What is Hypercholesterolemia Hypercholesterolemia is a common condition in recent times; people who have the condition are more common to having very high levels of cholesterol in the blood. Cholesterol is a waxy, fat-like substance that is produced in the body and comes from what we eat. (Citkowitz, 2006).
However it is not just about having high cholesterol that is the problem as there is two types of cholesterol one which is good for you and the other which is bad for you health. The two types are Low Density Lipoproteins (LDL) and High Density Lipoproteins (HDL).
Low Density Lipoproteins are bad for a person's health. It has been reported that high Levels of LDL cholesterol increase the risk of cardiovascular disease, (Brunzal et al 2008). Too much LDL in a person's blood causes plaque to build up (Rooke 2007). This build up of plaque can cause Atherosclerosis which is the process of the arterial walls getting narrower (Stemme et al 1995). It is more dangerous than Hypercholesterolemia as it is one of the biggest killers of people over the world (Toth 2005). Plaque is caused by a build up of cholesterol (Toth 2005), this causes the blood flow in the arteries to decrease causing problems such angina and greatly increases a person's risk of having a heart attack. (Austin et al, 2004). It has been recommended that LDL levels should not be higher than 130 mg/dl (National Institutes of Health 2007).
High Density Lipoproteins on the other hand have been found to protect against Atherosclerosis (Rooke 2007). HDL contains certain antioxidants which inhibits the production of LDL (Rooke 2007). HDL main ability is to drive a process called "Reverse Cholesterol Transport." (Toth 2005). Reserve Cholesterol Transport is a process which results in the movement of cholesterol from other organs and the arteries back to the liver via the plasma in the blood. (Tall 1998). This process is important as it has been reported than even a rapid decrease in LDL levels does not
fully protect from Cornary Heart disease even though it decrease the chances, Smith (1997) this is due to LDL concentrations not being able to be lowered to stop the disease. (Spady 1999). It has been recommended that HDL levels should be higher than 60 mg/dl (National Institutes of Health 2007).
There are many causes of Hypercholesterolemia; they include primary cause such as obesity and poor diet. There are also secondary causes such as type 2 diabetes, alcohol, kidney dialysis (Bhatnagar et al 2008). A person age and gender also have an effect as it has been reported than even though women tend to have lower cholesterol levels than men, at the age of about 55 a women's cholesterol level increases Sandmaier (1992).
Genetics has also been reported as a cause Hypercholesterolemia with a defect in the LDL receptor gene. People how have this gene have been found to have an increased plasma LDL therefore an increased risk for the development of atherosclerosis. Leitersdorf (1989)
However Hypercholesterolemia is hard to diagnose unless a cholesterol test is performed this is of more importance has it has been found that only 34% of registered patients in UK had had a cholesterol test within the previous 5 years, 28% had HDL (high-density lipoprotein) tested as well (The NHS Information Centre, Lifestyle Statistics 2008). This means 66% don't know if they have high cholesterol as it may only be revealed as symptoms of heart disease or diabetes. In some patients, cholesterol deposits called xanthomas may develop on skin, this are yellow patches which are caused by -cholesterol deposits and indicate a person as high cholesterol levels in your blood. (James et al 2006)
The risks of Hypercholesterolemia have been reported to include a 5 times increased risk heart attack if cholesterol is higher than 300 mg/dL (Anderson, 1991). Also combined with smoking Hypercholesterolemia can cause Atherosclerosis by damaging the artery wall. Allowing substances to break up and block the artery. (DeBakey, 1984).
Exercise and Hypercholesterolemia
To help reduce the risk of Hypercholesterolemia it is recommended that adults should undertake at least 150 min of aerobic exercise at moderate intensity each week, or at least 75 min of at vigorous level each, or a mixture of both, Moderate activity is activity where a person heart rate raises and breathing gets harder but the
person is still able to speak comfortably (O'Donovan et al 2010). Adults who have an increased risk of high cholesterol, diabetes and heart attacks should be doing more
than the recommended guidelines and should aiming for 300 min or more of moderate-intensity aerobic activity each week (O'Donovan et al 2010)
A study found that 40% of men and 28% of women met current physical activity recommendations, while only 27% of men and 29% of women knew the physical activity recommendations of 150 minutes of moderate activity per week (The NHS Information Centre, Lifestyle Statistics 2009).
Among men the main reasons given for not doing the guidelines, were work commitments (45% selected this from the lists), lack of leisure time (38%). For women the list included a lack of leisure time (37%), long working hours (34%). Lack of motivation was also an important factor for both men and women (21% and 25% respectively). (The NHS Information Centre, Lifestyle Statistics 2009).
The people that do not met the guidelines are increasing the chance of developing Hypercholesterolemia or other conditions that increase the chance of getting Hypercholesterolemia such as diabetes, being obese and having a heart attack because (Kuller 2001) reported that regular exercise decreases risks cardiovascular disease as well as modifying the risk factors of cardiovascular disease.
