Cholesterol is found in every cell of the body and has important natural functions when it comes to digesting food, producing hormones, and generating vitamin D. It is manufactured by the body, but can also be taken in from food. It is waxy and fat-like in appearance.
There are two types of cholesterol - LDL (lowdensity lipoproteins, bad cholesterol) and HDL (high-density lipoproteins, good cholesterol).
LDL (bad) cholesterol
LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This condition narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease, or PAD.
HDL (good) cholesterol
HDL cholesterol can be thought of as the “good” cholesterol, because experts believe it acts as a scavenger, carrying some of the LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body.
A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show that low levels of HDL cholesterol increase the risk of heart disease.
WHAT CAUSES HIGH CHOLESTEROL?
All of the below can either increase your cholesterol level or affect the ratio of good to bad cholesterol:
- eating a diet high in saturated fat
- smoking – a chemical found in cigarettes called acrolein stops HDL transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis)
- having diabetes or high blood pressure (hypertension)
- having a family history of stroke or heart disease
- being over weight
- There’s also an inherited condition called familial hypercholesterolaemia, which can cause high cholesterol even in someone who eats healthily.
Sometimes the way we live our life can affect how our genetic makeup is expressed. For example a diet high in saturated fat or being overweight may help “switch on” certain genes which increase cholesterol levels.
By making significant changes to your diet, within a few weeks you should see a reasonable reduction in your cholesterol levels. It is important to maintain these changes and perhaps even build on them in order to keep your cholesterol consistently low.
WHEN SHOULD CHOLESTEROL LEVELS BE TESTED?
Your GP may recommend that you have your blood cholesterol levels tested if you:
- have been diagnosed with coronary heart disease, stroke or mini stroke (TIA), or peripheral arterial disease (PAD)
- have a family history of early cardiovascular disease
- have a close family member who has a cholesterol-related condition
- are overweight
- have high blood pressure, diabetes, or a health condition that can increase cholesterol levels
WHAT SHOULD MY CHOLESTEROL LEVELS BE?
Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.
As a general guide, total cholesterol levels should be:
- 5mmol/L or less for healthy adults
- 4mmol/L or less for those at high risk
As a general guide, LDL levels (bad) cholesterol should be:
- 3mmol/L or less for healthy adults
- 2mmol/L or less for those at high risk
- An ideal level of HDL is above 1mmol/L.
A lower level of HDL can increase your risk of heart disease.
Your ratio of total cholesterol to HDL may also be calculated. This is your total cholesterol level divided by your HDL level. Generally, this ratio should be below 4, as a higher ratio increases your risk of heart disease.
However, cholesterol is only 1 risk factor and the level at which specific treatment is required will depend on whether other risk factors, such as smoking and high blood pressure, are also present.
HOW CAN I LOWER MY CHOLESTEROL LEVEL?
The first step in reducing your cholesterol is to maintain a healthy, balanced diet. It’s important to keep your diet low in fatty food.
Try to avoid or cut down on the following foods, which are high in saturated fat:
- fatty cuts of meat and meat products, such as sausages and pies
- butter, ghee and lard • cream, soured cream, crème fraîche and ice cream
- cheese, particularly hard cheese
- cakes and biscuits
- milk chocolate
- coconut oil, coconut cream and palm oil
You can swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help prevent high cholesterol returning.
The government recommends that a maximum of 11% of a person’s food energy should come from saturated fat. This equates to no more than:
- 30g of saturated fat a day for the average man
- 20g of saturated fat a day for the average woman
- Children should have less
Check the labels on the foods you’re eating to find out how much saturated fat you’re consuming. Many experts believe that the fats found in avocados and oily fish, such as mackerel, salmon and tuna, are good for you. These are known as omega-3 fatty acids and high doses can improve (lower) triglyceride levels in some people. However, too much omega-3 fatty acids can contribute to obesity.
Other lifestyle changes, such as taking regular exercise and giving up smoking, can also make a big difference in helping to lower your cholesterol.
If these measures don’t reduce your cholesterol and you continue to have a high risk of developing heart disease, your GP may prescribe a cholesterol-lowering medication, such as statins. Your GP will take into account the risk of any side effects from statins, and the benefit of lowering your cholesterol must outweigh any risks.
If you’ve been diagnosed with high cholesterol, you’ll be advised to make changes to your diet and increase your level of exercise. If after a few months, your cholesterol level hasn’t improved, you may be advised to take cholesterol-lowering medication.
Changing your diet, cutting down on alcohol, stopping smoking and exercising more will also help to prevent high cholesterol developing.
There are several different types of cholesterol-lowering medication that work in different ways. Your GP can advise you about the most suitable type of treatment, and may also prescribe medication to lower high blood pressure (hypertension) if it affects you.
The most commonly prescribed medications are:
Statins block the enzyme (a type of chemical) in your liver that helps to make cholesterol. This leads to a reduction in your blood cholesterol level. Statins are prescribed to people who are at high risk of heart disease, because they need to be taken for life, otherwise cholesterol levels start to rise again once you stop taking them.
You’ll usually be started on a medication called atorvastatin. Other statins include simvastatin and rosuvastatin.
In some cases, a low daily dose of aspirin may be prescribed, depending on your age (usually over 40 years old) and other risk factors.
Low-dose aspirin can help to prevent blood clots forming, particularly for someone who’s had a heart attack, has established vascular disease, or a high risk of developing cardiovascular disease (CVD).
You may also be advised to have periodic blood tests to ensure your liver is functioning well.
Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. It’s generally not as effective as statins, but is less likely to cause side effects.
Bile acid sequestrants (resins) or fibrates
If statins or ezetimibe aren’t effective, you may be prescribed a bile acid sequestrant or a fibrate.
Bile acid sequestrants bind to bile acids in the intestine and stop them from being reabsorbed. The body has to use cholesterol to make more bile acid, which reduces cholesterol levels in the blood.
Fibrates help to slow or halt the build-up of cholesterol in the arteries to reduce the risk of heart problems. They are given to people who have high cholesterol levels because they have a raised level of triglycerides in their blood.
If you have concerns about your cholesterol levels then it’s probably best to talk to your GP and get tested, but in the meantime why not take the ONE YOU Heart Age Test, which estimates your heart age compared to your real age. It also explains why it’s important to know your blood pressure and cholesterol numbers and advice on how to reduce your heart age.
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