Managing Cholesterol

About this course

Cholesterol, a naturally occurring bio-compound, serves as a vital component for various biological functions. Managing cholesterol is not merely about correcting an imbalance. It is a fundamental aspect of initiative-taking healthcare, essential for reducing the risk of serious cardiovascular conditions and promoting long-term well-being across populations. This course examines the intricacies of cholesterol metabolism, describes modifiable and nonmodifiable behaviors, and explains appropriate interventions that can help prevent and mitigate the devastating consequences of hypercholesterolemia.

Learning objectives

• Define cholesterol as a subtype within a class of steroids, including the molecular structure of cholesterol.
• Review the types of cholesterol, the lipid panel, and common values within the lipid panel.
• Review the modifiable and nonmodifiable risk factors associated with high cholesterol (hypercholesterolemia).
• Understand the pharmacological and nonpharmacological management options for elevated cholesterol levels.
• Review nursing considerations when caring for a patient with hypercholesterolemia.

Course outline

19 sections · finish in any order across devices

1. 1

   Introduction

   Cholesterol, a naturally occurring bio-compound, serves as a vital component for various biological functions.1 However, like a double-edged sword, its imbalance can silently undermine health, leading to severe complications. Elevated cholesterol is a principal risk factor for cardiovascular disease

   4 min

2. 2

   Cholesterol Definition

   Cholesterol is a fatty, wax-like substance found in all cells of the body.1 While it is often grouped with fats, it is not technically a fat. Cholesterol is a lipid, a broader category that includes fats and other substances such as phospholipids. Chemically, cholesterol is a sterol, a subtype of a

   4 min

3. 3

   Cholesterol Synthesis

   Approximately 80% of cholesterol needed for normal biological function is synthesized by the body.6 Only 20% is obtained from dietary sources such as dairy products, meat, and eggs. Internally, this process primarily occurs in the liver but can also take place in other tissues. The synthesis of chol

   4 min

4. 4

   Function of Cholesterol

   In biological systems, cholesterol serves several important functions.8 It is an elemental component of all cell membranes, such that it helps to modulate fluidity and stability. Cholesterol is a precursor compound to steroid hormones such as cortisol, aldosterone, estrogen, and testosterone. It is

   4 min

5. 5

   Types of Cholesterol

   In the bloodstream, cholesterol travels in small packages called lipoproteins, where the lipids are on the inside and proteins on the outside.10 Two main types of lipoproteins carry cholesterol throughout the body: 10

   4 min

6. 6

   The Lipid Panel

   Healthcare professionals use a lipid panel to assess the amount of cholesterol in the body. A lipid panel is an in-depth blood test that evaluates key lipid components, including total cholesterol, LDL, HDL, and triglycerides.12 Total cholesterol is the overall cholesterol level in the blood; LDL pl

   4 min

7. 7

   Signs and Symptoms of High Cholesterol

   High cholesterol, often referred to as hypercholesterolemia, is a condition where there is an excessive amount of cholesterol in the bloodstream.13 The primary challenge of hypercholesterolemia is that it usually presents with no apparent symptoms. This makes it a "silent" condition that can go unde

   4 min

8. 8

   Risk Factors of High Cholesterol

   High cholesterol is influenced by multiple risk factors, which can be broadly categorized into non-modifiable and modifiable.17 Non-modifiable risk factors include genetics, age, and biological sex. These are inherent and cannot be changed. Modifiable risk factors include diet, physical inactivity,

   4 min

9. 9

   Non-Modifiable Risk Factors

   Genetic predisposition is a chief non-modifiable risk factor for high cholesterol. Familial hypercholesterolemia is a genetic issue that causes higher levels of LDL cholesterol. Research suggests it is caused by mutations in genes related to LDL receptor function, such as the LDLR gene, APOB gene, o

   4 min

10. 10

    Modifiable Risk Factors

    In terms of modifiable risk factors, diet plays a central role. A diet based on saturated fats, trans fats, or dietary cholesterol elevates LDL cholesterol levels and lowers HDL cholesterol.17 Saturated fats are dietary fats without double bonds between the carbon atoms in their fatty acid chains.19

