In the development of atherosclerosis, the following are significant risk factors: Male gender Being a male predisposes you to acquire atherosclerosis. This is one of the irreversible risk factors. Family history of premature IHD (before age 55 in a parent or sibling) If you do not have a family history of IHD. Meaning, your parents, brothers, or sisters did not experience IHD before the age of 55, then very likely you will not suffer from it. This is also one of the irreversible risk factors. Hyperlipidemia Hyperlipidemia refers to the elevation of cholesterol (hypercholesterolemia) and/or elevation of triglycerides (hypertriglyceridemia) in your blood. Men with cholesterol blood level of greater than 6 mmol/L (240 mg/dL) have more than a threefold increase in the risk of IHD death compared with men with cholesterol levels below about 5 mmol/L (200 mg/dL). As the cholesterol level in your blood increases, there is a corresponding increase in your risk of having IHD and an increase in cholesterol level is greatly associated with an increase in the low-density lipoproteins (LDL). Hypertriglyceridemia is also associated with the occurrences of IHD. This association further increases if there is a concomitant elevation of your cholesterol level. Increase in your triglycerides is associated with an increase in very low-density lipoproteins (VLDL).

Atherosclerosis refers to the growth and development of fatty streaks on the innermost lining of your blood vessels, such as your aorta and coronary arteries. Initially, these fatty streaks are focal, small, and non-obstructive. Thus, you will not experience any form of health disturbances at this stage. However, when these fatty streaks become large and obstruct the diameter of your blood vessels, such that blood flow is hindered, you will experience medical problems such as hypertension and ischemic heart disease (IHD). Both of these conditions could lead to stroke and myocardial infarction (heart attack), which could, in turn, lead to your possible death. There are several theories which aim to explain the development of atherosclerosis. Reaction to injury Based on this theory, the endothelium which covers the inner lining of your blood vessels will be exposed to an injurious event. Examples of such injuries are metabolic, mechanical, and immunologic. A metabolic injury would be hypercholesterolemia or homocysteinemia, while mechanical stress is when there is added pressure on the veins from hypertension or due to a blunt force injury. The immunologic injury may be seen after cardiac or renal transplantation.  When the endothelium around the vein is broken due to an injury, this will expose the next inner lining of your blood vessels, which is called the subendothelial tissue.

The elimination of cholesterol from your body is done through the bile.Where does bile come from and how is it produced?  What is its biological importance? The bile is produced from your liver, and its biological importance is to emulsify fats from the other contents of your small intestine. Through this, much of the fats in your diet are separated, and they are acted upon by the enzymes, lipases, for proper digestion. Without the bile, it will be very hard to digest the fats that you take in from your diet. Once formed in the liver, your bile goes to the gallbladder, and it is stored and concentrated there. When you eat, bile is released from your gallbladder and goes to your small intestine, where it will emulsify the dietary fats for proper and efficient digestion. Your bile has four organic components: Bile acids One of the components of your bile are the bile acids, which are formed and synthesized from cholesterol. Thus, without cholesterol, you cannot form bile. If you look at the chemical structures of bile acids and cholesterol, you could easily and immediately say that they are related structurally. To a large extent, cholesterol is eliminated from your body, as bile is poured into your small intestine and eliminated through your fecal matter.

Diet (exogenous source) When you consume food from animal and plant sources, you will inevitably derive cholesterol from them. The cholesterol content of different food items vary. Some food items contain high quantities of cholesterol, such as meats, egg yolks, butter, and processed foods. Other foods will have a low quantity such as egg whites, fruits, vegetables, and whole grains. When you ingest meat, which contains high saturated fats, there will be an increase in the amount of cholesterol in your body. Recommended Read:  10 Foods That Lower Cholesterol Naturally Produced in your body (endogenous production or source) In your body, there are a number of biochemical processes that lead to the breakdown or production of cholesterol. Regardless of whether you are asleep or awake, these processes continue to take place. The biochemical processes that will lead to the production of cholesterol in your body are divided  into  5 stages: Step 1 —Mevalonate, when a six-carbon substance, is produced from acetyl coenzyme A. The three basic nutrients that you consume every day are classified as; carbohydrates, fats, and proteins. These nutrients are complex in nature, which means they cannot be used readily by your body until they are broken down into their simplest components.

Drug therapy Hyperlipidemias refer to the elevation of cholesterol and/or triglycerides in your blood. In some individuals, only the cholesterol or triglycerides are elevated, in others, both are elevated. Hence hyperlipidemia is used as a term to encompass all elevations of either cholesterol or triglycerides or both. Drugs for hypercholesterolemia Hypercholesterolemia refers to the elevation of cholesterol in your blood and is associated with the increase in your LDL which carries most of your cholesterol. Treatment for elevated cholesterol is recommended for any adult patient when your LDL cholesterol level remains greater than 4.9 mmol/L (190 mg/dL) or greater than 4.1 mmol/L (160 mg/dL) in the presence of two or more risk factors as mentioned in the preceding after a sufficient trial of at least 3 months of diet therapy alone. If there are clinical indications that you have been suffering from IHD, drug therapy will be started if your LDL cholesterol level is 3.4 mmol/L (130 mg/dL) or greater. There are three groups of drugs used to lower your LDL cholesterol. These are: -bile acid-binding resins -nicotinic acid -HMG-CoA reductase inhibitors. The resins act by enhancing sterol excretion and indirectly increasing LDL receptor-mediated catabolism of circulating LDL. These drugs have been proven by clinical trials to be safe and effective; thus, they can be used for children who have been suffering from familial hypercholesterolemia, and for primary prevention of IHD in young adults.