How to Treat High Cholesterol: Frequently Asked Questions

This article discusses several frequently asked questions and answers about how to treat high cholesterol.

How to treat high cholesterol: Introduction

The critical question is, why did humans evolve to such high cholesterol levels today?

Why do so many Americans have excessively high cholesterol? So many tens of millions of people walking around with excessively high cholesterol levels must have a reason why, right?

Although still seeking answers, science has moved far in how to treat high cholesterol.

Side notes:

• Not all cholesterol is bad, find out all about it in our other article explaining the difference between bad and good cholesterol.
• You can also brush up on your basic understanding of cholesterol by reading the following article: Where does cholesterol come from and what is it exactly?

A consequence of human evolution

The explanation relies on the fact that nature does not invest in the aging of individuals but in the species' survival.

That makes nature select particular traits in humans to reproduce well and protect their offspring long enough until they are on their own.

That protection used to last, in the prehistoric period, 15 to 20 years, after which the children were on their own.

Until the age of 20, higher cholesterol is not a problem since you consume that to grow and develop.

People rarely had cholesterol problems before age 30, when your job as a parent (in prehistory) was done.

Thus, high cholesterol did not adversely affect the species' survival and was never penalized by nature.

By the way, this is not the only way to explain this. Extra weight, higher blood pressure, and more aggressive blood clotting are also advantages for survival in primitive living conditions.

Evolutionary advantages to ensure survival

For the species, therefore, these are evolutionary advantages to ensure survival.

Indeed in primitive conditions, the species is more likely to be threatened by ongoing famines, so the ability to store some extra fat was life-saving.

Similarly, in the primitive conditions of prehistoric times, young people were threatened primarily by accidents, attacks by wild animals, and tribal disputes.

The ability to have efficient blood clotting and thus reduce blood loss in the event of injury was a massive advantage to reaching adulthood.

So, Mother Nature is not stupid at all and has ensured for millions of years to ensure the survival of our species.

It did so by protecting us during that period of growth and young adulthood until our children are on their own.

Health benefits become health risks with increasing longevity

But for the individual living much longer today, those health benefits such as elevated cholesterol turn into health risks over time.

Nature may never have foreseen that we would live to be 75 and older today.

For millions of years, the survivors who reproduced:

• could survive famine (thanks to mild obesity),
• reacted quickly when a wild animal walked into the cave (stress and higher blood pressure), and
• were good at making blood clots after combat (increased tendency to thromboses).

That legacy of millions of years of evolution is, in part, the basis of our diseases of old age. But now how to treat high cholesterol has become a matter of survival, because cholesterol is a silent killer.

Do our cholesterol levels change much during our lifetime?

As a general rule, we have reached our adult cholesterol level by the age of 18. Once we're reached adulthood, cholesterol levels are pretty stable. It may however determine if medication is needed or not, so age determines the necessary treatment rather than the levels themselves.

Slight increase in cholesterol levels with age

With aging, most of us become a bit heavier and less active, so we still continue to see a slow rise in cholesterol.

Alongside this, there is also a small LDL increase during menopause in women.

Thus, from adulthood onwards, age plays a negligible role in the production of cholesterol. However, it is one of the major determining factors in deciding whether to initiate cholesterol-lowering therapy.

Age does not determine cholesterol levels but rather how we treat them. The lower the age, the lower the risk of cardiovascular disease over the next decade.

As the years go by, that risk increases, and so does the need to treat it with medicines.

On the other hand, there is no lower age limit for cholesterol reduction through a healthy lifestyle. So how to treat high cholesterol?

Living as healthy as possible is recommended

Basically, it is advisable for anyone with elevated cholesterol to live as healthy as possible.

However, once the absolute risk of cardiovascular disease exceeds a certain limit, which depends greatly on age, it will be easier to resort to medication.

Cholesterol in the very elderly: Some comments

In the case of the very elderly (80 years and older), some attention is warranted.

Here, the causal relationship between high cholesterol and the occurrence of cardiovascular disease is very much weaker.

And this is also the case, for example, with obesity at a very old age.

That argument is sometimes misused to undermine the cholesterol hypothesis (which strongly links high cholesterol to cardiovascular disease).

The reason cholesterol at very old age seems to lead to fewer cardiovascular problems is that these are so-called survivors.

In other words, those who are more susceptible to the effects of excessively high cholesterol are not found in this oldest age group.

After all, those more susceptible rarely reach such an advanced age. You see the same thing with obesity, which is a significant risk factor for all kinds of ailments throughout your adult life.

However, those who reach very old age are, paradoxically, somewhat protected by obesity, partly because this way, they are somewhat more resilient to infections.

Are women better protected against cholesterol?

As a general rule, women have better cholesterol levels than their male counterparts. With menopause, the hormonal protection is removed and the pattern is closer to that of males in the same age group. The ratio between LDL (bad) and HDL (good) cholesterol may then become unfavorable.

The ratio of LDL-HDL is different. Women tend to have a lower LDL and a somewhat higher HDL, which is a favorable ratio.

But beware: This is the situation until menopause. After that, hormonal protection in women expires.

Around that menopausal period, women acquire a cholesterol pattern closer to that of men. The target values for cholesterol are the same for both genders.

What is the ideal ratio of good (HDL) to bad (LDL) cholesterol?

