Cholesterol and blocked arteries

Understanding cholesterol

Cholesterol is a fatty, waxy substance the body needs — it builds cell walls, helps make certain hormones and supports digestion. The liver makes most of the cholesterol in your blood; the rest comes from food. Problems begin not because cholesterol exists, but because too much of the wrong type circulates for too long, gradually building up inside artery walls. This build-up, called atherosclerosis, narrows arteries and stiffens them, restricting the blood flow that carries oxygen to the heart, brain and limbs.

Cholesterol cannot dissolve in blood on its own — like oil in water — so the body packages it inside carrier particles called lipoproteins for transport. The two you will hear about most are LDL and HDL, and a related fat called triglycerides. Understanding what each one actually does makes it much easier to understand your own results.

LDL, HDL and triglycerides — what they actually are

These are not three different types of fat competing for the same job. Each carrier does something different, which is why a lipid profile reports them separately rather than giving one combined score.

• ●LDL (low-density lipoprotein) — often called "bad" cholesterol. LDL particles carry cholesterol from the liver out to the rest of the body. When there is more LDL circulating than the body needs, the surplus can work its way into artery walls, where it triggers inflammation and gradually forms plaque. This is the particle most directly linked to heart attack and stroke risk, which is why lowering LDL is usually the main treatment target.
• ●HDL (high-density lipoprotein) — often called "good" cholesterol. HDL particles work in the opposite direction: they collect excess cholesterol from tissues and artery walls and carry it back to the liver for disposal, a process sometimes called reverse cholesterol transport. Higher HDL is generally protective, though HDL is a less powerful treatment target than LDL — medicines that raise HDL have not reliably been shown to lower heart attack or stroke risk the way LDL-lowering medicines do.
• ●Triglycerides. A different type of fat, used mainly for energy storage. Triglycerides rise with excess calories, sugar and alcohol, and with poorly controlled diabetes. Very high triglycerides also raise cardiovascular risk and, at marked levels, can trigger pancreatitis (inflammation of the pancreas).
• ●Total cholesterol. A combined figure (LDL, HDL, a fraction of triglycerides and other particles). On its own it is a rough guide only — two people with the same total cholesterol can have very different risk if their LDL and HDL differ, which is why clinicians look at the full profile rather than one number.

What high cholesterol feels like

This is the central difficulty with cholesterol: on its own, it produces no sensation at all. Blood vessels have no nerve endings that register a build-up of plaque, so cholesterol can climb for years, and arteries can narrow substantially, before a person feels anything different.

• ●Most people with high cholesterol feel completely well — it is found on a blood test, not by symptoms
• ●The first noticeable sign is sometimes a complication itself: chest pain or pressure on exertion (angina), leg pain when walking that eases with rest, or a heart attack or stroke
• ●Very high, usually inherited cholesterol levels can occasionally show visible clues — small yellowish deposits around the eyelids, a pale ring at the edge of the coloured part of the eye, or firm lumps over tendons such as the Achilles
• ●A strong family history of early heart attacks or stroke is itself a clue worth mentioning, even without any visible sign

What causes high cholesterol

Cholesterol levels usually reflect a combination of what the liver produces, what is eaten, and how the body processes fat — grouping the causes this way helps explain why treatment is rarely about diet alone.

Diet and lifestyle

Diets high in saturated fat (found in fatty meat, full-fat dairy, and many fried and processed foods) push the liver to produce more LDL. Excess calories, refined carbohydrates and alcohol raise triglycerides. Low physical activity tends to lower protective HDL.

Genetics

Cholesterol levels run strongly in families. Familial hypercholesterolaemia is an inherited condition in which LDL is very high from birth because the liver cannot clear it efficiently; it is under-recognised and worth actively asking about if early heart disease runs in the family.

Other medical conditions

• ●Diabetes — commonly raises triglycerides and lowers HDL, and changes the LDL particles themselves to a more artery-damaging type
• ●An underactive thyroid gland — slows the clearance of LDL from the blood
• ●Kidney disease — commonly disturbs the whole lipid profile
• ●Liver disease — the liver both makes and clears cholesterol, so disease here can push levels either way

Medicines

Some medicines can raise cholesterol as a side effect, including certain steroids, some blood pressure and immune-suppressing medicines, and some hormonal treatments. Tell your clinician about everything you take so this can be considered.

