Hypercholesterolemia: Stroke Risk And How To Prevent It

High cholesterol, or hypercholesterolemia, is a common condition that can lead to serious health issues, including an increased risk of stroke. Cholesterol is a waxy, fatty substance found in the blood, which, when present in high levels, can cause a build-up of deposits, or plaques, in the blood vessels. This build-up can lead to a blockage that prevents blood from reaching the brain, resulting in an ischemic stroke. While the relationship between cholesterol and stroke is complex, with varying factors influencing the likelihood of stroke, it is clear that elevated cholesterol levels are a risk factor. Understanding and managing cholesterol levels through lifestyle changes and, in some cases, medication, are crucial steps in reducing the chances of experiencing a stroke.

High cholesterol can increase the risk of ischemic stroke

Low-density lipoprotein (LDL), or "bad cholesterol", is a major contributor to plaque development. Levels of LDL cholesterol higher than 130 milligrams per deciliter (mg/dL) are linked to an increased risk of ischemic stroke. Conversely, high-density lipoprotein (HDL), or "good cholesterol", helps protect against ischemic stroke by ferrying LDL out of the bloodstream and stabilising plaques. HDL levels above 35 mg/dL are protective, while levels below 35 mg/dL are associated with a higher risk of stroke.

The impact of cholesterol on stroke risk is complex and depends on the type of stroke and cholesterol involved. While high cholesterol is a risk factor for ischemic stroke, it is not associated with an increased risk of hemorrhagic stroke, which is caused by the rupture of a blood vessel in the brain.

Lifestyle factors such as diet, exercise, alcohol consumption, and weight can influence cholesterol levels and, subsequently, the risk of ischemic stroke. Adopting a healthy diet, increasing physical activity, and maintaining a healthy weight can help reduce cholesterol levels and lower the risk of stroke. Additionally, cholesterol-lowering medications, such as statins, have been shown to effectively reduce the risk of ischemic stroke.

High cholesterol is not associated with hemorrhagic stroke

In fact, some studies have suggested that low cholesterol levels may be linked to an increased risk of hemorrhagic stroke. This relationship is not yet fully understood, but it is thought that low cholesterol may lead to arterial medial layer smooth muscle cell necrosis, impairing the endothelium and making it more susceptible to microaneurysms, which are often found in patients with hemorrhagic stroke. However, it is important to note that other studies have found no significant association between total cholesterol levels and hemorrhagic stroke risk.

The type of cholesterol also plays a role in stroke risk. Low-density lipoprotein (LDL) cholesterol, or "bad cholesterol," contributes to the buildup of arterial plaques and is a major risk factor for ischemic stroke. On the other hand, high-density lipoprotein (HDL) cholesterol, or "good cholesterol," helps protect against ischemic stroke by facilitating the removal of LDL cholesterol from the bloodstream. While LDL cholesterol levels higher than 130 mg/dL are linked to an increased risk of ischemic stroke, HDL cholesterol levels above 35 mg/dL provide protection against it.

While high cholesterol is not a risk factor for hemorrhagic stroke, there are other factors that can increase the risk of this type of stroke. These include hypertension, smoking, alcohol consumption, and certain medical conditions such as bleeding disorders and sleep apnea. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help reduce the risk of stroke overall.

High-density lipoprotein (HDL) is good cholesterol

High cholesterol can increase your risk of having a stroke. This is due to the waxy substance contributing to the buildup of deposits, known as plaques, within blood vessels. There are two types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

HDL, or high-density lipoprotein, is often referred to as "good cholesterol". This is because it absorbs excess cholesterol in the blood and carries it back to the liver, which then flushes it from the body. HDL helps to reduce the risk of heart disease and stroke by lowering cholesterol levels in the blood. It also helps to stabilise existing plaques, further reducing the risk of blocked blood flow to the brain, which can cause a stroke.

HDL levels above 35 mg/dL provide protection against ischemic stroke, with levels above 60 mg/dL offering the greatest benefits. Conversely, HDL levels below 35 mg/dL are associated with a higher risk of stroke.

To increase HDL levels, it is recommended to eat a healthy diet, maintain a healthy weight, exercise regularly, avoid smoking, and limit alcohol consumption. These lifestyle changes can also help lower LDL levels and reduce the risk of stroke.

