Cholesterol is a fatty substance that plays an important role in cell function. However, if cholesterol levels are high, cholesterol can bind to other debris to form plaques that stick to the inner walls of arteries. A cholesterol embolism is a crystal of cholesterol that has broken away from a plaque and traveled through the circulatory system, eventually becoming stuck in a smaller artery.

Cholesterol emboli can restrict blood flow to major organs. Depending on the severity of the blockage and the organs affected, this may lead to serious and potentially life threatening conditions.

Cholesterol embolism syndrome is usually a gradual process that damages the major organs over time. The main types of organ damage are mechanical obstruction and inflammation. Typical sites of organ damage include:

• the brain
• the eyes
• the skin
• the muscles
• the kidneys
• the gastrointestinal (GI) tract

The plaque that causes CE can contain various types of debris, but cholesterol crystals are generally the main substance. Plaque develops when cholesterol levels are high. Reasons for this can include:

• consuming a diet high in saturated and trans fats
• having a sedentary lifestyle
• experiencing stress and associated hormone changes
• having a genetic predisposition
• having existing health conditions, such as hypothyroidism and nephrotic syndrome

The biggest risk factor for CE is atherosclerosis, which is a buildup of plaque in the arteries. Other risk factors include:

People receiving certain treatments for diseases of the heart or blood vessels also have a higher risk of developing CE. During vascular procedures, cholesterol plaques are more likely to break off and embolize.

Common generalized symptoms of CE include:

A person may also experience more specific symptoms due to a lack of blood flow to individual organs. Cholesterol emboli most commonly affect the kidneys, skin, and GI tract. According to a 2021 review, kidney issues occur in 31.5% of cases, skin issues in 15.5% of cases, and GI issues in 13.4% of cases.

The symptoms a person experiences will depend on the organ affected. Possible symptoms may include:

• Kidney symptoms. In the early stages of kidney disease, a person likely will not experience any symptoms. In the later stages, a person may experience multiple symptoms, including:
• Skin symptoms. These may include the following:
  • blue or purple toe color
  • skin ulcers
  • gangrene
  • livedo reticularis, which is a rash with a lacy appearance
• Gastrointestinal symptoms. These may include:
• Central nervous system (CNS) symptoms. These may include:
• Eye symptoms. These may include:

Doctors frequently underdiagnose CE. However, as researchers are learning more about the condition, diagnosis is becoming more common.

The main tool that doctors use to diagnose CE is tissue biopsy. Doctors may collect tissue samples from the following areas:

• kidney
• gastric and colonic mucus
• skin
• muscle
• bone marrow

Other tests that are usually included in the workup include a complete blood count, a basic metabolic panel, and urinalysis.

The presence of a CE usually becomes clear when a person who has been experiencing relevant symptoms experiences a sudden event, such as a stroke. Imaging techniques such as magnetic resonance imaging (MRI) can help establish a diagnosis. CT angiography of the affected area is another commonly used imaging technique.

There is no specific treatment for CE. The main strategy for improving a person’s outlook is preventing cardiovascular complications.

In some cases, a doctor may recommend anti-inflammatory medications to reduce organ inflammation associated with CE. Examples of these medications include:

If a doctor can identify the location of the CE, they may recommend surgery to remove or bypass the obstruction. However, the risks associated with surgery can be high, so doctors will typically try more conservative methods where possible.

A person who has received a diagnosis of CE will need to make certain lifestyle changes to reduce their risk of further cardiovascular disease. Preventive measures include:

The outlook for CE is often poor. This is because CE increases the risk of cardiovascular complications.

A 2021 review suggests that 63–81% of CE cases result in mortality. The 4-year survival rate for CE is around 52%.

People can test their cholesterol levels using a home testing kit available from most pharmacies. The test kit will indicate whether a person’s cholesterol levels are within an acceptable range. Anyone who learns that their cholesterol is high should see their doctor for further advice.

A person should also contact their doctor if they experience signs and symptoms of CE. They may wish to ask their doctor the following questions:

• Which medications can I take to help lower my cholesterol, and what are their side effects?
• How can I reduce my cholesterol intake?
• How often should I check my cholesterol levels?

A cholesterol embolism is a crystal of cholesterol that has broken away from an arterial plaque and become lodged within a smaller artery. The CE creates a blockage within the artery that can restrict blood supply to the major organs. This can result in severe and potentially life threatening complications.

A CE can cause generalized symptoms, such as fever, fatigue, and muscle aches. It may also cause symptoms specific to the organ that it affects.

There is no specific treatment for CE. The primary aim is to implement lifestyle changes or take medications that will help prevent cardiovascular complications. People who have already experienced such complications may require medications to manage any secondary conditions.

A person who is concerned about their cholesterol levels or concerned about a possible CE should see their doctor for further advice and testing.