- Top 10 Questions About High Cholesterol, Answered
- 1. What Does High Cholesterol Do to the Body?
- 2. Whom Does High Cholesterol Affect?
- 3. Can High Cholesterol Be Genetic?
- 4. Can High Cholesterol Make You Tired?
- 5. Can High Cholesterol Cause a Stroke?
- 6. Will High Cholesterol Make You Feel Bad?
- 7. Will High Cholesterol Cause Erectile Dysfunction (ED)?
- 8. Can High Cholesterol Cause Headaches or Dizziness?
- 9. When Should High Cholesterol Be Treated With Medication?
- 10. Is High Cholesterol Always Bad?
- TIA: When a Dizzy Spell is a Warning Sign
- Summit Medical Group Web Site
- Migraine Frequency and Intensity Linked to Cholesterol Levels
- Migraine With Aura May Mean Higher Cholesterol
- Symptoms and Signs of High Cholesterol
- Cholesterol medications not making you feel better? It is still working even if you don’t feel any different.
- CV risk and cholesterol
Top 10 Questions About High Cholesterol, Answered
1. What Does High Cholesterol Do to the Body?
Having high cholesterol can lead to the stiffening and narrowing of the arteries, as well as reduced or blocked blood flow through them because of a buildup of plaque — a combination of cholesterol, fats, your cells’ waste products, calcium, and fibrin (which causes blood clotting), explains the American Heart Association (AHA). That’s why cholesterol matters: Lack of sufficient blood flow to your brain or heart can lead to a stroke or heart attack.
2. Whom Does High Cholesterol Affect?
High cholesterol can affect anyone at any age. About 73 million adults in the United States have high cholesterol, according to the Centers for Disease Control and Prevention (CDC). But it can also be a problem for children when high cholesterol runs in the family.
3. Can High Cholesterol Be Genetic?
Yes. High cholesterol is genetic for about 1 in 200 people in the United States who live with a condition called familial hypercholesterolemia (FH).
Unfortunately, 90 percent of people who have FH don’t know it, according to the FH Foundation, a national nonprofit organization based in Pasadena, California. Screening for high cholesterol is the only way to identify people who have FH. Because of this, all children should have a cholesterol screening test once between ages 9 and 11, recommends the American Academy of Pediatrics.
If your LDL cholesterol level is above 100, it’s considered high. But if it’s higher than 190, you may have inherited FH, according to leading heart groups such as the AHA, the American College of Cardiology, and the National Lipid Association. If a parent has familial hypercholesterolemia, you have a 50 percent likelihood of having it, too. Finding out if you have it — and getting treated if you do — are vital, because having FH means you have a 20-times higher risk of heart attack or stroke than people who don’t have inherited high cholesterol.
4. Can High Cholesterol Make You Tired?
No, high cholesterol doesn’t usually cause fatigue. But it can lead to heart diseases, like coronary microvascular disease, that do. In this heart condition, excess LDL cholesterol builds up as plaque in the small arteries of your heart, narrowing and stiffening them. This reduces blood flow, which can make you feel tired or short of breath, as well as cause chest pain, notes the National Heart, Lung and Blood Institute (NHLBI).
If you’re taking a statin medication to treat your high cholesterol, possible side effects include symptoms that come with fatigue, like memory loss, forgetfulness, and confusion, according to the Food and Drug Administration (FDA). The Mayo Clinic describes this as mental fuzziness. Be sure to discuss any similar symptoms with your doctor.
5. Can High Cholesterol Cause a Stroke?
Yes, if you have high cholesterol, you’re at risk for stroke due to the excess cholesterol circulating in your blood, according to the AHA.
LDL cholesterol builds up in your arteries, where it slows or blocks the flow of oxygen- and nutrient-rich blood to your body, including your brain. As arteries narrow and stiffen, blood clots may form and cause a stroke from a blockage in the brain.
About 795,000 Americans have a stroke each year, and 130,000 of these are fatal, making stroke the fifth leading cause of death, according to the American Stroke Association. Stroke is also one of the main causes of disability in the United States, but it’s preventable; keeping your cholesterol levels down is one way to cut your risk.
6. Will High Cholesterol Make You Feel Bad?
No. For most people, high cholesterol has no symptoms at all, according to the AHA. But when it causes plaque buildup in larger arteries in your heart, coronary artery disease results, along with angina, chest pain, arrhythmia (an irregular heart beat), and shortness of breath that can leave you short on energy, notes the NHLBI.