Low-density lipoprotein (LDL) is bad cholesterol

High cholesterol can increase your risk of having a stroke. Cholesterol is a waxy, fat-like substance found in all the cells in your body. While your body needs some cholesterol to function properly, too much cholesterol in your blood can lead to a buildup of deposits, known as plaques, within your blood vessels. This is particularly true of low-density lipoprotein (LDL), often referred to as "bad cholesterol".

LDL cholesterol is called "bad cholesterol" because it collects in the walls of your blood vessels, increasing the chances of health problems like a heart attack or stroke. It is a major contributor to arterial plaque development. When plaque builds up in the coronary arteries, it can cause a blockage of blood flow to the heart, leading to angina (chest pain) or a heart attack. Similarly, when plaque accumulates in the carotid arteries, it can cause a blockage that prevents blood from reaching the brain, resulting in an ischemic stroke. Levels of LDL cholesterol higher than 130 milligrams per deciliter (mg/dL) are linked to an increased risk of this type of stroke.

In contrast, high-density lipoprotein (HDL) is considered "good cholesterol". HDL helps to remove LDL cholesterol from the blood by carrying it from other parts of the body back to the liver, where it is flushed out. Higher levels of HDL provide protection against ischemic stroke, with HDL levels over 60 mg/dL being particularly beneficial.

To maintain a healthy balance of LDL and HDL cholesterol, it is important to make certain lifestyle choices. This includes eating a healthy diet that limits saturated and trans fats, as well as maintaining a healthy weight and engaging in regular physical activity. Avoiding tobacco products and managing stress can also help lower LDL levels. If lifestyle changes alone are not sufficient, medications such as statins can be prescribed to help lower LDL cholesterol and reduce the risk of stroke.

Lifestyle changes can help reduce high cholesterol

High cholesterol can increase your risk of having a stroke. This is because cholesterol is a waxy substance that contributes to the buildup of deposits, or plaques, within blood vessels. These plaques can block blood flow to the brain, causing an ischemic stroke.

Diet

Eating a healthy diet is one of the most effective ways to reduce high cholesterol and lower your risk of stroke. This involves limiting your intake of total fat, saturated fat, and cholesterol. Saturated fat, in particular, raises your LDL ("bad") cholesterol level more than anything else in your diet. It is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Instead, opt for foods with healthier fats, such as lean meats, nuts, and unsaturated oils like canola, olive, and safflower oils.

The American Heart Association recommends limiting saturated fat to less than 6% of daily calories and avoiding trans fats. No more than 25 to 35% of your daily calories should come from dietary fats, and less than 7% from saturated fat.

Choose skim milk, low-fat or fat-free dairy products, and limit fried foods. Emphasize fruits, vegetables, whole grains, poultry, fish, nuts, and nontropical vegetable oils in your diet, while limiting red and processed meats, sodium, and sugar-sweetened foods and beverages.

Eat plenty of soluble fiber, which helps prevent your digestive tract from absorbing cholesterol. Good sources of soluble fiber include whole-grain cereals (oatmeal, oat bran), fruits (apples, bananas, oranges, pears, prunes), and legumes (kidney beans, lentils, chickpeas, black-eyed peas, lima beans).

Increase your intake of plant stanols and sterols, which are found in whole grains, nuts, legumes, and oils like olive oil and avocado oil. These substances help prevent your digestive tract from absorbing cholesterol.

Eat foods rich in omega-3 fatty acids, which can lower LDL and triglyceride levels. These include fish like salmon, tuna, and mackerel (aim for two servings per week), as well as plant sources like walnuts, flaxseed, chia seeds, and certain plant-based oils.

Limit your salt and alcohol intake. Salt should be limited to no more than 2,300 milligrams (about 1 teaspoon) per day, as it can increase your risk of heart disease by raising your blood pressure. Alcohol adds extra calories, which can lead to weight gain and subsequent increases in LDL and decreases in HDL.

Exercise

Physical activity is crucial in managing cholesterol levels. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, which has been shown to lower both cholesterol and high blood pressure. This can include brisk walking, swimming, bicycling, or vigorous yard work.

Smoking

Smoking and vaping lower HDL ("good") cholesterol levels. Quitting smoking can help increase HDL levels and reduce damage to arteries, thereby lowering your risk of coronary heart disease.

Weight Management

Maintaining a healthy weight is essential in keeping your cholesterol levels in check. Even a modest weight loss of 5-10% can help improve cholesterol numbers and other heart disease risk factors.

Frequently asked questions