1. What are the common complications of high cholesterol?
Cholesterol is important for a variety of different functions. Some of these functions include making hormones, serving as a building block in cell walls, and the metabolism of some vitamins. However, persistently high cholesterol can have detrimental effects on your health and is a risk factor for a disease process called atherosclerosis.
Atherosclerosis involves the buildup of cholesterol, fats, and calcium with other substances inside your arteries. This includes the blood vessels that provide blood, oxygen, and nutrients to your entire body. As a result, these important vessels will narrow and harden, reducing or completely blocking blood flow. This can ultimately lead to pain, reduced function, and even death.
Severe atherosclerosis or a blood clot associated with a plaque will lead to a stroke or heart attack and can be fatal. The development of atherosclerosis in other arteries of the body may not be as life-threatening, but it can affect your quality of life.
2. What are the symptoms of these complications? When should I call a doctor?
The symptoms of atherosclerosis affecting the heart include chest pain, sometimes radiating to the arms, shoulders, and jaw. Other symptoms include shortness of breath, rapid weight gain, and lower extremity swelling, which may be a sign of heart failure.
Atherosclerosis affecting the arteries to the brain may lead to a variety of non-specific symptoms like confusion and localized weakness or paralysis to one or several extremities. It can also cause difficulty speaking, which may be a sign of a stroke or a transient ischemic attack (TIA). We differentiate between these by the duration and intensity of your neurological symptoms.
Atherosclerosis affecting other parts of your body will have symptoms associated with the function of that muscle group or organ. For instance, the arteries of your legs or arms might cause aches or pains when you're walking or running. When the vessels of your gastrointestinal (GI) system are affected, you might experience frequent nausea or vomiting after eating.
As long as you're not experiencing intense or severe pain, shortness of breath, or dizziness, it's reasonable to schedule an appointment with your doctor within the same week for an evaluation. However, if you have new or changing symptoms, it's important to go to the emergency room and get an expedited assessment.
3. Are there ways to avoid complications other than medication?
My number one prescription to every single patient I see is an adequate amount of aerobic exercise daily and a healthy diet. As obvious as it may seem, I can't emphasize enough the value of a healthy lifestyle. It can have beneficial effects for the heart and brain, and nearly every medical condition.
What I recommend is doing 30 minutes of a moderate-intensity aerobic workout each day. Try to establish a daily routine and to get the exercise you need to stay healthy.
As far as diet goes, fried foods, added sugars, and food with high trans and saturated fat should be eliminated. If you have to open it, such as from a bag or a can, it most likely has excessive salt quantities.
Follow the general approach of consuming more fruits, vegetables, whole grains, nuts, vegetable oils —particularly olive oil — low-fat dairy products, and some fish.
4. What are the prescription medications that help prevent complications?
There are a number of medications that can lower your high cholesterol levels to prevent complications. The lower your cholesterol, the less likely you'll experience adverse events.
The most effective and widely used cholesterol-lowering medications are statins. These drugs are proven to have remarkable effects at lowering your cholesterol levels and reducing your risk of having a heart attack or stroke in the future. Statins act on the liver to reduce the production of cholesterol. They also have anti-inflammatory effects.
There are other classes of medications that can help to reduce your cholesterol levels, but they don't provide the same amount of cardiovascular protection as statins. Zetia (Ezetimibe) is an option for individuals that are unable to tolerate statins or have had a severe reaction to them. This medication can also be used in combination with a statin if your levels remain high despite using high-intensity statins.
Fibrates are a class of medication that reduce your cholesterol levels. But they're more effective at lowering your triglycerides — a type of the fat in the blood. Triglycerides can be a marker of your overall health and can increase your risk of cardiovascular disease if they're very high.
Bile acid sequestrants are a class of medications that may be used to help lower high cholesterol levels. They facilitate excretion of cholesterol via stool, which indirectly lowers your blood cholesterol.
A novel revolutionary class of medications called PCSK9 inhibitors are a very effective way to reduce your cholesterol levels. They can also reduce your risk of cardiovascular disease. They're specially designed antibodies or proteins that interact with your liver cells and promote the absorption and destruction of blood cholesterol. Although they are remarkably effective, they are very expensive and administered by injection only. There are certain criteria you must meet to be considered for this type of therapy.
5. What is peripheral artery disease (PAD)?
Peripheral arterial disease (PAD) is atherosclerosis of the arteries in the blood vessels of your extremities (or periphery), like your arms and legs.