Who is more likely to have high cholesterol

These factors raise the likelihood of an abnormal lipid profile, and matter even more when several occur together:

• ●A diet high in saturated fat, refined carbohydrates or fried and processed foods
• ●Low physical activity
• ●Excess weight, particularly abdominal weight
• ●Diabetes or pre-diabetes
• ●High blood pressure — very common in Nigeria and often undiagnosed, and it compounds the artery damage cholesterol causes
• ●Smoking, which damages the artery lining and makes it easier for LDL to lodge there
• ●A family history of high cholesterol or early heart attack or stroke
• ●Kidney disease
• ●Increasing age

What happens if high cholesterol goes untreated

Cholesterol's danger lies almost entirely in what it does silently over years, not in any immediate effect.

Coronary artery disease. Plaque narrows the arteries that supply the heart muscle itself, which can cause angina (exertional chest pain) or, if a plaque ruptures and a clot forms suddenly on top of it, a heart attack.

Stroke. The same process in arteries supplying the brain, or a clot travelling there, can cut off blood flow and damage brain tissue.

Peripheral artery disease. Narrowed arteries in the legs reduce blood flow to the muscles, causing pain on walking and, in advanced cases, poor wound healing.

Pancreatitis. Uncommon, and specifically linked to very high triglycerides rather than high LDL — sudden severe abdominal pain in this context needs urgent assessment.

How Cardiocare finds the cause

The right pathway depends on your history, examination and overall cardiovascular risk. It typically draws on some or all of the following:

• 01
  History and examination. Diet, activity, smoking, family history and a check for visible cholesterol deposits around the eyes or tendons.
• 02
  Lipid profile. A blood test measuring total cholesterol, LDL, HDL and triglycerides; your clinician will advise whether fasting beforehand is needed for your situation.
• 03
  Overall cardiovascular risk assessment. Your cholesterol result is interpreted alongside blood pressure, diabetes status, smoking, age, family history and other conditions — treatment decisions are based on total risk, not the cholesterol number alone.
• 04
  Liver and kidney tests. Checked before starting treatment and periodically afterwards, partly because liver and kidney function affect how the body handles cholesterol medicines.
• 05
  Thyroid and glucose testing. To identify or rule out an underlying cause.
• 06
  Family screening. Where familial hypercholesterolaemia is suspected, close relatives may be offered testing, since finding it early allows treatment well before complications develop.

How high cholesterol is treated

Treatment aims to lower overall cardiovascular risk, not simply to move one number — which is why the plan is built around your total risk profile.

Lifestyle change

Reducing saturated fat, increasing fibre, vegetables and fish, limiting fried and processed food, moderating alcohol, achieving a healthy weight, regular physical activity and stopping smoking all improve the lipid profile and lower risk independently of any medicine.

Medicines, by class

Where lifestyle change alone is not enough, or risk is high, medicine is added. Each class works differently, and your clinician will discuss which is right for you:

• ●Statins — reduce the liver's own cholesterol production, which lowers LDL and is the best-established way to reduce heart attack and stroke risk
• ●Ezetimibe — reduces the amount of cholesterol absorbed from food in the gut, often added alongside a statin
• ●PCSK9 inhibitors — injectable medicines that help the liver clear LDL from the blood more effectively, generally reserved for very high risk or when other treatment is not enough
• ●Fibrates — mainly used to lower very high triglycerides

Treating the underlying cause

Where high cholesterol comes from another condition — an underactive thyroid, poorly controlled diabetes, or kidney or liver disease — treating that condition often improves the lipid profile as well.

Living with high cholesterol: everyday self-care

Cholesterol management is a long-term routine, not a short course of treatment:

• ✓Take prescribed cholesterol medicine consistently, even once you feel well — the benefit is in preventing damage you cannot feel happening
• ✓Build sustainable food choices rather than short, extreme diets — more vegetables, beans, fish and whole grains; less fried food, fatty meat and sugary drinks
• ✓Stay physically active regularly, in whatever form fits your daily life
• ✓Keep follow-up blood tests, including liver checks where advised
• ✓Do not stop treatment because a repeat test looks better — ask your clinician first
• ✓Manage related conditions — blood pressure, diabetes and weight — alongside cholesterol, since they interact

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous lipid results or hospital letters
• ✓Details of family history — especially early heart attack, stroke or high cholesterol in close relatives
• ✓Your HMO card or payment details

What we will ask

Your diet, activity, alcohol and smoking habits, any medicines and supplements, your family history, and whether you have diabetes, kidney disease or thyroid problems.

Questions worth asking us

• ●What is my overall cardiovascular risk, not just my cholesterol number?
• ●Do I need medicine, or can lifestyle change alone be tried first?
• ●How often should my cholesterol be rechecked?
• ●Should my close relatives be tested too?