    4 min

11. 11

    Statins

    Statins work by inhibiting HMG-CoA reductase.25 By blocking this key enzyme, statins effectively reduce the liver's ability to produce cholesterol. Statins also modestly increase HDL cholesterol levels and lower triglycerides, contributing to a more favorable lipid profile. Commonly prescribed stati

    4 min

12. 12

    Bempedoic Acid

    Bempedoic acid is a lipid-lowering agent that targets ATP citrate lyase. By blocking this enzyme, bempedoic acid reduces the production of acetyl-CoA and, in turn, cholesterol synthesis. Approved by the FDA in 2020, bempedoic acid is primarily used as an add-on to diet and maximally tolerated statin

    4 min

13. 13

    Bile-Acid Binding Inhibitors

    Bile-acid binding inhibitors, also known as bile acid sequestrants, attach to bile acids in the intestine.30 In the liver, cholesterol is used to make bile acids, compounds essential for the digestion and absorption of dietary fats. By binding to bile acids, these medications prevent fat reabsorptio

    4 min

14. 14

    Cholesterol Absorption Inhibitors

    Cholesterol absorption inhibitors are a class of medications that reduce the amount of cholesterol absorbed from the diet in the small intestine.32 This leads to a decrease in the amount of cholesterol entering the bloodstream, subsequently lowering LDL cholesterol levels. One of the most commonly u

    4 min

15. 15

    PCSK9 Inhibitors

    PCSK9 inhibitors are a class of medications that act on proprotein convertase subtilisin/kexin type 9 (PCSK9).34 This protein binds to LDL receptors on the surface of liver cells and helps regulate cholesterol. Normally, when PCSK9 levels are high, fewer LDL receptors are available in liver cells, r

    4 min

16. 16

    Pharmacologic Management for Triglycerides

    Several pharmacologic treatments are available to lower triglycerides: fibrates, niacin, and omega-3 fatty acid supplements.35 Fibrates work by activating peroxisome proliferator-activated receptors (PPARs), particularly PPAR-alpha. These receptors are nuclear transcription factors that regulate the

    4 min

17. 17

    Non-Pharmacologic Interventions

    Non-pharmacologic interventions play a critical role in managing cholesterol and diminishing the risk of cardiovascular diseases.38 They complement pharmacological treatments and, in some cases, may be sufficient to maintain healthy cholesterol levels, especially in individuals with borderline or mi

    4 min

18. 18

    Nursing Considerations

    When managing a patient with hypercholesterolemia, there are crucial nursing considerations to ensure effective care and achieve optimal patient outcomes.44 For instance, regular assessment of cholesterol levels is essential. Nurses should closely monitor lipid profiles, including LDL, HDL, and trig

    4 min

19. 19

    Conclusion

    Cholesterol is an indispensable component of our biological systems, crucial for numerous physiological processes. Still, its delicate balance is easily disrupted, leading to serious cardiovascular complications. While the risks associated with high cholesterol are multifaceted, many are within our