Coronary artery disease, also called coronary heart disease, is the most common heart disease, but many people have no symptoms at all until they suffer a heart attack, according to the CDC. For them, a heart attack was the first sign that they’d been living with high cholesterol.
The AHA advises having your cholesterol checked every four to six years starting at age 20 (or more frequently if you’re at risk). If your numbers are too high, you can take steps to lower your risk for both heart disease and stroke. Eat a diet low in saturated and trans fats but rich in fruits, vegetables, and whole grains; stay physically active; and take medications as instructed if your doctor prescribes them.
7. Will High Cholesterol Cause Erectile Dysfunction (ED)?
High cholesterol alone is not thought to cause erectile dysfunction, but plaque-clogged arteries can, because blood flow is essential to an erection, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“High cholesterol is atherogenic and can cause erectile dysfunction on that basis,” says Seth J. Baum, MD, president of the American Society for Preventive Cardiology and director of women’s preventive cardiology at the Boca Raton Regional Hospital in Florida. “When we see patients with ED, we have to consider not only cholesterol disorders, but also that other parts of the body might be afflicted with atherosclerotic plaque. The heart, lower extremities, and brain are the areas we typically examine to look for such disease.”
8. Can High Cholesterol Cause Headaches or Dizziness?
No, says Baum. “High cholesterol doesn’t cause these symptoms. Sometimes, rarely, the medications we use to treat high cholesterol can cause such side effects,” he says. For example, statins used to lower cholesterol can cause headaches as a side effect in some people. Check with your doctor if you’re having headaches or dizziness to find out if your symptom is related to drug side effects, or points to another health condition that may need treatment.
9. When Should High Cholesterol Be Treated With Medication?
If you’ve had a heart attack or been diagnosed with inherited high cholesterol, you’ll probably need to try a cholesterol-lowering medication or medications, in addition to being careful with your diet and staying active.
“Almost all people who’ve had a heart attack should be on a statin,” recommends Arthur Agatston, MD, medical director of wellness and prevention for Baptist Health South Florida, and clinical assistant professor of medicine at Florida International University’s Herbert Wertheim College of Medicine in Miami.
In addition to statins, cholesterol-lowering drugs include bile-acid sequestrants and cholesterol absorption inhibitors. If these aren’t effective for you, injectable biologics are also available: Praluent (alirocumab) and Repatha (evolocumab).
If you found out your cholesterol was high after a routine checkup, discuss your test results with your healthcare provider. If the doctor recommends it, give a healthy diet and an active lifestyle a try first. If your cholesterol levels remain high, you may need a heart scan to look for plaque buildup in your arteries, and your doctor may recommend cholesterol-lowering drugs to lower your heart disease and stroke risk.
10. Is High Cholesterol Always Bad?
Not all cholesterol is bad. Higher levels of HDL cholesterol — optimally 60 mg/dL or higher — may protect your heart from disease, heart attack, and stroke, according to the AHA.
But high total cholesterol, and high LDL cholesterol levels in particular, do put you at risk for heart disease, heart attack, and stroke. The higher your LDL cholesterol, the higher your risk, notes the FH Foundation.
TIA: When a Dizzy Spell is a Warning Sign
A Golden Opportunity to Prevent Stroke
You’ve been gardening on a warm day, and you suddenly experience confusion and dizziness. You don’t know where you are or what you’re doing. The disorientation lasts a few minutes and then passes. Relieved, you walk into the air-conditioned house, pour yourself a glass of water and resolve to garden in cooler weather next time.
Sounds innocent enough, but this type of “spell” could actually be a transient ischemic attack (TIA) and an important early warning sign that you are at risk for stroke.
Symptoms of a TIA
The symptoms of a TIA are the same as those experienced during an actual stroke, but they last for just a short time. In fact, TIAs are sometimes called mini-strokes.
“Unlike a stroke, TIA symptoms are brief – usually spanning seconds to a few minutes,” says Dr. Marc Schermerhorn (right), Chief of Vascular Surgery at Beth Israel Deaconess Medical Center’s CardioVascular Institute.
