DR. MARTIN SCURR: Secret signs I use to detect patients with high cholesterol
What does someone with high cholesterol look like? The fact is that they can appear apparently ‘healthy’ – and slim people are just as at risk as anyone else.
While there are some subtle signs that as a doctor I should look out for (more on that later), the only way to know for sure is to do a blood test.
And it is very important that you know what your levels are.
Because besides cancer, atherosclerosis, or clogged arteries, is the biggest cause of ill health and death, and much of the blame for that lies with cholesterol.
Almost any artery can be affected by cholesterol, writes Dr. Martin Scurr
Ultimately, this furring leads to heart disease and heart attack or stroke – or even both.
Almost any artery can be affected and, for example, if the cholesterol blocks small blood vessels that supply the penis, it can lead to erectile dysfunction.
The problem with elevated cholesterol (i.e. a total cholesterol level of more than 5 mmol/l, and low-density lipoprotein, or ‘bad’ LDL of more than 3 mmol/l) is that it is a silent killer, with little or no symptoms until the damage is corrected. en route. Yet alarming new figures published last week show that 53 percent of adults in Britain have high cholesterol, but many are unaware that their levels are higher than they should be, and that is dangerous.
We do need some cholesterol. It is an important resource that the body uses to produce certain hormones, for example, and although we absorb some of the cholesterol from the food we eat – such as eggs – the liver produces up to 80 percent of it from foods containing saturated fat. that contain a lot of sugar.
Although there is an appropriate level for cholesterol, high amounts are quietly harmful as it gradually builds up in the artery walls. The deposits can build up due to a number of factors, including high blood pressure, diabetes, aging and family history.
Your gender also plays a role. Women are most likely to have high cholesterol, with the number affected increasing from 45 percent in 2019 to 56 percent in 2022. This compares with an increase in men from 40 percent to 49 percent in the same period.
The hormone estrogen is thought to be crucial because a woman’s cholesterol levels change over the month and tend to rise after menopause. Men and women also metabolize and store fat differently.
But for both sexes, high cholesterol poses a major health risk and more emphasis needs to be placed on each of us being aware of our cholesterol levels and making extra efforts to bring it down to a safe range.
If you are otherwise healthy, tests are usually carried out as part of the NHS Health Check, which is offered every five years to people aged between 40 and 74.
That’s the time to start looking at your risk factors, including weight – because a good diet and maintaining a healthy weight are the most important lifestyle choices anyone can make.
One warning sign I look for in my patients is a buildup of cholesterol deposits in the skin, known as xanthelasmas or xanthomas. These are yellowish waxy cholesterol plaques, usually 10 to 12 mm in size. It could be one or two, but it could also be many.
They start as small yellow lumps, like seeds, but – if the cholesterol is high enough – can grow to several centimeters long.
Most often you see them on the sensitive skin just under the lower eyelids, but they can also appear on the knees, hands and feet: wherever they are located, they are a warning that cholesterol levels need to be checked.
Another sign is an arcus senilis, a gray ring around the edge of the irises in your eyes, although it’s not clear why they appear here.
Xanthomas subside within weeks or months of lowering cholesterol levels, but an arcus senilis will persist for good.
Some people are born with a predisposition to high cholesterol, a condition called familial hypercholesterolemia: they may look slim and fit, but they have very high levels of ‘bad’ LDL cholesterol because their liver – for complicated reasons – is unable to clear the cholesterol. Remove LDL from their blood. They almost universally have a family history of premature death from previous generations.
If it’s some time before your next NHS Health Check, I think it would be wise to do one of those do-it-yourself tests you can buy on the high street – or visit a pharmacy that does cholesterol testing in the store offers.
In the past, the advice was to get tested in the morning on an empty stomach, but this is now considered less important. I would encourage all adults to start testing. It’s best to know if levels are rising as soon as possible so you can take action.
While statins may be offered to some with high cholesterol, this should not be seen as a way to avoid lifestyle changes needed to lower cholesterol – such as losing weight, exercising more and improving your diet.
But unless you know your numbers, you can’t take action.
