How do I know I’m at risk? Are there any symptoms or risk factors?
Unfortunately, there are no risk factors or warning symptoms for most forms of elevation, so the condition is first recognized after a heart attack or stroke. However, if high blood lipids are recognized and treated early, such events can be prevented. In many cases, the increase in cholesterol levels is due to a genetic change. Therefore, high levels also occur in patients with a healthy lifestyle, who eat a balanced diet and are regularly physically active. If patients already have coronary heart disease or another vascular disease, the cholesterol should be checked regularly and adjusted with medication. Special limits apply here. If these are achieved, the progression of the disease can be stopped.
What therapy options are there?
Statins are the leading therapy option for elevated cholesterol levels. They are among the most scientifically researched drugs and are very well tolerated by many patients. In recent years, numerous other therapy options have been added. These are mostly used in combination therapy with statins. In case of intolerance, however, monotherapy of these newer substances can also be considered. While statins can often be prescribed by family doctors, PCSK-9 inhibitors, for example, a very efficient injection therapy, can only be prescribed for the first time by specialists with the appropriate focus. Which therapies come into question always depends on the risk of the patient and the previous illnesses. Due to the different options available today, we can tailor the therapy according to the blood lipid levels and the risk of the individual patient. But also specific therapy options for special lipid metabolism disorders will further enrich the drug therapy options in the coming years. These include therapeutics for patients with elevated lipoprotein(a) or elevated triglycerides. However, these are currently only available as part of clinical studies.
Which therapy is the right one for me?
Elevated blood lipids should always be treated individually. The first step is to measure blood lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides). Once in a lifetime, the lipoprotein(a) should also be determined, which is a marker of genetic risk that cannot be changed by conventional therapy and lifestyle. In primary prevention, i.e. when no cardiovascular disease has yet occurred, this is usually followed by a discussion with the treating physicians in which individual goals are set. The blood values are included here, as well as the other risk factors and the patient’s wishes. Imaging technologies can also be used to examine whether deposits are already detectable in the vessels. Physicians have recently also been able to use calculators to advise their patients, which help them to estimate the benefit of primary prevention measures in relation to the increase in life expectancy. The European Society of Cardiology (ESC), for example, provides such tools. The aim is to be able to better and better assess the risk and benefit of a therapy for the individual patient. We’re certainly not at the end of the road here. In the future, machine learning techniques will also be added to support doctors in interpreting the ever-increasing flood of data in a combined way. Ultimately, however, it is the individual patient who needs to be prevented from developing cardiovascular disease. The way to get there can be different for each patient.
What can I do myself to positively influence my blood lipids?
A healthy lifestyle can have a positive effect on blood lipids. This includes a balanced diet, which ideally avoids daily meat consumption and includes fish dishes at least once a week. Regular endurance sports also have a positive overall effect on blood lipids and cardiovascular risk. A healthy lifestyle including exercise not only has a positive effect on cholesterol levels and free fats. This can also lower blood pressure and reduce the risk of diabetes. But there are also genetic causes for increased blood lipids. Unfortunately, it is often not possible to control blood lipid levels through a healthy lifestyle alone. In particular, when cardiovascular disease has already occurred, drug options to lower cholesterol levels become necessary.