAC, Haueisen Sander Diniz MF, Duncan BB, & Figueiredo RC. (2024). Uncovering the Relationship Between Statins and Muscle .... Cardiovascular drugs and therapy, 37261675.
https://pubmed.ncbi.nlm.nih.gov/37261675/
Backes JM, Ruisinger JF, Gibson CA, & Moriarty PM. (2017). Statin-associated muscle symptoms-Managing the highly .... Journal of clinical lipidology, 28391891.
https://pubmed.ncbi.nlm.nih.gov/28391891/
Cham S, Evans MA, Denenberg JO, & Golomb BA. (2010). Statin-associated muscle-related adverse effects - PubMed - NIH. Pharmacotherapy, 20500044.
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