Doing the recommended amount of exercise has been reported to help a person lose weight, reduce LDL and triglyceride levels, and increase levels of HDL and
lower blood pressure (Stevinson et al, 2000). Powers et al (2007) reported that exercise can lower LDL cholesterol by 5 to 10%, as well as raise HDL cholesterol by between 3 and 6% with regular exercise. This is supported by Couillard et al
(2001) who also found that regular exercise training may increase HDL cholesterol, low triglycerides and lower body fat in men. Exercise also helps reduces the chance of atherosclerosis and can even help reverse atherosclerosis
Doing exercise also increases the chance of weight loss a study by Stefanick et al (1998) reported a decrease in LDL cholesterol levels for women and men in the diet-plus-exercise group, as compared with the no exercise, suggesting weight loss due to diet and exercise can help control cholesterol.
Results
Figure 1: Percentage of males or females questioned who knew the recommended exercise guidelines
Figure 2: Percentage of males or females questioned who met or exceeded the recommended exercise guidelines
Figure 3: The Barriers to exercise
Figure 4: Percentage of males or females questioned who had their cholesterol tested
The results of the study found that only 28% of males and 8% of females knew the exercise guidelines (Fig 1). The results also show that 56% of males and only 12% of females completed the 150 min of aerobic exercise at moderate intensity each week. (Fig 2)
The main barriers identified where lack of time with 68% of males and 54% of females choosing it as one of their reasons they don't exercise. Long working hours was the second most common barrier to exercise with 44% of males and 20% of females choosing that as an option (Fig 3)
Only 44% of the total number of people questioned have had or remember having their cholesterol tested with males (24%) just being higher than females (20%).
Discussion
In this study most of the people surveyed did met the exercise guidelines, with only 36% knowing that they should do the recommended 150 min of aerobic exercise at moderate intensity each week (Fig 1). This is lower than a report which found while 66% of those questioned knew the guidelines. (The NHS Information Centre, Lifestyle Statistics 2009). This study also found that more males knew the guidelines but the study conducted before found slightly more females knew the guidelines. Not knowing the guidelines mean it makes it more likely that someone will not do the guidelines which are shown in Figure 2.
The percentage of 66% shown in this study that knew the guidelines is higher than the 36% of people not knowing the guidelines (Fig 2), This could be down to people doing the guidelines without actually thinking about doing them or people thinking they have done when they have not due to perceiving the exercise to be more intense than it really is, which has been suggested as a reason for the higher value in the men as it has been reported than men thought they were more active and fitter compared to women (The NHS Information Centre, Lifestyle Statistics 2009). The value of 66% is similar to the value of 68% reported in a similar study (The NHS Information Centre, Lifestyle Statistics 2009). The consequences for the 30% or so people that do not do the guidelines are an increased risk of Hypercholesterolemia or related conditions to it such as diabetes, angina, obesity and heart attacks (Anderson, 1991) (Bhatnagar et al 2008). This is because it has been widely reported that exercise helps lower LDL cholesterol (Powers et al 2007), increase levels of HDL (Stevinson et al, 2000), as well as reduce the risk of getting conditions that are caused by Hypercholesterolemia such as diabetes and angina (Kuller 2001).
The most common barriers identified in this study where long Work Hours and Lack of time, other factors where transport to facilities, funding and health related issues. The same barriers where identified in a similar study with lack of time and work commitments being the most common, (The NHS Information Centre, Lifestyle Statistics 2009). The same study found different barriers between gender and age.
It is important for people who don't have enough time to do the guidelines to find ways of exercising around their commitments due to the relationship between exercise and Hypercholesterolemia. One such way is to walk 10,000 steps a day which has been found to have the same effect as 30 minutes of exercise a day (Johnson et al 2008); this could be achieved by walking to work and taking the stairs instead of the lift.
Finally this study found that less than half of those surveyed (44%) remember not having their cholesterol tested, this is higher than the 34% reported in a similar study (The NHS Information Centre, Lifestyle Statistics 2008). The problem for people that do not have their cholesterol tested is due to the difficult nature of diagnosing Hypercholesterolemia without having a test, due to the only really symptom being yellow patches on the skin called xanthomas (James et al 2006). Another problem is Hypercholesterolemia can be a symptom of other serious conditions such as coronary heart disease.
In conclusion Hypercholesterolemia is not a major health problem but if unchecked it can lead to other more serious conditions like angina, heart attacks and coronary heart disease. One way of controlling cholesterol is to exercise for the recommended 150 minutes per week at moderate intensity, doing this has been found to reduce risks of Hypercholesterolemia. However it has been found that more people need to be educated on the guidelines as well have their cholesterol tested. However a much larger survey needs to be done to see whether the trends found in this study are a recurring theme across the country.