The signs of a TIA or stroke include one or more of the following symptoms:
- Weakness on one side of the body, such as the face, an arm or a leg
- Difficulty in speaking or understanding
- Partial or complete loss of vision in one or both eyes
- Dizziness or loss of balance and coordination
While these symptoms don’t last long and may be mild, they are serious warning signs for stroke. And while the body is experiencing these signs, there’s no way to know whether it’s a stroke or a TIA without physician intervention. That’s why anyone experiencing TIA symptoms should get to a hospital emergency department as soon as possible.
“Up to 25 percent of stroke patients have experienced a TIA in the past,” says Dr. Magdy H. Selim (right), Co-Director of BIDMC’s Stroke Clinic and Associate Professor of Neurology at Harvard Medical School. “On average, for those who experience a TIA, eight percent will have a stroke within a month, 12 percent within a year and 30 percent within five years.”
Causes of TIA
A TIA occurs when blood stops flowing to an area of the brain for a brief period of time. This usually happens when there is low blood flow in a major artery that carries blood to the brain, like one of the carotid arteries, which are located on both sides of the neck. TIAs can also result when a blood vessel in the brain is blocked by plaque build-up or by a blood clot that has traveled to the brain from elsewhere in the body.
Top risk factors linked to stroke are:
- High blood pressure
- High cholesterol
- Atrial fibrillation or irregular heartbeat
- Family history
The common denominator for many of these risk factors is atherosclerosis (another name for plaque build-up). Atherosclerosis occurs when inner layers of arteries are damaged due to high levels of blood pressure, cholesterol or sugar (from diabetes or insulin resistance) in the blood or smoking. Plaque can accumulate on the inside of damaged arteries, restricting blood flow and, if the plaque ruptures, causing blood clots to form.
Treatments for TIA
TIA management is aimed at preventing a future stroke, the number three killer and leading cause of disability in the United States. If evidence of atherosclerosis or carotid artery blockage is found, treatment may include the use of medications such as statins to lower cholesterol and blood-thinning medications (antiplatelets such as aspirin or anticoagulants) to help prevent blood clots from forming.
For severe narrowing of the carotid artery, a vascular surgeon can open the artery and remove plaque. Some vascular surgeons also perform a newer, endovascular (non-surgical) procedure called carotid stenting, in which a small wire mesh tube is placed within the plaque-lined artery to keep it open.
Even so, a preventive approach remains essential. Atherosclerosis is a chronic and incurable disease, according to Dr. Schermerhorn, who performs both surgical and endovascular procedures.
“As with any chronic disease, slowing down its progress is the key to extending health,” he says. “Surgery to open the artery is an option. And lifestyle changes can make a significant difference in the amount of plaque build-up and the frequency of procedures required to treat it. You can’t cure it, but you can manage it and slow down the process. Surgery can open an artery, but lifestyle changes can help avoid the plaque building back up again and requiring further procedures.”
Measures to reduce risk for carotid artery disease and stroke include a healthy diet and weight, regular exercise and not smoking. Medications may be needed to aggressively treat diabetes, high blood pressure or high cholesterol levels.
“Recovery from stroke is a long process. We do our best with patients, but sometimes the damage is permanent,” says Dr. Selim. “A TIA can be a once-in-a-lifetime chance to decrease your risk of a disabling stroke. It’s a golden opportunity to build healthy habits into your lifestyle and, if needed, to take advantage of medical interventions like surgery or medication.”
Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
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Summit Medical Group Web Site
What is carotid artery disease?
Carotid artery disease is a disease caused by a narrowing or blockage of the carotid arteries. These 2 arteries in your neck bring blood to your head and brain. A narrowing or blockage of a carotid artery can slow or stop blood flow. If blood flow to your brain is slowed, it can cause temporary symptoms such as dizziness, partial blindness, or numbness. It can also cause stroke or death.
What is the cause?
Most often narrowing of the arteries is caused by fatty deposits called plaque that build up in blood vessels and make them narrower. The narrowing decreases the amount of blood flow to your brain. Pieces of plaque may break off from the wall of a blood vessel and form clots that can block blood flow to the brain.
Your risk of developing fatty deposits is higher if you:
- Have a family history of carotid artery disease
- Have high blood pressure
- Have diabetes or insulin resistance
- Are very overweight
- Don’t get enough exercise
- Have high levels of blood fat–for example, high cholesterol
What are the symptoms?
