Total Cholesterol

Total Cholesterol (TCH)

Cholesterol is a fat-like substance necessary for building cell membranes, synthesizing hormonesHormones are biologically active substances that are produced by specialized cells or glands (such as endocrine glands) and regulate various physiological processes in the body. They act as chemical signals that are transmitted through the bloodstream to organs and tissues to control and coordinate a wide range of functions, including metabolism, growth and development, reproduction, mood, and more. Examples include insulin, testosterone, estrogen, and adrenaline. (sex hormones, cortisol), vitamin D, and bile acids. It comes from food (20-30%) and is produced by the liver (70-80%).

The total cholesterol test reflects the total amount of:

LDL (‘bad’ cholesterol) – transports cholesterol to tissues, promotes atherosclerosis.
HDL (‘good’ cholesterol) – removes excess cholesterol from the blood vessels.
Triglycerides are a form of fat, a source of energy.

Norms of total cholesterol in the blood

(as recommended by WHO and ESC/EAS 2021)

Category	Optimal Level (mmol/L)
Healthy Adults	< 5.2
With Cardiovascular Risks	< 4.5
Children	2.9–5.2

Note:

In women, cholesterol is usually lower until menopause, then rises.
During pregnancy, cholesterol increases (physiological norm).

Deviations from the norm

1. High cholesterol (hypercholesterolemia)

Reasons:

An unbalanced diet (excess saturated fat, trans fat).
Hypodynamia (sedentary lifestyle).
Obesity, metabolic syndrome.
Genetic disorders (familial hypercholesterolemia).
Concomitant diseases: hypothyroidism, diabetes, liver and kidney diseases.

Symptoms of excess:

It is asymptomatic for a long time!
Xanthomas are yellowish fatty plaques on the skin (eyelids, elbows, tendons).
Xanthelasma – deposits of cholesterol on the eyelids.
Early atherosclerosis – chest pain (angina pectoris), intermittent claudication.
Heart attacks, strokes – in severe forms at a young age.

How dangerous is it?

Formation of atherosclerotic plaques → vasoconstriction → organ ischemia.

2. Low cholesterol (hypocholesterolemia)

Reasons:

Fasting, strict diets (anorexia, bulimia).
Liver diseases (cirrhosis, hepatitis) – cholesterol synthesis is disrupted.
Hyperthyroidism (excess of thyroid hormones).
Hereditary disorders (abetalipoproteinemia).
Chronic infections, sepsis.

Symptoms of deficiency:

Weakness, muscular dystrophy (cholesterol is a component of cell membranes).
Hormonal disorders – menstrual cycle disorders, decreased libido.
Depression, aggression (cholesterol is involved in the synthesis of serotonin).
Malabsorption of fat-soluble vitamins (A, D, E, K).

How dangerous is it?

Increased risk of hemorrhagic stroke (due to vascular fragility).
Depression and cognitive impairment (decreased hormone production).

What should I do if there are deviations?

If cholesterol is elevated:

Diet: reduce animal fats, add vegetables, omega-3 fatty acids, and fiber.
Physical activity (≥150 minutes / week).
Weight control, quitting smoking and alcohol.
Medications: statins (as prescribed by your doctor).

If your cholesterol is low:

Diet: fatty fish, nuts, vegetable oils, eggs.
Treatment of the underlying disease (for example, correction of hypothyroidism).
Cancellation of strict diets (if the reason is in them).

Important!

Total cholesterol – only primary screening. A lipid profile is needed to accurately assess risks :

LDL (‘bad’) – must be < 3.0 mmol/L (for cores < 1.8).
HDL (‘good’) – > 1.0 mmol / L (male), > 1.2 mmol/L (female).
Triglycerides – < 1.7 mmol/l.

Consultation with a doctor (cardiologist, endocrinologist) is mandatory!