High Cholesterol Management: Prevention and Treatment Strategies

Cholesterol, glucose, and protein are the three essential nutrients required by the human body. One gram of fat can provide approximately 9.2 kilocalories of energy when fully oxidized. Beyond energy production, fats play a crucial role in forming cell membranes and facilitating various biochemical reactions. A healthy body depends on the presence of fats, which are maintained in a dynamic equilibrium to support metabolic needs.

In a healthy individual, body fat consists primarily of total cholesterol and triglycerides, which are stored in adipose tissue and circulate in the bloodstream. Within the blood, fats are transported either freely or bound to lipoproteins, maintaining a relatively stable concentration. When metabolic imbalances or pathological factors cause excessive accumulation of lipids in the blood, it leads to a condition known as hyperlipidemia — a major contributor to cardiovascular and metabolic diseases.

Common Symptoms of Hyperlipidemia

Under normal conditions, adult blood triglyceride levels range from 0.22 to 1.2 mmol/L, and cholesterol levels range from 3.12 to 5.20 mmol/L. In the early stages of elevated lipid levels, symptoms may be absent, allowing individuals to maintain normal eating habits and daily routines. However, prolonged hyperlipidemia can lead to systemic complications affecting multiple organs.

Obesity

About two-thirds of individuals with high cholesterol are overweight or obese. Body weight can be estimated using the formula: Ideal Body Weight (kg) = Height (cm) – 110. Excess fat accumulation is often a visible sign of lipid imbalance and metabolic dysfunction.

Arteriosclerosis

Many middle-aged and elderly patients with hyperlipidemia experience vascular damage due to impaired lipid metabolism. This affects endothelial cell function and promotes the deposition of fats beneath the inner lining of blood vessels. Over time, this process leads to arterial hardening, ulceration, and clot formation — the foundation of cardiovascular and cerebrovascular diseases.

Fatty Liver Disease

The liver, being the largest digestive organ, contains numerous enzymes responsible for fat metabolism. Blood lipids are transported to the liver via lipoproteins for processing and utilization. When lipid levels exceed the liver's metabolic capacity, fat accumulates within liver cells, leading to non-alcoholic fatty liver disease (NAFLD). If left untreated, this can progress to liver fibrosis and cirrhosis.

Increased Blood Viscosity

Elevated lipid levels increase the number of chylomicrons in the blood, raising blood viscosity and slowing circulation. This increases the risk of microvascular blockages and thrombosis, especially in smaller vessels.

Primary Causes of Hyperlipidemia

Unhealthy Dietary Habits

Most cases of hyperlipidemia are linked to long-term poor dietary choices, including excessive consumption of sweets, irregular eating patterns, overeating fatty foods such as meats and eggs, and imbalanced caloric intake. These behaviors often result in more calories consumed than burned.

Sedentary and Irregular Lifestyle

Irregular sleep patterns, late-night meals, and lack of physical activity can disrupt metabolic rhythms. Reduced physical exertion decreases energy expenditure, contributing to fat accumulation and elevated lipid levels.

Underlying Medical Conditions

Conditions such as obesity, diabetes, and genetic metabolic disorders can impair the body's ability to process lipids. Deficiencies in specific enzymes or hormonal imbalances may also lead to increased cholesterol and triglyceride levels.

Prevention and Treatment of Hyperlipidemia

Hyperlipidemia, often grouped with diabetes and fatty liver disease as "modern lifestyle diseases," is closely linked to sedentary habits, technological reliance, and nutritional imbalances. Effective prevention and treatment require a holistic approach targeting root causes.

1. Balanced Caloric Intake and Nutritional Balance

Healthy adults require varying amounts of calories based on activity level: 25–30 kcal/kg for sedentary lifestyles, 30–35 for light activity, 35–40 for moderate, and over 40 for heavy labor. For a 60 kg adult, this translates to 1500–2400+ kcal per day. A balanced diet should include 50–70 g of protein, 40–60 g of fat (about one-third of total calories), and 200–300 g of carbohydrates (two-thirds of calories), supplemented with fruits, vegetables, vitamins, and minerals. Individuals with high cholesterol should slightly reduce caloric and fat intake.

2. Adopt a Healthy Lifestyle and Regular Exercise

For those working desk jobs or engaging in mentally demanding tasks, establishing a structured routine is essential. Regular sleep, scheduled meals, and a balance between work and rest help maintain metabolic health. Engaging in aerobic activities like walking, jogging, swimming, or fitness training can effectively burn excess fat and improve overall cardiovascular health.

3. Regular Health Screenings

Periodic medical checkups are vital for monitoring lipid levels and detecting early signs of metabolic disorders. Key indicators such as total cholesterol, LDL, HDL, and triglycerides should be reviewed regularly to guide preventive or therapeutic interventions.

4. Pharmacological Interventions When Necessary

When lifestyle changes are insufficient or when conditions like fatty liver or elevated liver enzymes are present, medication may be required. Commonly prescribed drugs include:

Fenofibrate – Effective for lowering both cholesterol and triglycerides. Usual dose: 0.2 g once daily. Some patients may experience a rebound after discontinuation.
Simvastatin – A globally recognized cholesterol-lowering medication. Usual dose: 20 mg once or twice daily. Newer options like Atorvastatin (20 mg once daily) offer broader benefits, including lowering triglycerides and reducing arterial plaque buildup.
Vitamin E Niacinate – Offers mild lipid-lowering and vasodilatory effects. Dosage: 0.1 g three times daily.
Dextranase – Helps lower cholesterol and activates lipase enzymes. Dosage: 0.15 g three times daily.
Other options include Lipid-Lowering Pills, Xuezhikang, and Zhibituo, which are also used in clinical settings.

Managing hyperlipidemia requires a combination of dietary discipline, active lifestyle choices, regular monitoring, and, when necessary, medical treatment. By addressing the condition proactively, individuals can significantly reduce their risk of heart disease, stroke, and other related health complications.