High levels of cholesterol can cause heart and circulatory diseases including heart attack and stroke. But there are simple things you can do like eating healthier and taking medication. to help bring your cholesterol down to a healthy level
Cholesterol is a fatty substance in our blood, which is produced naturally in our liver. Some of the blood cholesterol comes from the food that we eat. Everybody has cholesterol and we need it to stay healthy. Every cell in our body uses it.
Cholesterol is carried in your blood by proteins. When cholesterol and proteins combine, they are called lipoproteins.
High Density Lipoproteins (HDL) carry “good” cholesterol as HDL takes cholesterol that you don’t need back to the liver to be broken down.
Non High Density Lipoproteins (Non-HDL ) are mostly made up of Low Density Lipoproteins (LDL). The cholesterol carried by LDL is sometimes referred to as “bad” cholesterol as when this is high, it can stick to the walls of your arteries.
Total cholesterol is carried by both HDL and non-HDL.
For a healthy heart aim for a low LDL cholesterol and a higher HDL cholesterol.
Trigylcerides are another fatty substance in our blood. These are stored in our body’s fat cells and are also found in foods such as dairy products, meat and cooking oils. Triglycerides also can contribute to the narrowing of artery walls and increase your risk of heart disease and strokes.
Further reading and information can be found here:
BFH High Cholesterol – Causes, Symptoms & Treatments
BHF leaflet – Understanding Cholesterol
NHS – What is High Cholesterol?
Causes of high cholesterol
High cholesterol can be due to a combination of factors including eating a diet high in saturated and trans fats, commonly found in processed foods. Other significant causes include smoking, lack of exercise and too much body fat especially around your middle.
Other possible causes include diabetes (particularly Type 2 diabetes), kidney or liver disease, an underactive thyroid or an inherited condition known as familial hypercholesterolaemia (FH). Ethnic background and age are also factors you can’t change, which can also affect cholesterol levels.
How is cholesterol tested?
Readings for total cholesterol, HDL, non HDL (LDL) and triglycerides can be obtained from a blood test which can be done on admission to hospital or by your GP practice. This is sometimes a fasting sample, taken before you eat anything in the morning.
Targets for cholesterol readings
If you have been given a statin because of a heart attack, angina or bypass surgery then we would be looking to get a 50% reduction in your LDL cholesterol. Current local guidance suggests aiming for LDL cholesterol of less than 2.0. However this may not be possible in all individuals, and the most important thing is to lower your LDL cholesterol consistently. Your cardiologist can provide further advice on an LDL cholesterol appropriate for your individual case. If you don’t know your levels please just ask your cardiac rehab professional and they will let you know.
How to get cholesterol down
- Changing what you eat
- Being more active
- Reducing the amount of alcohol you drink
- Stopping smoking
- Medication
Changing what you eat
Reduce Trans fats or Trans – fatty acids. These are artificially produced fats and can be found in some baked products (for example – doughnuts, pastries, cookies and cakes) and deep fried foods. Margarine used to commonly contain significant levels of trans-fats but the vast majority of UK margarine brands now have very little trans-fat content, and are generally considered to be more healthy than butter.
Eat less saturated fat and replace with good fats such as vegetable oils, nuts and 1-2 portions of oily fish a week. Saturated fat is found in:
- Butter, ghee, suet, lard, coconut oil and palm oil
- Cakes, biscuits
- Fatty cuts of meat, bacon, sausages, cured meats,
- Cheese
- Pastries, pies, quiches, sausage rolls, croissants
- Cream, crème fraiche and sour cream
- Ice cream, milk shakes
- Coconut milk and cream
- Chocolate and chocolate spreads
There is 2.1 g of sat fat in a chocolate digestive biscuit and 6 g in a well known cheeseburger! UK guidelines recommend that:
- The average man (aged 19 to 64) should eat no more than 30g of saturated fat a day
- The average woman (aged 19 to 54) should eat no more than 20g of saturated fat a day.
Further reading and information can be found here:
BHF Leaflet – Taking control of saturated fats
NHS – How to eat less saturated fat
Inactivity
If you can, aim to do at least 150 minutes of exercise a week. If not able to do this then look for ways to move more every day and attempt to be more active. Walk more, use the car less, use stairs instead of the lift, get off bus a stop early, try to reduce your time sitting in the day. Aim to get up every hour for a short walk around the room.
Alcohol
Alcohol has been linked to increased cholesterol levels by increasing the amount of triglycerides and cholesterol in the body.
If your triglyceride levels become too high, they can build up in the liver, causing fatty liver disease. The liver can’t work as well as it should and can’t remove cholesterol from your blood, so your cholesterol levels rise.
Alcohol can affect your health in other ways;
- it can lead to weight gain and raise your blood pressure, which raises your risk of heart disease
- it can lead to some types of cancer, liver disease, pancreatitis, depression and dependency
Try to:
- Avoid drinking more than 14 units of alcohol a week
- Have at least 2 alcohol free days a week
- Avoid drinking lots of alcohol in a short time (binge drinking > 6 units on one occasion)
See BHF Leaflet – Taking Control of Alcohol
Smoking
Smoking can increase bad cholesterol levels and lower good levels. The chemicals in cigarettes make it easier for cholesterol to stick to your artery walls. For support to stop smoking see the NHS Inform Stopping Smoking pages.
Medications
Statins are given to treat high cholesterol and are given to all people with cardiovascular disease to reduce the risk of further heart disease. They lower total cholesterol by more than 40% and can lower LDL cholesterol by more than 50%. Not only that they raise good cholesterol (HDL) by 3 – 10%. Overall reducing the risk of heart attack by around 25%.
As well as reducing cholesterol, statins also help to stabilize the fatty, hardened parts of the arteries, known as plaques. Plaques can form when you have high cholesterol or other problems such as high blood pressure or diabetes. This is why you might be prescribed a statin even if you don’t have high cholesterol.
There are five types of statins prescribed in the UK. The first two are used most often:
- Atorvastatin (Lipitor)
- Simvastatin (Zocor)
- Fluvastatin (Lescol)
- Pravastatin (Lipostat)
- Rosuvastatin (Crestor).
Other types of cholesterol-lowering medications are usually prescribed in addition to statins or when statins are not tolerated. Some treatments need specialist input from the NHS Lothian Lipid Clinic. You may also be referred here by your cardiologist or cardiac rehab practitioner for genetic testing if you meet certain criteria.
Heart UK
Heart Uk is the cholesterol charity in the UK. They have lots of good information on their website for all things cholesterol. Including information on diet and treatments.
