Image by Gerd Altmann from Pixabay
by Dr Deborah Lee, Dr Fox Online Pharmacy
What is a raised cholesterol?
The cholesterol blood test measures your levels of total cholesterol, LDL cholesterol, HDL cholesterol, and your total cholesterol to HDL ratio.
- Total cholesterol
Normal values should be –
- 5mmol/L or less for healthy adults
- 4mmol/L or less for those at high risk
- LDL cholesterol
Normal values should be
- 3mmol/L or less for healthy adults
- 2mmol/L or less for those at high risk
- HDL cholesterol
A normal value should be above 1mmol/L.
- Your total cholesterol to HDL ratio
This should be < 4
If your cholesterol is raised, it means some of these parameters are abnormal.
What is cholesterol?
Cholesterol is a fatty substance your body makes in the liver, but you also take it in, in the food you eat. Cholesterol is essential for health, however, when levels are too high, this is harmful. Cholesterol is a major constituent of cell membranes and provides the basis for the production of steroid hormones such as cortisol and aldosterone, and the reproductive hormones estrogen, progesterone and testosterone. It is also important for the formation of vitamin D.
Why is raised cholesterol dangerous?
Raised cholesterol is a risk factor for cardiovascular disease (heart attacks and strokes). Raised blood pressure is also a risk factor for cardiovascular disease, and the two are often found together.
When cholesterol levels are too high, fatty plaques – known as atherosclerosis – are laid down in the artery walls. The artery walls become stiffer and less able to cope with the pressure of the blood flow. Because of this, when cholesterol is raised, blood pressure is often raised too.
High blood pressure can also cause damage to your arterial walls, causing tiny, micro-tears. Atherosclerotic deposits accumulate at these damaged sites, weakening the arterial wall. These fatty plaques can rupture, or the arterial wall can rupture, causing a major event such as a heart attack, a stroke, or a ruptured aneurysm. Even mildly elevated cholesterol can cause raised blood pressure.
If you reduce cholesterol by taking statins, this also helps to lower blood pressure.
Why do I have high blood pressure?
Most often, a raised cholesterol is due to your diet, but there are other causes, listed below –
- An underactive thyroid gland (hypothyroidism)
- Obesity
- A high alcohol intake
- Cushing’s syndrome
- Anorexia nervosa
- Nephrotic syndrome
- Chronic kidney disease
- Obstructive jaundice
- Premature menopause – Premature Ovarian Failure (POF)
Raised cholesterol levels are also caused by –
- Smoking – this raises levels of LDL cholesterol (‘bad) cholesterol).
- Obesity – this is associated with a dyslipidemic profile – raised triglycerides, raised LDL, lowered HDL cholesterol (‘good cholesterol’).
- Too much salt in the diet – excess salt (sodium) causes raised blood pressure.
- Too much alcohol – If you drink more than a moderate amount of alcohol, this is linked to raised total cholesterol and triglyceride levels.
Other factors that raise cholesterol –
- Age – Your cholesterol tends to increase as you get older.
- Ethnicity – Raised cholesterol is more common in people with South Asian, African, or African-Caribbean, backgrounds.
- Menopause – Your cholesterol profile tends to change at and after menopause.
https://patient.info/heart-health/high-cholesterol
- Genetic mutations – Around 1 in 200 people are born with a genetic mutation that causes familial hypercholesterolaemia (FH).
How to lower your cholesterol
There is a lot you can do to lower your cholesterol. Take a look at the points listed below –
Change your lifestyle – What you can do to lower your cholesterol naturally?
- Stop smoking
- Take more physical exercise
- Lose weight
- Reduce your alcohol consumption
- Optimal treatment of any other medical conditions, including high blood pressure, diabetes, thyroid disease, kidney disease, or others.
It takes time to improve all these factors – this is a marathon and not a sprint. Nevertheless, if you take each factor on the list and make changes, you can make great progress. Improving these factors will also do wonders to improve your general health, and lower your risk of chronic diseases, including cardiovascular disease, diabetes, dementia and cancer.
Change your diet –
You need to reduce the amount of saturated fat in your diet. Here are some steps to follow –
- Avoid the following – full-fat dairy products, fatty meat such as bacon, sausages, salami and meat products such as pastries, and pies, biscuits, cakes and pastries, butter, cream, ghee, lard and cheese, coconut and palm oils, ice cream and chocolate.
- Swap to healthy unsaturated fats – Monounsaturated fats include olive, sesame, and rapeseed oil, avocados, and nuts such as almonds, cashews, and hazelnuts. Polyunsaturated fats are found in oily fish such as salmon, mackerel or trout, sunflower, soya, corn or sunflower oils and spreads, flax, pumpkin and sesame seeds and walnuts.
Say no to creamy, cheesy sauces, fatty meats such as sausages, bacon, meat pies and pasties, cakes, biscuits and chocolate and desserts.