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• National Heart, Lung, and Blood Institute. (2022, March 24). Blood Cholesterol - What is Blood Cholesterol? | NHLBI, NIH. Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/blood-cholesterol
• WHO. (2023). Indicator Metadata Registry Details. Www.who.int. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3236
• CDC. (2024, May 20). High Cholesterol Facts. Cholesterol. https://www.cdc.gov/cholesterol/data-research/facts-stats/index.html
• PubChem. (2019). Cholesterol. Nih.gov; PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/Cholesterol
• Amphipathic - Definition and Examples - Biology Online Dictionary. (2019, November 10). Biology Articles, Tutorials & Dictionary Online. https://www.biologyonline.com/dictionary/amphipathic
• Harvard Health Publishing. (2019, July 31). How it’s made: Cholesterol production in your body - Harvard Health. Harvard Health; Harvard Health. https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body
• Cholesterol Synthesis - an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. https://www.sciencedirect.com/topics/medicine-and-dentistry/cholesterol-synthesis
• Zampelas, A., & Magriplis, E. (2019). New Insights into Cholesterol Functions: A Friend or an Enemy? Nutrients, 11(7). https://doi.org/10.3390/nu11071645
• Vitali, C., Wellington, C. L., & Calabresi, L. (2014). HDL and cholesterol handling in the brain. Cardiovascular Research, 103(3), 405-413. https://doi.org/10.1093/cvr/cvu148
• Das, P., & Ingole, N. (2023). Lipoproteins and Their Effects on the Cardiovascular System. Cureus, 15(11). https://doi.org/10.7759/cureus.48865
• Jebari-Benslaiman, S., Galicia-García, U., Larrea-Sebal, A., Olaetxea, J. R., Alloza, I., Vandenbroeck, K., Benito-Vicente, A., & Martín, C. (2022). Pathophysiology of Atherosclerosis. International Journal of Molecular Sciences, 23(6). https://doi.org/10.3390/ijms23063346
• US National Library of Medicine. (2020, October 2). Cholesterol Levels: What You Need to Know. Medlineplus; National Library of Medicine. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html
• Soran, H., Adam, S., Mohammad, J. B., Ho, J. H., Schofield, J. D., Kwok, S., Siahmansur, T., Liu, Y., Syed, A. A., Dhage, S. S., Stefanutti, C., Donn, R., Malik, R. A., Banach, M., & Durrington, P. N. (2017). Hypercholesterolaemia – practical information for non-specialists. Archives of Medical Science : AMS, 14(1), 1-21. https://doi.org/10.5114/aoms.2018.72238
• Parwani, D., Ahmed, M. A., Mahawar, A., & Gorantla, V. R. (2023). Peripheral Arterial Disease: A Narrative Review. Cureus, 15(6). https://doi.org/10.7759/cureus.40267
• Kowalski, S., Goniewicz, K., Moskal, A., Al-Wathinani, A. M., & Goniewicz, M. (2023). Symptoms in Hypertensive Patients Presented to the Emergency Medical Service: A Comprehensive Retrospective Analysis in Clinical Settings. Journal of Clinical Medicine, 12(17). https://doi.org/10.3390/jcm12175495
• (2019). Good to Know: Diabetes Symptoms and Tests. Clinical Diabetes : A Publication of the American Diabetes Association, 38(1), 108. https://doi.org/10.2337/cd20-pe01
• CDC. (2024, May 20). Risk Factors for High Cholesterol. Cholesterol. https://www.cdc.gov/cholesterol/risk-factors/index.html
• Zubielienė, K., Valterytė, G., Jonaitienė, N., Žaliaduonytė, D., & Zabiela, V. (2022). Familial Hypercholesterolemia and Its Current Diagnostics and Treatment Possibilities: A Literature Analysis. Medicina, 58(11). https://doi.org/10.3390/medicina58111665
• Saturated Fatty Acid - an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. https://www.sciencedirect.com/topics/medicine-and-dentistry/saturated-fatty-acid
• Oteng, B., & Kersten, S. (2020). Mechanisms of Action of trans Fatty Acids. Advances in Nutrition, 11(3), 697-708. https://doi.org/10.1093/advances/nmz125
• Addissouky, T. A., El Sayed, I. E., Ali, M. M., Wang, Y., El Baz, A., Elarabany, N., & Khalil, A. A. (2024). Oxidative stress and inflammation: Elucidating mechanisms of smoking-attributable pathology for therapeutic targeting. Bulletin of the National Research Centre, 48(1), 1-16. https://doi.org/10.1186/s42269-024-01174-6
• Gao, C., Yu, W., Zhao, X., Li, C., Fan, B., Lv, J., Wei, M., He, L., Su, C., & Zhang, T. (2021). Four-Way Decomposition of Effect of Alcohol Consumption and Body Mass Index on Lipid Profile. International Journal of Environmental Research and Public Health, 18(24). https://doi.org/10.3390/ijerph182413211
