Control cholesterol

What is cholesterol?

  • Cholesterol is a fatty substance (lipid), which is essential to keep your body healthy.

Cholesterol is produced naturally within your body - mainly in your liver. It is also present in saturated fats in your diet (e.g. meat, dairy products and processed foods). Excess saturated fat in your diet increases blood cholesterol.

  • Triglycerides are another fatty substance that your body needs. Like cholesterol, triglycerides are produced in your body and are also found in saturated fats.

Understanding 'good' and 'bad' cholesterol

Lipoproteins are substances (composed of fat and proteins) which carry cholesterol and triglycerides from your liver to wherever they are needed throughout your body.

There are several groups of lipoproteins. Measuring the amounts of these lipoproteins can give an indicator of how much fat is being carried in your blood stream that may be harmful.

  • LDL (low-density lipoprotein) is known as 'bad cholesterol'. It carries cholesterol from your liver to the tissues around your body.
  • The recommended LDL level is below 3.0mmol/l
  • HDL (high-density lipoprotein) is known as 'good cholesterol' because it carries surplus cholesterol from the tissues back to your liver to be recycled or excreted.
  • The recommended HDL level is above 1.0mmol/l (men) and above 1.2mmol/l (women)

Why is too much cholesterol harmful?

Atheroma build up in a coronary artery causing a restricted blood flow

A high cholesterol level can contribute to atheroma build up in a coronary artery -  causing a restricted blood flow

When the cholesterol level in your blood is high it contributes to the fatty build up in the lining of your blood vessels, called atheroma, which increases your risk of heart disease and strokes.

Most doctors use risk assessment charts to help identify your risk in terms of how likely you are to develop heart or stroke problems in the future. Based on your other risk factors your doctor will decide what cholesterol level is safe for you.

  • If you have other risk factors, a high LDL cholesterol level will multiply your overall risk not just add to it.

Understanding your cholesterol test

Your initial blood test will give a 'total cholesterol' level. This level will be looked at alongside your other CVD risk factors.

  • It is recommended that your total cholesterol level is below 5.0mmol/l
  • If you have, or are assessed to be at risk of, heart disease or stroke it may be recommended that your total cholesterol should be below 4.0mmol and LDL less than 2.0mmol

Your doctor may decide that you need a further blood test, called a lipid profile, which is taken after an overnight fast. This provides a detailed breakdown of the different lipoproteins in your blood.

A comparison of total cholesterol and HDL can give a more accurate indicator of risk. This is called the 'total cholesterol / HDL ratio'. Generally a figure greater than 4.5 indicates increasing risk.

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What you can do to help lower your cholesterol level

If you have a low cardiovascular risk you may be initially advised to try to lower your cholesterol yourself over a period of time.

  • Eat a healthy varied diet. This can often mean making small changes in meals you already eat - eating a little more of some things and less of another.
  • Reduce your total fat - this means limiting the number of calories you take in that come from any fat.
  • Replace saturated fat with poly and mono unsaturated fat - this means replacing fat from animals in meat and dairy products with oils and fish.
  • Increase your fruit and vegetables to at least 5 portions a day - this increases your intake of fibre as well as A, C, and E vitamins.
  • Increase your carbohydrates, i.e. pasta, cereals, rice, bread - this will give you the energy you need that used to come from fat.
  • If necessary, reduce your weight to the recommended level for your sex and height.
  • Increase your physical activity and exercise - ideally exercising for 30 minutes most days of the week.
  • Limit your alcohol to recommended levels - men and women should not regularly drink more than 14 units per week. This should be spread over 3 days or more, with at least 2 alcohol-free days a week. Avoid binge drinking (drinking large amount over a short period of time) at any time.
  • Don't smoke. Seek help from local smoking cessation services to help you stop.

Drug treatment

If your cholesterol levels remain too high, you may need drugs to lower the amount of cholesterol your body manufactures. Drugs to treat high cholesterol are mainly from the 'statin' family and usually have to be taken for life.

Though it is possible to buy some statin medicines over the counter it is always advisable to speak to your doctor before starting any new treatment.

  • If you are at higher risk of developing heart and stroke problems you will be recommended to take statin drug treatment to lower your cholesterol level even if it is not high. This is alongside other measures to reduce your risk.

Some people produce more cholesterol than they need. This problem often runs in families and is sometimes called familial hyperlipidaemia or familial hypercholesterolaemia, however it its quite rare in the general population. See Heart UK for more information.

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