Your Cholesterol

Cholesterol is a fatty substance known as a lipid. It is mostly made by the liver from the fatty foods we eat and is vital for the normal functioning of the body however having an excessively high level of lipids in your blood (hyperlipidemia) can have a serious effect on your health as it increases your risk of having a heart attack or stroke.

‘Good’ and ‘bad’ cholesterol

Cholesterol cannot travel around the body on its own because it does not dissolve in water. Instead, it is carried in your blood by molecules called lipoproteins.

The two main lipoproteins are LDL and HDL.

Bad Cholesterol: Low-density lipoprotein (LDL) this carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, this can cause a harmful build in the artery walls, leading to disease of the arteries restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing.

Good Cholesterol: High-density lipoprotein (HDL) carries cholesterol away from the cells and back to the liver, where it is either broken down or passed from the body as a waste product.

The amount of cholesterol in the blood (including both LDL and HDL) can be measured with a blood test.

Normal cholesterol level

Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.

The government recommends that cholesterol levels should be less than 5mmol/L.

In the UK, two out of three adults have a total cholesterol level of 5mmol/L or above.  On average, men in England have a cholesterol level of 5.5mmol/L and women have a level of 5.6mmol/L.

The UK population has one of the highest average cholesterol concentrations in the world.

There are many risk factors that can increase your chance of having heart problems or stroke if you have high cholesterol.

• an unhealthy diet, obesity, alcohol or smoking (can be changed by altering your lifestyle)

• having diabetes or high blood pressure (can be treated with medication)

• having a family history of stroke or heart disease (cannot be changed)

Who is at risk and should be tested?

Anyone can have their blood cholesterol level tested, but it is particularly important to have it checked if:

• You have been diagnosed with coronary heart disease, stroke or mini-stroke or you have leg artery disease.

• You are over 40.

• You have a family history of early cardiovascular disease (for example, if your father or brother developed heart disease or had a heart attack or stroke before the age of 55, or if your mother or sister had these conditions before the age of 65).

• A close family member has a cholesterol-related condition, such as familial hypercholesterolaemia (inherited high cholesterol).

• You are overweight or obese.

• You have high blood pressure or diabetes.

• You have another medical condition such as a kidney condition, an underactive thyroid gland or an inflamed pancreas (pancreatitis). These conditions can cause increased levels of cholesterol or triglycerides.

Assessing your risk

Your HBS Pharmacist can carry out the test.

This sample will be used to determine the amount of LDL (bad cholesterol), HDL (good cholesterol) and triglycerides (other fatty substances) in your blood.

When assessing your risk of heart attack or stroke, your PHARMACIST may refer to your cholesterol ratio. This is your total cholesterol level divided by your level of HDL cholesterol.

Cholesterol levels or cholesterol ratio should not be looked at on their own. A number of other factors should be taken into consideration when assessing your risk, including:

• BMI (body mass index), which measures your weight in relation to your height.

• Treatable risk factors, such as high blood pressure (hypertension), diabetes and other medical conditions.

• Your age, sex, family history and ethnicity.

At the end of your assessment, you will be told whether you have a high, moderate of low risk of getting cardiovascular disease (heart disease or stroke) within the next 10 years.

If you have been diagnosed with high cholesterol, the first method of treatment will usually involve making some changes to your diet (adopting a low-fat diet) and doing plenty of regular exercise.

After a few months, if your cholesterol level has not dropped, you will usually be advised to take cholesterol-lowering medication.

Diet

Eating a healthy diet that is low in saturated fats can reduce your level of LDL (bad cholesterol), these include:

• carbohydrates (cereals, wholegrain bread, potatoes, rice and pasta)
• proteins (lean meat, beans and oily fish)
• unsaturated fats (avocados, nuts and seeds, sunflower, rapeseed and olive oil)
• fruit and vegetables (at least five portions a day)

You should try to avoid or cut down on the following foods, which are rich in saturated fat:

• fatty cuts of meat and meat products, such as sausages and pies
• butter, ghee and lard
• cream, soured cream, creme fraiche and ice cream
• cheese, particularly hard cheese
• cakes and biscuits
• chocolate
• coconut oil, coconut cream and palm oil

According to the Food Standards Agency:

• the average man should have no more than 30g saturated fat a day
• the average woman should have no more than 20g saturated fat a day

To get an idea how much saturated food you are consuming, take a look at the food labels of the foods you are eating.

Cholesterol-lowering medication

There are several different types of cholesterol-lowering medication which work in different ways.  Your GP can advise you about the most suitable type of treatment.

Commonly prescribed medication is outlined below.

Statins which block the enzyme (a type of chemical) in your liver that is needed to make cholesterol, and reduce your blood cholesterol level.

Low-dose aspirin (depending on your age -children under 16 should not take aspirin and a number of other factors)  can prevent blood clots from forming.

Niacin is a B vitamin that is found in foods and multivitamin supplements. In high doses (available by prescription), niacin lowers LDL and triglycerides and raises HDL. However, it can cause side effects, particularly flushing (turning red in the face), so is not commonly used.

Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. It is generally not as effective as statins, but is well tolerated and can be taken at the same time as your usual statin if required and tolerable.

You can help prevent getting high blood cholesterol by eating a healthy, balanced diet that is low in saturated fat.

Losing weight

If you are overweight, losing weight should help reduce your cholesterol level. Regular exercise can help you lose weight.