As a general rule, the medical community believes the best ratio of HDL to LDL cholesterol is an equal distribution, therefore 50 percent HDL and 50 percent LDL. HDL, the good cholesterol, has a protective effect, but has no target values so this is calculated according to LDL cholesterol levels.

Unfortunately, the statement that high HDL (good) would compensate for high LDL (bad) cholesterol is not entirely correct.

HDL cholesterol is undoubtedly a protective factor because those particles carry away excess cholesterol and prevent it from forming plaques in the artery walls.

But you can't simply weigh both cholesterol effects against each other. This reasoning is not correct.

Today, the medical community believes that the best ratio of HDL-LDL cholesterol is an equal distribution: 50 percent HDL and 50 percent LDL.

Important and interesting to know: That 50-50 ratio is consistent with the ratio found in mammals in the wild, and it is also the ratio we are all born with.

Perhaps that ratio offers the best protection. They primarily refer to LDL cholesterol when target values are mentioned. For HDL cholesterol, there are no real target values.

Can I also have a cholesterol level that is too low?

As a general rule, a total absence or too low cholesterol is rarely, if ever, reported because without cholesterol there is no cell production. A low cholesterol level is exceptional but possible, resulting in better protection against cardiovascular disease.

A total absence of cholesterol is rarely, if ever, reported because it does not occur.

After all, the absence of cholesterol is not viable because, without cholesterol, there is simply no cell production possible.

Of course, there are people with very low cholesterol levels. This is exceptional compared to the total population, but it is perfectly possible.

Those results usually come to light by chance, based on blood results.

These people enjoy additional protection against cardiovascular disease because of their advantageous low cholesterol.

From when should I have my cholesterol measured?

As a whole, there is no hard and fast rule when to start measuring cholesterol. While adults should know their cholesterol levels, younger people should generally only be aware of their levels if their family is genetically predisposed towards abnormal cholesterol levels or cardiovascular disease.

If, for some reason, you need to have a blood check in adulthood (and you don't have an infection at that time), it is helpful to have your cholesterol levels measured.

There are plenty of opportunities to have that done. This measurement does not need to be repeated frequently afterward, only every 2 to 3 years, for example.

This is provided, of course, that there are no health problems and that you do not belong to a high-risk category.

If you are genetically disposed towards cholesterol issues, this is a bit different. Are elevated cholesterol levels or cardiovascular disease common in your family?

Then you would do well to have your cholesterol levels closely monitored.

This is especially true if so-called familial hypercholesterolemia is suspected. This inherited condition gives sky-high cholesterol levels from a young age.

Then a cholesterol determination may already be indicated from a very young age (from 2 years old). Seasons also have a particular influence on cholesterol levels.

For example, scientists have found that (bad) LDL cholesterol levels increase slightly during the winter. In contrast (good) HDL cholesterol rises somewhat during the summer.

That difference is linked to lifestyle changes. Most people are more physically active during the summer and eat healthier than during the colder winter months.

Can young children and adolescents also struggle with excess cholesterol?

As a whole, children are usually born with low cholesterol levels that are divided optimally between HDL and LDL levels. If there is a family history of issues with cholesterol levels and/or cardiovascular problems, then children should be tested as early as possible.

Of course, most children and adolescents do not yet have cholesterol problems. They also have lower values than adults during their growth and development.

They are in the middle of their development, going through growth phases, and also need cholesterol to produce the cell walls, among other things.

Measuring cholesterol levels is not necessary for children and adolescents. Unless they are descendants of a family where there is familial hypercholesterolemia.

This is an inherited congenital disorder in which people face extremely high cholesterol levels from an early age.

Children suspected of having a possible hereditary strain are best to have their blood tested as early as possible.

Prompt and timely treatment is vital to prevent premature cardiovascular disease.

Is there a treatment for children with elevated cholesterol?

There is a treatment for children with elevated cholesterol. A diet not aimed at making the child lose weight but rather at making them eat healthily, with as little added cholesterol as possible. This is not a low-calorie diet as they still need to get enough calories, vitamins, and minerals.

One of the significant advantages of a diet that starts from toddlerhood is that you teach children to eat healthy from a very young age.

Young children also accept such a modified diet much more readily. If you do not implement such a turnaround until adolescence, it will be met with many more struggles and protests.

At that age, young people have already developed their own habits. And, in the minds of adolescents, health arguments often don't carry too much weight.

Thus, parents have everything to gain from starting a heart-friendly diet as early as possible.

This is perfectly possible because such a diet will not affect the growth and development of the child in any way.

After all, this is not a low-calorie diet. The children get just as many calories, vitamins, and minerals.

The only choices are more lean meats, healthier fats, more soy products, etc. There is usually no need for special functional foods (so-called nutraceuticals) that lower cholesterol in children. Those are reserved for adults.

Of course, in these children, we will also address the non-cholesterol portion of the risk and place extra emphasis on not starting smoking, maintaining a healthy weight, and getting enough physical activity.

If you teach children these healthy habits from an early age, you have much better chances of success than if you try to change their ingrained habits later in life.

How to treat high cholesterol: Conclusion

There are a number of ways to treat high cholesterol, and they all involved healthy lifestyle choices, even from an early age.

The choice of treatment will depend on age, genetics, and possible dangers of further issues due to high cholesterol.