High Cholesterol

Cholesterol is produced by your liver and although it is an essential part of all your body cells, having too much cholesterol in your blood can adversely affect your health. As with high blood pressure you will usually not have any visible signs that you have raised cholesterol and the only way you will know is by a blood test. All adults over 40 should be tested for high cholesterol, though if you are at increased risk of elevated cholesterol levels, you will usually be tested sooner. High cholesterol levels can be associated with narrowing’s in your heart arteries and make you more susceptible to a heart attack, stroke or peripheral vascular disease. While high blood cholesterol increases your risk of cardiovascular disease, it is possible to lower your cholesterol with the help of lifestyle modifications and medication.

Understanding High Cholesterol

When your blood cholesterol level is checked it is usually performed as a lipid profile and it is often preferred to have this fasting. Included in the results will be total cholesterol, LDL cholesterol and HDL cholesterol, and triglycerides.

Cholesterol is transported in your blood by proteins including LDL and HDL. LDL transports cholesterol away from your liver into your cells including the cells in the walls of your arteries. Low levels of LDL cholesterol are better for your cardiovascular health. Meanwhile HDL cholesterol removes cholesterol from your cells such as the cells in the walls of your arteries and transports it to your liver for breakdown. Higher levels of HDL cholesterol protects your arteries. Whilst it is possible to reduce the levels of LDL with medications it is not possible to increase the levels of HDL with medication.

If you are in good health, a total cholesterol reading less than 5mmol/l is desirable, and below 4mmol/l if you are at increased risk of cardiovascular disease. For LDL cholesterol, a value below 3mmol/l is desirable, and less than 2mmol/l if you are at increased risk of cardiovascular disease. For HDL cholesterol, a level greater than 1mmol/l is desirable, as lower levels are associated with an increased risk of cardiovascular disease. Finally, you may also be told the ratio of total to HDL cholesterol, with doctors looking for a ratio under 4.

When measuring your cholesterol levels, your levels of triglycerides may also be assessed. Triglycerides are a different type of fat from cholesterol, but raised triglycerides also increase your risk of cardiovascular disease and ideally levels should be below 1.7mmol/l.

Risk Factors for High Cholesterol

Blood cholesterol levels tend to increase with increasing age, but the following factors may also increase your likelihood of elevated cholesterol:

• A family history of early cardiovascular disease

• A family history of familial hypercholesterolaemia (an inherited condition leading to high blood cholesterol levels)

• Certain other medical conditions such as an underactive thyroid or liver disease

• Being overweight which increases levels of LDL cholesterol and triglycerides and lowers HDL cholesterol

• A diet high in saturated fat may elevate LDL cholesterol

• A sedentary lifestyle raises LDL cholesterol and lowers HDL cholesterol

• A high alcohol intake increases triglyceride levels

Managing High Cholesterol

Making dietary changes, increasing your activity levels, reducing your weight and addressing your alcohol intake can all benefit your cholesterol and triglyceride levels. If your high cholesterol and other risk factors place you at increased risk of developing cardiovascular disease within ten years, you will need to start medication to reduce your cholesterol. If lifestyle changes fail to sufficiently lower your cholesterol level you will need to take medication to lower your cholesterol. For the greatest benefit you should combine lifestyle modifications with medication for your high cholesterol.

The most commonly prescribed cholesterol-lowering drugs are statins (eg Simvastatin, Pravastatin, Atorvastatin and Rosuvastatin) which reduce cholesterol production by your liver. Whilst these are very effective at lowering cholesterol a small proportion of people develop side effects such as muscle aching. Other medications (eg Ezetimibe, Fenofibrate and Bezafibrate) to lower cholesterol can be used instead of statins or in combination.