Most people with carotid artery disease have no symptoms. The most common symptoms of carotid artery disease are transient ischemic attacks (TIAs) or stroke. A TIA is a brief loss in brain function. It happens when the brain does not get enough blood because a blood vessel is blocked for a short time. Symptoms of TIA and stroke are the same, except TIA symptoms go away within 24 hours and stroke symptoms may not. A TIA is different from a stroke because it does not cause any lasting damage to the brain. Even if your symptoms are gone within 24 hours, it’s possible that there is brain damage and you have had a stroke.
It helps to think of the word FAST (face, arm, speech, time) to remember TIA or stroke symptoms and what to do. The symptoms come on FAST and may include:
- Weakness, numbness, drooping, or tingling of face (may just be on one side)
- Trouble seeing (one or both eyes)
- Severe headache
- Trouble thinking
- Trouble swallowing
- Feeling dizzy along with one or more of the symptoms listed above
- Weakness, numbness, or tingling in your arm or leg (may be on just one side of your body)
- Trouble walking or moving your arm or leg
- Trouble talking or understanding speech
- Call 911 for emergency help right away if you have symptoms of a TIA or stroke.
If you have had a TIA, you have a high risk of having a stroke. Do not ignore symptoms of a TIA. Get emergency medical care to help prevent a stroke and to be tested to see if your symptoms were caused by blockage of your carotid arteries.
How is it diagnosed?
Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:
- MRI, which uses a strong magnetic field and radio waves to show detailed pictures of your brain and blood vessels
- CT scan, which uses X-rays and a computer to show detailed pictures of your brain and blood vessels
- Ultrasound, which uses sound waves to show pictures of the blood vessels in your neck and brain
- Angiogram, which uses dye injected into a vein and X-rays to look at blood flow in the carotid arteries or brain
How is it treated?
The goal of treatment is to prevent more blockage of the arteries and stroke.
Your healthcare provider may prescribe medicine that helps prevent blood clots or medicine to lower cholesterol. Your provider may tell you to take a low-dose aspirin every day. Aspirin lowers the chance that blood clots will form and lowers your risk of having a stroke caused by a blood clot. However, some strokes are caused by bleeding and aspirin may increase your risk of having this type of stroke. If you are having sudden symptoms of a stroke, do not take aspirin unless recommended by your healthcare provider.
If your carotid artery is severely blocked and is causing symptoms, you will likely need a procedure to open the blood vessel.
- Carotid endarterectomy involves making cuts in your neck and the artery and then removing the blockage.
- Carotid angioplasty and stenting involves passing a balloon-tipped tube (catheter) into the blocked artery in your neck. Once the catheter is in the proper place, the balloon is inflated to open the blood vessel and improve blood flow. A metal mesh device called a stent is usually left in the artery to help keep the blood vessel open.
How can I take care of myself?
Follow the full course of treatment prescribed by your healthcare provider. Take any medicines exactly as prescribed.
Try to have a healthy lifestyle:
- Eat a healthy diet.
- Try to keep a healthy weight. If you are overweight, lose weight.
- Stay fit with the right kind of exercise for you.
- If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
Get your cholesterol levels and blood pressure checked by your healthcare provider regularly.
If you have high blood pressure, high cholesterol, diabetes, or another medical problem, follow your treatment plan.
Ask your healthcare provider:
- How and when you will hear your test results
- How long it will take to recover
- What activities you should avoid and when you can return to your normal activities
- How to take care of yourself at home
- What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
How can I help prevent carotid artery disease?
Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know what you can do to lower your risk for carotid artery disease. Taking good care of your health, including a healthy lifestyle, can help prevent this disease.
In the present study, we found U-shaped associations between sleep duration and a high triglyceride or a low HDL cholesterol level among women. Using the data of a cohort study conducted on 71,617 women in the USA, Ayas et al. examined the associations between sleep duration and CHD.10 They reported that the relative risk of CHD was significantly higher among those with shorter or longer sleep durations, and that the association was U-shaped.10 Recently, in a study comprising 2,437 participants from the general population in Germany, Wolff et al. reported that the carotid intima-media thickness was greater among those with short and long sleep durations.11 From these study results, it is suggested that both short and long sleep durations can be regarded as individual risk factors of CVDs such as CHD and atherosclerosis. Since an increase in the triglyceride level or a decrease in the HDL cholesterol level in blood are risk factors for the onset of CVD,12–14 the present results are important for explaining the association between sleep duration and CVD. It is logical to consider that the incidence or prevalence of a high triglyceride or a low HDL cholesterol level are high among individuals with short and long sleep durations, predisposing them to a higher relative risk of CVD. There are associations between two of the three elements (sleep duration, dyslipidemia, and CVD) and each element can produce a confounding effect on the association between the other two elements. These associations must be examined individually in the future using a study design that can account for the confounding effects of all the above elements.
