Synonyms: Cholesterol, cholesterol. Blood cholesterol, Cholesterol, Chol, Cholesterol total.
Brief characteristics of the analyte Total cholesterol
About 80% of all cholesterol is synthesized by the human body (liver, intestines, kidneys, adrenal glands, gonads), and the remaining 20% comes from food of animal origin (meat, butter, eggs). Cholesterol is insoluble in water; it is transported in the blood in lipoprotein complexes. There are fractions of high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), very-low-density lipoprotein cholesterol (VLDL), and some others that differ in composition and functions. Total cholesterol includes cholesterol contained in all types of circulating lipoproteins, esterified and free.
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The content of cholesterol in the blood largely depends on age. Its level at birth is less than 3.0 mmol / l, then gradually increases. Emerging differences in its concentration are associated with gender. In men, the concentration of cholesterol in the blood increases in early and middle age and decreases in old age. In women, cholesterol levels increase more slowly with age, up to menopause; in the future, it may exceed cholesterol levels in men. The described age-related changes in the content of cholesterol in the blood are associated with the action of sex hormones: estrogens reduce, and androgens increase the level of total cholesterol. During pregnancy, there is a physiological increase in total cholesterol levels.
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The determination of cholesterol is mainly used to assess the risk of developing atherosclerosis and in the diagnosis of any type of lipid metabolism disorder. It has been established that elevated blood cholesterol levels contribute to the development of vascular atherosclerosis and coronary heart disease. The level of total cholesterol in combination with data on existing diseases, age, gender, blood pressure, the fact of smoking, is taken into account when assessing the individual risk of developing severe complications of cardiovascular diseases (myocardial infarction or stroke) according to the SCORE (Systematic Coronary Risk Evaluation) scale. It is advisable to investigate cholesterol in combination with the determination of triglycerides (see test No. 30), HDL cholesterol (see Test No. 32), the calculation of non-HDL cholesterol (see Test No. NHDL) and LDL cholesterol (see Test No. 33), since for a correct assessment of cardiovascular risks it is important to understand the ratio of different fractions of lipoproteins. Thus, high HDL cholesterol indicates a low risk, and the detection of an increased concentration of triglycerides, in combination with a decrease in HDL, makes it possible to suspect certain pathological conditions (including metabolic syndrome, and insulin resistance), which are themselves associated with increased cardiovascular risk.
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What is the purpose of determining the level of cholesterol in the blood?
A change in diet can reduce blood cholesterol levels by 10-15%, although sensitivity to changes in dietary cholesterol levels and the effect of diet on cholesterol levels can be expressed differently in different people. To reduce the risk of complications of cardiovascular diseases, it is recommended to maintain the concentration of total cholesterol in the blood below 5.0 mmol / l. The therapeutic goal of lipid-lowering therapy is to lower LDL cholesterol levels.
Disorders of cholesterol metabolism, accompanied by an increase in its content in the blood, are characteristic of hypothyroidism. Secondary hypercholesterolemia is also observed in hepatic cholestasis, nephrotic syndrome, chronic renal failure, gout, diabetes, and other diseases. Before starting therapy with lipid-lowering drugs, diseases that lead to an increase in cholesterol levels should be excluded.
The level of cholesterol reflects the activity of synthesis processes in the liver. In severe liver damage, there is a significant decrease in the concentration of cholesterol in the blood. Acute tissue injury also causes a marked drop in total and LDL cholesterol levels. It begins within the first day after a heart attack, surgery, or septicemia and can reach a 40% reduction from baseline. Lipid levels do not return to normal for up to three months. Therefore, a lipid study to assess the risk of atherosclerosis should not be performed within three months after acute conditions.
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