Personalized Approach Era Begins in Cholesterol Lowering Treatment

Recent cases of heart attacks at young ages in our country have brought high cholesterol and treatment methods back to the agenda. Altınbaş University Faculty of Medicine, Head of the Department of Cardiology Prof. Dr. Özlem Esen emphasized the importance of a personalized approach in cholesterol treatment.

The role and dangers of cholesterol

Prof. Dr. Esen stated that cholesterol is a vital building block for the body, but high levels of it predispose to arteriosclerosis and cardiovascular diseases. He stated that high LDL (bad cholesterol) levels increase the risk of heart attack, stroke and sudden death.

“Cholesterol-lowering drugs reduce the incidence of events related to atherosclerosis, namely heart attack, stroke and mortality, by 25%. The efficacy of these treatments has been scientifically proven,” said Prof. Esen and underlined personalized treatment approaches.

The situation in Turkey and familial high cholesterol

Prof. Esen said that high cholesterol levels in Turkey are often associated with inactivity and obesity, and familial hypercholesterolemia is more common. “The risk of heart attack in individuals with this condition is about 20 times higher than in healthy individuals,” Esen said, emphasizing that early diagnosis is vital in cases of high LDL levels. He stated that individuals living in high-risk countries such as Turkey should pay more attention than those living in low-risk countries.

The risk is different in every country

Stating that it is no longer necessary to take blood samples on an empty stomach in cholesterol assessment, Prof. Dr. Özlem Esen drew attention to the importance of individual and social risk maps in treatment. “Only patients with very high triglyceride values should have their blood samples taken on an empty stomach,” Esen said.

Esen also emphasized the importance of everyone having their Lipoprotein a (Lpa) levels measured once in their lives, and stated that with the latest developments, targeted cholesterol values and drug doses are determined according to individual risks. Esen stated that differences between countries have gained importance at this point and gave examples: “Country-specific social heart disease risk maps are decisive in treatment. For example, while Belgium, Denmark and France are among the low-risk countries, Turkey, Hungary, Poland and Croatia are considered high-risk countries. Two men of the same age with the same cholesterol and blood pressure values have different risk levels in Denmark and Turkey. In addition, people who have had a heart attack, diabetes or kidney disease are at very high risk.”

New treatment era and psychosocial factors

Stating that the era of the same treatment for everyone is over, Prof. Esen said that even the social isolation and psychosocial stress conditions of individuals should be taken into consideration in treatment planning. Pointing out that an important concept that makes cholesterol values risky is the social life of the individual, Prof. Esen shared the following information

“How socially isolated a person is or whether they are under psychosocial stress are among the factors that affect cholesterol risk but are difficult to quantify. These conditions can be detected through detailed interviews. The presence of comorbid psychiatric illnesses, migraines or immune disorders should also be taken into account. Just as each individual's fingerprint is different, so is their cardiovascular risk and cholesterol.”

Misconceptions about cholesterol

Prof. Dr. Esen also touched upon the common misconceptions about cholesterol and summarized them in 7 articles:

1. We only get cholesterol from what we eat

The liver produces most of the cholesterol. Diet contributes only 15-20% of total cholesterol levels.

2. High cholesterol is only seen in the elderly

High cholesterol can be seen in all age groups. Genetic factors and lifestyle can also cause problems at a young age.

3. If Cholesterol Level Rises, Medication Should Be Used Immediately

Medication may be needed, but healthy eating, exercise and stress management are usually the first step.

4. People with Cholesterol Problems Should Not Eat Eggs

Egg yolks contain cholesterol but are not harmful when consumed in moderation. What matters is the overall balance of the diet.

5. Vegetable oils are cholesterol-free and completely safe

Vegetable oils may contain trans fats. Sunflower oil and coconut oil in particular, although natural, can pose a risk to heart health.

6. Lowering Cholesterol Eliminates the Risk of Heart Disease

Lowering cholesterol levels reduces the risk, but other factors such as smoking, high blood pressure and genetic factors should also be taken into account.

7. Cholesterol Measurement Only on an Empty Stomach

Fasting is not necessary for modern methods of measuring total cholesterol and LDL. This is only necessary for individuals with high triglyceride levels.

Benefits of cholesterol-lowering drugs

Describing the use of cholesterol-lowering drugs as a “safety belt against heart attack”, Prof. Esen stated that these drugs reduce the risk of heart attack, protect against stroke and improve quality of life. “Health is a whole,” Esen said, noting that drug treatment should be supported by a healthy diet and regular exercise, and emphasized the importance of treating everyone according to their individual characteristics.

Side effects and things to watch out for

Pointing out that cholesterol-lowering drugs may also have side effects, Esen said, “Muscle aches, elevated liver enzymes and, rarely, increased blood sugar are known side effects of these drugs. Therefore, the use of cholesterol-lowering drugs should be under the control of a doctor and requires regular follow-up. Of course, it would be the most correct approach to be told by a doctor who examines and handles the patient in all aspects.”