While we were preparing the present report, a study on the associations between sleep duration and dyslipidemia was published by another group.22 Williams et al. examined the associations between sleep duration and biomarkers that could be risk factors for CVDs in 935 women with type 2 diabetes. They indicated that among the subjects whose blood pressure was within the normal range, the serum HDL cholesterol level was low among those with both short and long sleep durations. They stated that the result partially explained how sleep habit could become a risk factor for CVDs. A simple comparison between their study and ours is not warranted because in their study the subjects were limited to women with type 2 diabetes. However, the data are helpful for clarifying the associations between dyslipidemia and sleep duration, i.e., an inverted U-shaped association was observed between serum HDL cholesterol levels and sleep duration in both studies.
Recently, it has become increasingly clear that sleep has a strong influence on the metabolic hormones that regulate energy balance. Sleep restriction lowers the blood concentration of leptin, which acts to suppress appetite, and increases the blood concentration of ghrelin, which promotes appetite.8,23–25 In addition, it is known that administration of leptin decreases serum triglyceride level.26,27 In addition, it was recently reported that short sleep duration was associated with a reduced leptin level and being overweight.28 Mechanisms such as a decrease in the blood concentration of leptin or an increase in the blood concentration of ghrelin due to sleep restriction may be involved in the biological mechanisms responsible for the associations between short sleep duration and dyslipidemia: associations that were observed among women.
Meanwhile, it is not easy to explain the biological mechanism responsible for the association between long sleep duration and a high triglyceride or a low HDL cholesterol level. Existing knowledge of metabolic hormones and sleep duration cannot explain this association. Certain metabolic endocrinological changes caused by long sleep duration may result in increased triglyceride level and decreased HDL cholesterol level. However, because it is difficult to experimentally induce individuals to sleep for long periods, data related to this field are sparse. Meanwhile, there is a possibility that a specific factor may be associated separately with long sleep duration and a high triglyceride or a low HDL cholesterol level, and that through this unidentified confounding factor, an apparent association between long sleep duration and these dyslipidemia becomes evident. In this study, as age, overweight, hypertension, and glucose intolerance could have been potential confounding elements, various covariates, including the above factors, were fed into multivariate logistic models to study the association between long sleep duration and serum lipid and lipoprotein levels. However, the associations were independent of these factors, and could not be justified using them. Several previous studies have reported that various pathologic features such as obesity, hypertension, and glucose intolerance are associated with long sleep duration.5–9 However, in those studies, biological mechanisms responsible for such associations were not completely elucidated. Therefore, studies on the physiological characteristics of long sleep must be conducted in the future.
Previous studies have reported that the relative risk of death or CHD was lowest among those who slept for 7 to 8 h.1–4,10,29 Meanwhile, in the present study, the relative risk of a high triglyceride level or a low HDL cholesterol level was lowest among women who slept for 6 to 7 h. Thus, the optimal sleep duration suggested in the present study was not in accord with those indicated by previous studies. However, the results of the present and the previous studies are similar in that the relative risks were lowest among the categories of sleep duration to which the largest numbers of participants belonged. In an attempt to interpret the optimal sleep durations for disease prevention based on epidemiological data, it is inferred that the optimal sleep durations vary with the target population. In addition, when considering optimal sleep duration, bidirectional causal relationships must be taken into consideration from a biological viewpoint. In other words, sleep duration may affect physical status, but conversely, physical status may also affect sleep duration. It must be recognized that according to the type of disease being examined, the optimal sleep duration may differ.
With regard to the associations between sleep duration and mortality among Japanese, 3 cohort studies have been reported so far, but their results were discordant.4,29,30 Kojima et al. reported that a U-shaped association was observed among male subjects,29 whereas Tamakoshi et al. reported that a U-shaped association was observed among women.4 Conversely, Amagai et al. reported that a U-shaped association was not observed among either men or women.30 The reason for these gender-based differences in the associations between sleep duration and mortality among the studies is unclear. In the present study, a U-shaped association between sleep duration and dyslipidemia was recognized among women. Our data support the results of Tamakoshi et al. Further studies will be necessary to clarify the associations of sleep duration with dyslipidemia and mortality among Japanese.