• Benedetti, A., Paolo, A. D., Giannese, D., & Cupisti, A. (2021). Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review. Nutrients, 14(1). https://doi.org/10.3390/nu14010212
• American Heart Association. (2018). Cholesterol Medications. Www.heart.org. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications
• Ramkumar, S., Raghunath, A., & Raghunath, S. (2016). Statin Therapy: Review of Safety and Potential Side Effects. Acta Cardiologica Sinica, 32(6), 631-639. https://doi.org/10.6515/ACS20160611A
• News-Medical. (2009, December 11). Statin History. News-Medical.net. https://www.news-medical.net/health/Statin-History.aspx
• Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., Davis, E. M., Donahue, K. E., Jaén, C. R., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Stevermer, J., & Wong, J. B. (2022). Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. JAMA, 328(8), 746. https://doi.org/10.1001/jama.2022.13044
• Pradhan, A., Bhandari, M., Vishwakarma, P., Singh, A., Perrone, M. A., & Sethi, R. (2023). Bempedoic Acid: An Emerging Therapy for Uncontrolled Low-Density Lipoprotein (LDL) Cholesterol. Journal of Cardiovascular Development and Disease, 10(5). https://doi.org/10.3390/jcdd10050195
• PubChem. (n.d.). Bempedoic acid. Pubchem.ncbi.nlm.nih.gov. https://pubchem.ncbi.nlm.nih.gov/compound/Bempedoic-acid
• Bile Acid Sequestrant - an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. https://www.sciencedirect.com/topics/medicine-and-dentistry/bile-acid-sequestrant
• Bile acid sequestrants for cholesterol: MedlinePlus Medical Encyclopedia. (n.d.). Medlineplus.gov. https://medlineplus.gov/ency/patientinstructions/000787.htm
• Cholesterol Absorption Inhibitor - an overview | ScienceDirect Topics. (2016). Sciencedirect.com. https://www.sciencedirect.com/topics/medicine-and-dentistry/cholesterol-absorption-inhibitor
• Vavlukis, M., & Vavlukis, A. (2018). Adding ezetimibe to statin therapy: Latest evidence and clinical implications. Drugs in Context, 7. https://doi.org/10.7573/dic.212534
• Hajar, R. (2019). PCSK 9 Inhibitors: A Short History and a New Era of Lipid-lowering Therapy. Heart Views : The Official Journal of the Gulf Heart Association, 20(2), 74-75. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_59_19
• Ioanna Gouni‐Berthold, Jonas Andersson Schwarz, & Berthold, H. K. (2023). Updates in Drug Treatment of Severe Hypertriglyceridemia. Current Atherosclerosis Reports, 25(10), 701–709. https://doi.org/10.1007/s11883-023-01140-z
• Zeman, M., Vecka, M., Perlík, F., Hromádka, R., Staňková, B., Tvrzická, E., & Žák, A. (2015). Niacin in the Treatment of Hyperlipidemias in Light of New Clinical Trials: Has Niacin Lost its Place? Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 21, 2156-2162. https://doi.org/10.12659/MSM.893619
• Oscarsson, J., & Hurt-Camejo, E. (2017). Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing lipoproteins in humans: A review. Lipids in Health and Disease, 16. https://doi.org/10.1186/s12944-017-0541-3
• Matei, D., Buculei, I., Luca, C., Corciova, P., Andritoi, D., Fuior, R., Iordan, A., & Onu, I. (2022). Impact of Non-Pharmacological Interventions on the Mechanisms of Atherosclerosis. International Journal of Molecular Sciences, 23(16). https://doi.org/10.3390/ijms23169097
• Monounsaturated Fat - an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/monounsaturated-fat
• MedlinePlus. (2015). Facts about polyunsaturated fats: MedlinePlus Medical Encyclopedia. Medlineplus.gov. https://medlineplus.gov/ency/patientinstructions/000747.htm
• Barkas, F., Bathrellou, E., Nomikos, T., Panagiotakos, D., Liberopoulos, E., & Kontogianni, M. D. (2023). Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention. Nutrients, 15(13). https://doi.org/10.3390/nu15132845
• Cho, H., Nam, S., Kang, J., Park, H., & Kim, H. (2022). Long-Term Alcohol Consumption Caused a Significant Decrease in Serum High-Density Lipoprotein (HDL)-Cholesterol and Apolipoprotein A-I with the Atherogenic Changes of HDL in Middle-Aged Korean Women. International Journal of Molecular Sciences, 23(15). https://doi.org/10.3390/ijms23158623
• American Heart Association. (2024). American Heart Association recommendations for physical activity in adults and kids. American Heart Association. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
• Reiner, Ž. (2015). Management of patients with familial hypercholesterolaemia. Nature Reviews Cardiology, 12(10), 565-575. https://doi.org/10.1038/nrcardio.2015.92

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