Diabetes and hypercholesterolemia are commonly comorbid as they share a link with an obese population. Diabetes is thought to play a role in raising LDL and triacylglycerol levels and lowering HDL levels.
Cigarettes smokers are at increased risk for hypercholesterolemia and vascular disease. Toxins from cigarettes contribute to endothelial damage, which may facilitate cholesterol plaque formation and vessel narrowing. Cigarette smoking is also associated with a reduction in HDL levels.
Patients with a first degree male relative younger than 55 years old or a female relative younger than 65 years old with coronary heart disease are at increased risk for hypercholesterolemia. These patients may be more likely to have an inborn error of metabolism in the cholesterol regulation pathway.
Patients with hypertension are more likely to suffer from hypercholesterolemia as well. In many cases, hypertension is caused by atherosclerosis, an inflammatory response to the accumulation of cholesterol along vessel walls, which leads to narrowed blood vessels.
HDL transports cholesterol from peripheral tissues back to the liver. It is known as “good cholesterol” because it removes excess cholesterol from the blood. Ideal values for HDL for men is > 40 mg/dL and for women is > 50 mg/dL.
As patients age, the risk for hypercholesterolemia increases. Men older than 45 years of age are one of the patient populations at highest risk for disease.
As patients age, the risk for hypercholesterolemia increases. Women over 55 years old have increased risk for disease. The difference in age for risk of disease between men and women is thought to be related to the protective effects of the hormone estrogen.
Atheromas, also known as atherosclerotic plaques, are collections of lipid-containing macrophages that collect along blood vessel walls. As atheromas enlarge, vessel lumens narrow, decreasing the delivery of oxygen-rich blood to tissues and causing tissue ischemia. If atheromas are disrupted and endothelial damage occurs, thrombus formation begins and may eventually lead to total occlusion of a blood vessel or possible embolization.
Atherosclerotic plaques form due to accumulations of inflammatory cells, cholesterol, and triglycerides. This leads to cascading damage and the signaling of further inflammatory mechanisms.
Tissue ischemia is a restriction in blood supply to tissues. As atheromas enlarge, vessel lumens narrow, preventing the flow of blood and delivery of oxygen to vital organs and tissues.
Xanthomas manifest cutaneously as yellowish papules and represent deposits of cholesterol-containing macrophages seen in patients with hypercholesterolemia. They commonly occur on tendons and extensor surfaces, and when found along the eyelids are known as xanthelasmas.
This physical exam finding seen on fundoscopic exam is described as milky white retinal blood vessels. It is very rare, as it is seen in patients with triglyceride levels >1000 mg/dL, which is usually due to inborn errors of cholesterol metabolism.
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