In this study, unlike the situation in women, no significant associations were observed between sleep duration and serum triglyceride or HDL cholesterol level among men. However, the risk of a high LDL cholesterol level was lower among men who slept ≥8 h. From the viewpoint of CVD prevention, it was suggested that long sleep duration was not favorable for women, whereas it was favorable for men. Many previous studies have already reported that there is a gender-specific difference in the prevalence of dyslipidemia because sex hormones (estrogen, in particular) strongly affect lipoprotein metabolism.31–33 It has also been reported that certain gender-specific differences in sleep habits are influenced by differences in social or household roles,34 or in sex hormones.35 Since there are gender-based differences in the onset of dyslipidemia and sleep habits, it is not unusual to observe a gender-specific difference in the association between them. In any event, until the biological mechanisms associated with the relationship between sleep duration and dyslipidemia are elucidated, the reasons for the gender-specific difference in these associations will remain unclear. This issue should be addressed in future epidemiological and physiological investigations.
Several studies have reported U-shaped associations between sleep duration and various diseases. On the other hand, several studies have reported that the associations were negative linear, and not U-shaped (i.e., the risk was higher only among those with short sleep durations).36–39 In the present study, adjusted analyses failed to detect any significant associations of BMI, blood pressure, and fasting plasma glucose level with sleep duration; this was despite the fact that significant associations were recognized during unadjusted analyses (data not shown). Thus, the results of the present study did not always agree with those of previous ones. It is inferred that these differences were due to firstly, differences in the sampling of subjects, and secondly, differences in adjustment factors. It is important that future epidemiological studies regarding the associations between sleep duration and diseases are carefully designed to minimize the selection bias and are adjusted for confounding factors. Subsequently, the results from such studies should be integrated through a meta-analysis, and a consensus should be reached. Future development of studies along these lines is expected.
The present study had several limitations. First, as this was a cross-sectional study, causal relationships could not be determined, even for items between which an association was indicated. When examining a causal relationship, a longitudinal study such as a cohort study is required, and such a study will be required in the future. Second, there may have been a non-response bias. Since the subjects were asked to come to public facilities in each district on a particular day during the survey period for examination of physical status, many of them may not have been able to participate because they had to go to work. The percentage of subjects who did not participate in the survey of physical status is estimated to have been approximately 37%. Among the cases analyzed, the number of subjects in the 20 to 49-yr age group and that of male participants were relatively small. Third, objective data could not be used for the present evaluation of sleep habits. Lauderdale et al. showed that the self-reported sleep duration was systematically biased along gender and race line when compared to measured sleep duration.40 Therefore, the bias due to the use of self-reported data on sleep duration in this study remains to be resolved. Hereafter, the advantages of using measured data, such as those obtained with an actigraph, should be examined in a future study.
In conclusion, the results of this study indicate that both short and long sleep durations are associated with a high serum triglyceride level or a low HDL cholesterol level among women. Conversely, it was observed that the risk of a high LDL cholesterol level was lower among men who slept ≥8 h. Usual sleep duration is closely associated with serum lipid and lipoprotein levels.
Migraine Frequency and Intensity Linked to Cholesterol Levels
While everyone should keep their cholesterol levels under control, those who suffer from migraine headaches may want to pay extra attention to their diet and exercise routine.
It’s widely understood that high cholesterol levels increase the risk of many cardiovascular issues such as heart disease; in addition, there are some lesser-known risks like early memory problems and disease progression in patients with HIV. Now, researchers from the University of Chieti in Italy have linked high cholesterol with the frequency and intensity of migraines.
The team examined the lipid assets in 52 patients with migraine, 17 with and 36 without aura. Lipid levels were assessed before and after three months of drug treatment for migraine prophylaxis. High frequency was considered at least eight migraines per month and any less being low frequency. Numeric Rating Scores were also measured with five or more being high intensity and any less being low intensity.
High frequency and intensity were associated with significantly higher cholesterol levels, both LDL and total cholesterol, when compared to the low frequency and intensity patients. Furthermore, patients who underwent treatment experienced significantly less migraines with less intensity which led to reduced LDL and total cholesterol levels.
“A direct linear correlations was also found between frequency and intensity of crises and lipid levels,” the authors wrote in PAIN Practice.
