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High cholesterol

Hyperlipoproteinaemia · Vysoký cholesterol (hyperlipidémie)

What it is

Too much LDL circulating; it builds into arterial plaque over decades.

Symptoms & signs

  • None at all until a heart attack or stroke
  • xanthelasma or tendon xanthomas in familial forms
  • white ring around the iris (corneal arcus) before 45
  • chest pain or calf pain on walking once arteries narrow

🚩 Get help if…

  • call 112 / 911 now Chest pain or tightness lasting over 15 minutes
  • call 112 / 911 now Face drooping, arm weakness or slurred speech
  • see a doctor soon Chest tightness or calf pain on walking that eases with rest
  • see a doctor soon Muscle pain with dark urine on cholesterol tablets

Where it strikes

Medical treatment

  • Statins with no heart disease yet — about 1 event prevented per 100 over five years, and, in blinded trials, drug-caused muscle aches in about 1 in 100, mostly in the first year, plus a small rise in diabetes mixed evidence
  • Statins after a heart attack or stroke, where the same drug prevents four times as much trials support
  • Ezetimibe — small added effect mixed evidence
  • PCSK9 inhibitors in very high risk — about 1.5 fewer events per 100 over two years (FOURIER), no fall in deaths trials support
  • Fibrates — lower triglycerides, do not lower deaths not confirmed in trials
  • Inclisiran (Leqvio), twice-yearly siRNA — approved (EMA 2020, FDA 2021) to lower LDL

Natural & lifestyle

  • Soluble fibre (oats, psyllium 10 g/day)
  • plant sterols 2 g/day
  • nuts
  • reduce saturated fat
  • exercise
  • weight loss
  • red yeast rice (same molecule as lovastatin — treat as a drug)

Emerging & experimental

  • CETP inhibitors (obicetrapib)
  • Lp(a)-lowering ASOs (pelacarsen)
  • gene editing

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Berberine — trials lower LDL by about a fifth; interacts with many drugs trials support
  • Bergamot extract — small trials lower LDL mixed evidence
  • Red yeast rice — contains lovastatin itself; works, with statin side effects and uneven dosing mixed evidence
  • Garlic, artichoke leaf, amla — small trials, small effects early / small studies
  • 'Cholesterol is harmless' low-carb stance — some people's LDL falls on carnivore or keto diets and many people's rises; not a treatment with evidence anecdotal / traditional

ICD codes