When a blockage in the arteries of the legs becomes severe, you may start to feel aching and pain in the leg muscles when you move them. These symptoms are called claudication.
A similar phenomenon can occur in your arms, although it's less common.
If you're diagnosed with PAD, there are different treatments you can try in addition to leading a healthy lifestyle. Your doctor may recommend a supervised exercise program several times a week that emphasizes the use of your leg muscles. With time, you will have increased exercise tolerance and a reduction in claudication symptoms.
Your doctor may prescribe medication to help improve your symptoms. Medication for PAD falls into three main categories:
- Vasodilators. These help to widen or relax blood vessels and allow for more blood flow.
- Cholesterol medications. These will reduce your blood cholesterol levels and provide anti-inflammatory effects.
- Blood thinners. These will help to prevent the formation of blood clots at the site of disease and reduce your risk of any sudden blockage.
If a supervised exercise program and medication don't help with your symptoms, your doctor may consider invasive intervention by either stenting or surgical bypass of the blockages. Consult with your cardiologist or vascular specialist to see which invasive approach might be appropriate for you.
To help prevent PAD, follow a heart-healthy diet and try to get 30 minutes of a moderate-intensity workout each day. Lastly, quitting smoking will drastically slow down the development of atherosclerosis in all arteries.
6. What is coronary artery disease (CAD)? How is it treated and prevented?
Coronary heart disease (CHD) or coronary artery disease (CAD) is atherosclerosis of the blood vessels that supply oxygen and nutrients to the heart muscle.
As atherosclerosis progresses, it may lead to limitations in the blood supply to the heart muscle. This causes symptoms like chest pain and shortness of breath.
The severity of coronary atherosclerosis can vary with each case, so it's treated in different ways. Your cardiologist will test, diagnose, and provide recommendations across the cardiovascular spectrum from prevention to invasive intervention.
If you've been diagnosed with CAD, there are three main approaches to treat and manage it depending on the severity and extent. As always, the first step is to improve your diet and create an exercise routine to ensure you're living a healthy lifestyle.
Medication may also be used along with lifestyle changes. There are three broad categories of medication for CAD:
- Blood thinners. These prevent blood clots.
- Cholesterol medication. These reduce your cholesterol levels.
- Anti-anginal medication. These decrease chest pain through various pathways.
Your cardiologist will help to find the best combination of medications for you.
If your CAD progresses or worsens despite medical therapy, you may be a candidate for open-heart coronary artery bypass surgery (CABG). There are risks and benefits to each approach. Your cardiac team will recommend the best option for you.
Similar to peripheral arterial disease, coronary artery disease is prevented by slowing atherosclerosis. The best approach to take is to incorporate adequate aerobic exercise and a heart-healthy diet. Also, quitting smoking will work to minimize the risk factors of CAD.
7. Are there certain preventive measures I should be talking to my doctor about?
The most powerful tool I have as a cardiologist is to empower you to exercise, quit smoking if you smoke cigarettes, and follow a heart-healthy diet. These lifestyle modifications will address CAD risk factors of high blood pressure, high cholesterol, and diabetes, among others.
Ask your cardiologist about your personalized risk for cardiovascular disease. This can help tailor your treatment plan to your needs.
If you have questions about preventive measures for heart disease, bring them up at your appointments and don't hesitate to ask questions, no matter how big or small.
8. Are some complications more common than others? What puts me more at risk?
Cardiovascular disease (CVD) is extremely common. The major risk factors of CVD are high cholesterol, high blood pressure, diabetes, and smoking, among others. Much of your medical care with your primary care doctor target these risk factors. This includes controlling your resting blood pressure, making sure you have good blood sugar control if you're living with diabetes, and getting your cholesterol down to acceptable levels.
Dr. Harb Harb is a non-invasive cardiologist working within the Northwell Health System in New York, specifically at the North Shore University Hospital, affiliated with Hofstra University. He completed medical school at the University of Iowa Carver College of Medicine in Iowa City, Iowa, internal medicine at the Cleveland Clinic in Cleveland, Ohio, and cardiovascular medicine at Henry Ford Health System in Detroit, Michigan. Dr. Harb moved to New York City, choosing a career path in academic medicine as an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. There, he teaches and works with cardiovascular and medical trainees as well as medical students. He is a Fellow of the American College of Cardiology (FACC) and American board-certified in general cardiology, echocardiography, and stress-testing, and nuclear cardiology. He is a registered physician in vascular interpretation (RPVI). Lastly, he obtained graduate education in public health and business administration to contribute to national healthcare reform research and implementation.