The team noted that there was not a significant difference observed in patients with and without aura.
“This study shows a significant positive association between migraine frequency and intensity with total and LDL cholesterol, demonstrating for the first time a significant reduction of these lipid parameters after migraine prophylaxis,” the authors confirmed.
However, they went on to explain that these results should be viewed as preliminary, due to the small population pool, and advised that future research is necessary to verify the findings.
Migraine With Aura May Mean Higher Cholesterol
BERLIN – Do you have older patients who experience migraines with aura? You might want to check their lipid levels.
Older patients who experience migraines with aura may be at increased risk for elevated lipids, particularly total cholesterol and triglycerides, according to the EVA (Epidemiology of Vascular Aging) study.
Migraine with aura has been linked to increased risk of ischemic vascular events, Dr. Tobias Kurth said at the International Headache Congress, which was sponsored by the International Headache Society and the American Headache Society. “Migraine with aura is also associated with increased prevalence of cardiovascular risk factors, including elevated levels of some vascular biomarkers” (Eur. J. Neurol. 2011;18:504-11; Neurology. 2005;64:614-20).
However, “there is a lack of data in the elderly, a group with increased lipids,” Dr. Kurth said.
The researchers conducted a cross-sectional study of 1,155 EVA participants with complete lipid and headache information. The patients were classified into groups of three (called tertiles), based on their levels of different blood biomarkers. Their average age was 69 years.
A total of 166 participants had a history of migraine, including 23 who reported migraine with aura. Another 64 had nonmigraine headaches, and the vast majority (925 people) reported no severe headaches. Researchers determined the presence and type of headache through telephone interviews in this longitudinal study.
“There was a strong association with migraine with aura and increasing levels of cholesterol, with nearly a sixfold risk of being in third tertile” of total cholesterol, compared with patients without headache, said Dr. Kurth, director of research in the neuroepidemiology unit at Inserm (Institut National de la Santé et de la Recherche Médicale) in Paris.
Those with migraine with aura had greater adjusted odds (odds ratio, 5.97) of being in the third tertile for total cholesterol. Their risk for being in the second tertile also was greater (OR, 4.67), compared with those without headache.
Researchers also found a strong association between migraine with aura and elevated triglycerides (OR, 4.42 for the third tertile).
The findings confirm previous reports in the literature, Dr. Kurth said. “We observed a pattern consistent with other studies.”
Interestingly, the associations held only for migraine with aura. No other headache forms in this elderly population were associated with increased lipid levels, Dr. Kurth said. “Migraine with aura is associated with an unfavorable lipid profile. Migraine with aura could be a marker for increased lipid levels.”
A meeting attendee asked if the findings would warrant prescription of statin medication for patients with migraine with aura. “Enough is now published from population-based science that we can try, but I wouldn’t say statins are medications to treat migraine at this point,” Dr. Kurth replied.
The large, population-based nature of the study was a strength, Dr. Kurth said. Headache assessment by neurologists via a telephone interview is a possible weakness, he added.
Further targeted research is needed, said Dr. Kurth, who reported that he had no relevant disclosures.
Symptoms and Signs of High Cholesterol
High Cholesterol Causes
There are some foods that have a tendency to increase cholesterol and should be avoided if possible:
- Egg yolks
- Dairy products including butter and some cheeses, including cream cheese
- Processed meats like bacon
- Baked goods made with animal fats like lard
- Fast foods like hamburgers, French fries, and fried chicken
- Snack foods like microwave popcorn because of their high salt and butter content
- Red meats
High cholesterol levels are due to a variety of factors including heredity, diet, and lifestyle. Less commonly, underlying illnesses affecting the liver, thyroid, or kidney may affect blood cholesterol levels.
- Heredity: Genes may influence how the body metabolizes LDL (bad) cholesterol. Familial hypercholesterolemia is an inherited form of high cholesterol that may lead to early heart disease.
- Weight: Excess weight may modestly increase your LDL (bad) cholesterol level. Losing weight may lower LDL and raise HDL (good) cholesterol levels.
- Physical activity/exercise: Regular physical activity may lower triglycerides and raise HDL cholesterol levels.
- Age and sex: Before menopause, women usually have lower total cholesterol levels than men of the same age. As women and men age, their blood cholesterol levels rise until about 60 to 65 years of age. After about age 50 years, women often have higher total cholesterol levels than men of the same age.
