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Understanding Cholesterol Embolism: An Overview

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Cholesterol embolism is a type of blockage of blood vessels resulting from the breakage of an atherosclerotic plaque. Read below to learn more about it.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At May 15, 2023
Reviewed AtFebruary 21, 2024

Introduction

An embolism is a blood vessel blockage caused by a foreign object, such as a blood clot or air bubble. The tissues and organs of the body require oxygen, which is carried throughout the body by the bloodstream. When the blood supply to vital organs such as the brain, heart, and lungs is cut off, those organs lose all or part of their function. Two of the most serious medical conditions caused by an embolism are:

  • Stroke: In this, blood flow to the brain is cut off.

  • Pulmonary Embolism: A blockage by a foreign object in the artery carrying blood from the heart to the lungs (pulmonary artery).

What Is Cholesterol Embolism?

Cholesterol embolism (CE) occurs when cholesterol, usually from atherosclerotic plaque (buildup of fats, cholesterol on the artery walls), is released and migrates into the bloodstream as an embolism, where it stays (as an embolism), causing a blockage of blood flow to the organs. Most commonly, it causes cutaneous manifestations (usually livedo reticularis), gangrene of the limbs, and sometimes renal failure. Depending on where cholesterol crystals enter the bloodstream, problems can occur in the organs. When the kidneys are affected, the condition is called atheroembolic kidney disease. Diagnosis usually involves a biopsy (taking a tissue sample) from the affected organ. Cholesterol embolism is treated by removing the causative agent and supportive care. Statins may also be given to the person to prevent excessive cholesterol buildup in the blood vessels.

What Are the Causes of Cholesterol Embolism?

The causes of cholesterol embolism are listed below:

  • People with atherosclerosis are most at risk of developing cholesterol embolism. Narrowing of arteries due to the buildup of plaque atherosclerosis. The severity of atherosclerosis is directly related to the likelihood of developing cholesterol embolism.

  • Cholesterol embolism occurs after endovascular surgery in approximately 80 % of cases. Endovascular surgery is a procedure that involves access to the blood vessels and is less invasive compared to other procedures. The procedure may take the form of the following:

Plaques causing cholesterol embolisms occur when cholesterol levels are high. This could be due to the following reasons:

  • A diet high in saturated fat and trans fat.

  • Living a sedentary lifestyle.

  • Being under excessive stress and related hormonal changes.

  • Having a genetic predisposition.

  • Having pre-existing health problems such as hypothyroidism or nephrotic syndrome.

Who Is at Risk of Cholesterol Embolism?

The risk factors for cholesterol embolism are listed below:

  • Male gender.

  • Age (more common with older age).

  • High blood pressure.

  • High cholesterol.

  • Diabetes.

  • Peripheral vascular disease.

  • Kidney failure.

  • Systemic inflammation.

  • Smoking.

What Are the Symptoms of Cholesterol Embolism?

The common symptoms of cholesterol embolism are listed below:

  • Fever.

  • Fatigue.

  • Weight loss.

  • Muscle pain.

  • Loss of appetite.

  • Symptoms of kidney failure.

  • Blue or purple toes.

  • Skin ulcers.

  • Gangrene (death of body tissue in the absence of blood flow).

  • Foot or toe pain.

  • Skin discoloration.

  • Spots around nails.

  • Sudden blindness.

  • Headache.

  • Altered mental state or confusion.

  • Stroke.

  • Abdominal or back pain.

  • Bleeding or pain in the gastrointestinal tract.

  • Diarrhea.

When to Get Help for Cholesterol Embolism?

The symptoms of cholesterol embolism are similar to others, making it difficult to recognize. However, a person is advised to seek emergency medical attention for the development of the following conditions or symptoms:

  • Unexplained shortness of breath.

  • Seizure.

  • Coma.

  • Chest pain or pressure.

  • Confusion.

  • Other worrisome or rapidly worsening symptoms.

How Is Cholesterol Embolism Diagnosed?

The standard gold test is a tissue biopsy of the affected area. A doctor removes a small amount of tissue during a biopsy and analyzes it in a laboratory. Depending on the location of the embolism, biopsies can be taken from:

  1. Skin.

  2. Muscle tissue.

  3. Kidney.

  4. Stomach.

  5. Colon.

  6. Bone marrow.

  7. Brain.

  8. Eyes.

The doctor may perform a urinalysis or complete metabolic panel to rule out other conditions that may cause similar symptoms. They can also check for inflammatory markers often elevated in cholesterol embolism syndrome. This includes:

  1. Lactic acid.

  2. C-reactive protein.

  3. Erythrocyte sedimentation rate.

  4. Lactate dehydrogenase.

A complete blood count also shows anemia (lack of red blood cells), leukocytosis (elevated white blood cell count), and thrombocytopenia (low blood platelet count).

How Is Cholesterol Embolism Treated?

There is no definitive treatment for cholesterol embolism. Treatment includes managing symptoms, lowering cholesterol, and preventing future cardiovascular disease.

1. Medication - The following medicines can help treat cases of cholesterol embolism:

  • Corticosteroid.
  • Colchicine.
  • IL-1 antagonist.
  • Statins (anti-cholesterol medication)

2. Renal Replacement Therapy - When the kidneys are not working adequately, the blood is filtered using renal replacement therapy. Renal replacement therapy includes:

  • Dialysis - Removal of waste from the blood.

  • Blood filtration - Removal of the blood of all impurities.

  • Hemodiafiltration - Renal replacement therapy with diffusion.

  • Kidney transplant - Kidney removal is done in patients with kidney failure.

3. Surgery - In some cases, surgery such as bypass surgery or surgical removal of the blockage (endarterectomy) is suggested. However, doctors may be unable to pinpoint the problem's exact location.

How to Prevent Cholesterol Embolism?

Individuals with above-normal cholesterol levels are encouraged to adopt lifestyle habits that lower the risk of future cholesterol embolism events. Healthy habits include:

  • Quitting smoking.

  • Regular exercise.

  • Losing weight in case of being overweight.

  • Eating a low cholesterol diet.

  • Managing stress.

  • Eating a balanced diet.

What Are the Complications of Cholesterol Emboli?

Several organs within the body may sustain harm from cholesterol emboli. These consist of the skin, gastrointestinal tract, kidneys, and brain. If one has organ damage, medical professionals will treat it as best they can to maximize the likelihood of recovery.

What Is the Prognosis for Those Suffering From Cholesterol Embolism?

The prognosis for those who have experienced a cholesterol embolism is typically not good. They are at risk for developing various cardiovascular diseases in addition to atherosclerosis. The prognosis depends on the severity of the illness, risk factors, and extent of the blockage.

Those who survive frequently experience severe long-term consequences like:

  • Prolonged need for renal replacement therapy.

  • Amputation.

  • Long-term dialysis.

Conclusion

Cholesterol embolism, also known as atheroembolism or cholesterol embolism syndrome, occurs when cholesterol crystals from a plaque block the blood flow to an organ. These cholesterol crystals travel through the bloodstream and block blood flow in one of the small vessels. Symptoms of cholesterol embolism depend on the organ affected. Severe symptoms and even death can occur when one of the major organs is affected. High cholesterol can be a concern, but it's almost always a red flag. Being diagnosed with high cholesterol does not always mean a person will develop heart disease or stroke, but it must be taken seriously.

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Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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