- Alcohol use: Moderate (1-2 drinks daily) alcohol intake increases HDL (good) cholesterol but does not lower LDL (bad) cholesterol. Doctors don’t know for certain whether alcohol also reduces the risk of heart disease. Drinking too much alcohol can damage the liver and heart muscle, lead to high blood pressure, and raise triglyceride levels. Because of the risks, alcoholic beverages should not be used as a way to prevent heart disease.
- Mental stress: Several studies have shown that stress raises blood cholesterol levels over the long term. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they console themselves by eating fatty foods. The saturated fat and cholesterol in these foods contribute to higher levels of blood cholesterol.
Cholesterol medications not making you feel better? It is still working even if you don’t feel any different.
February 11, 2019
High cholesterol doesn’t introduce itself with a tap on the shoulder. It can give you a full-blown heart attack or a stroke — even before you know you have it.
In fact, cardiovascular disease accounts for nearly 801,000 deaths in the United States. That’s one out of every three deaths. And about 92.1 million American adults are living with some form of cardiovascular disease or the after-effects of stroke. The costs to treat these conditions add up, too. Direct and indirect costs of cardiovascular diseases and stroke are estimated to total more than $316 billion (including health care costs and lost productivity).1
Diet, exercise, medications
A simple blood test will check HDL (good) and LDL (bad) cholesterol and triglycerides. If levels are high, the treatment starts with a healthier diet, along with exercise. And it pays off. Losing even 5 to10 pounds can help lower cholesterol.2
If better diet and exercise isn’t working, then statins may be prescribed. Statins are medicines that lower LDL and triglycerides while slightly raising HDL cholesterol.
“I feel better so I don’t need medicines, right?” Wrong!
High cholesterol doesn’t usually cause any symptoms. So, members who take medicine for it won’t necessarily feel better. Some may actually feel worse, if their medicine has side effects. Either way, they may stop taking their medicines without talking to their doctor first.
Problem is, these members may be genetically at risk for heart disease. So, their cholesterol levels will elevate if medicine is stopped. In fact, about half the risk for heart disease is related to genetics.3 Generally, if a medicine helps lower cholesterol, then members need to stay on it long-term.
Helping members stay on track
At Prime Therapeutics, we don’t just help people get the medicine they need — we help them stay on their medicines, too. Our utilization management and GuidedHealth programs® identify members who are at risk for nonadherence. These programs keep all key players in the loop — members, doctors and pharmacists — to make sure members stay on treatment.
Nearly one-in-three Americans has high levels of LDL.4 Are some of your members part of that group? Contact your Prime representative to learn more.
CV risk and cholesterol
What is PRALUENT® (alirocumab)?
PRALUENT is an injectable prescription medicine used:
- in adults with cardiovascular disease to reduce the risk of heart attack, stroke, and certain types of chest pain conditions (unstable angina) requiring hospitalization.
- along with diet, alone or together with other cholesterol-lowering medicines in adults with high blood cholesterol levels called primary hyperlipidemia (including a type of high cholesterol called heterozygous familial hypercholesterolemia), to reduce low-density lipoprotein cholesterol (LDL-C) or bad cholesterol.
It is not known if PRALUENT is safe and effective in children.
Important Safety Information
Do not use PRALUENT if you are allergic to alirocumab or to any of the ingredients in PRALUENT.
Before you start using PRALUENT, tell your healthcare provider about all your medical conditions, including allergies, and if you are pregnant or plan to become pregnant or if you are breastfeeding or plan to breastfeed.
Tell your healthcare provider or pharmacist about any prescription and over-the-counter medicines you are taking or plan to take, including natural or herbal remedies.
PRALUENT can cause serious side effects, including allergic reactions that can be severe and require treatment in a hospital. Call your healthcare provider or go to the nearest hospital emergency room right away if you have any symptoms of an allergic reaction including a severe rash, redness, severe itching, a swollen face, or trouble breathing.
The most common side effects of PRALUENT include: redness, itching, swelling, or pain/tenderness at the injection site, symptoms of the common cold, and flu or flu-like symptoms. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
Talk to your doctor about the right way to prepare and give yourself a PRALUENT injection and follow the “Instructions for Use” that comes with PRALUENT.
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Click here for Full Prescribing Information for PRALUENT.
Click here to learn more about Sanofi’s commitment to fighting counterfeit drugs.