Sat yes to lower-fat milk, and yoghurts. If you need a sauce, have a tomato sauce instead. Go for lean meat such as chicken, or turkey, or eat fish. Eat plenty of vegetables, lentils, beans and chickpeas. Enjoy fresh fruit, nuts and seeds.
- Read food labels – Get in the habit of reading food labels before you buy. Look for green or amber labels. Green labels mean the food contains less than 1.5 g saturated fat per 100 g. Red labels mean the food contains 5 per 100 g or more of saturated fat and should be avoided. Don’t get confused when it comes to nuts. These are red as they are high in fat, but this is good as these are healthy, unsaturated fats.
- Eat more fibre – Fibre is an indigestible carbohydrate found in many fruits and vegetables, whole grains and pulses, nuts and seeds. Fibre is vital for good health. It bulks out the intestines and stimulates the passage of food through the gastrointestinal tract. As the food passes through, the fibre content of the partly digested food helps reduce the absorption of cholesterol into the bloodstream. It also helps improve glucose metabolism.
Make sure you eat 5 portions of fruit and vegetables per day. Avoid white foods such as white bread, and white rice and white pasta. Go for whole grains which are unrefined and have a higher fibre content – such as brown bread and bread, brown rice and brown pasta.
- Eat more plant stanols and sterols – Plant foods contain substances called stanols and sterols which can naturally lower cholesterol. You can buy foods that contain fortified levels of stanols and sterols specifically to help lower your cholesterol. If you take in 1.2g to 2.4 g per day, this can lower your cholesterol by 10%. These foods are fortified milks, spreads, and yoghurts.
As a general rule, you should have 2-3 portions of fortified products per day, for example, this might be 2 teaspoons of fortified spread, one fortified yoghurt, and/or one 250 ml glass of fortified milk.
These fortified products can be taken if you are also taking cholesterol-lowering medication. However, they should be used as well, and not instead, of any prescribed treatment.
Which supplements can help?
The following supplements may help improve your cholesterol profile –
- Fish oil – may reduce triglycerides
- Flaxseed – may lower LDL cholesterol
- Garlic – may reduce total cholesterol but studies are conflicting
- Green tea – may lower LDL cholesterol
- Niacin – may lower LDL and increased HDL cholesterol
- Plant sterols – may lower LDL cholesterol
When should you consider medication?
Do you have any other risk factors for cardiovascular disease? If not, you will be encouraged to improve diet and lifestyle measures, rather than going straight onto medical treatment. If do have other risk factors for heart disease (e.g., high blood pressure, obesity, or type-2 diabetes), you can be put straight onto a statin, although you still need to work on diet and lifestyle measures.
Statins
The most common medication used to lower cholesterol are called statins. Taking statins is thought to reduce the risk of a major cardiovascular event by 20%-30%. They have been extensively researched and are generally safe in clinical practice. Once statins have been started, you will probably be advised to stay on them for life.
Statins work by inhibiting the liver enzyme that your body needs to produce cholesterol. This is called HMG-CoA reductase. They often lead to a fall in LDL (‘bad’ cholesterol) and a rise in HDL (‘good’ cholesterol.) They can also lower levels of triglycerides.
Commonly prescribed statins include atorvastatin (Lipitor), fluvastatin (Lescol), and simvastatin (Zocor).
Side effects
Although statins are very effective, they are not suitable for everyone and can have side effects, such as skin rashes, bloating, abdominal pain and headaches. A very rare side effect affecting 1 in 10,000 people is skeletal muscle breakdown. This stops on discontinuing the drug.
Who should not use statins?
Statins should not be used by women who are pregnant, breastfeeding, or who have chronic liver disease. They should be taken if you are on a variety of types of medication, such as erythromycin, clarithromycin, itraconazole, or diltiazem, verapamil or protease inhibitors.
Taking statins may slightly increase the risk of developing type-2 diabetes.
You should not take stains with grapefruit juice.
Other drugs
For those who cannot tolerate statins, alternative drug treatments include –
- Ezetimibe – reduces the absorption of cholesterol from the GI tract.
- Fibrates – reduces the production of VLDL in the liver and speeds up the removal of triglycerides from the bloodstream.
- Bile acid sequestrants – these disrupt the production of bile and hence lower cholesterol.
- PCSK9 inhibitors (e.g., alirocumab, or evolocumab) – these work by reducing the production of a specific protein in the liver which is linked to raised cholesterol levels.
Who should have their cholesterol checked?
The British Heart Foundation recommend that all UK adults have a cholesterol check. If you haven’t had a cholesterol test, or your test was more than 5 years ago, you should see your GP. A raised cholesterol does not cause any symptoms, and you may only know your levels are too high when you are admitted to the hospital with a stroke or a heart attack. Don’t let this happen to you. Why not think ahead and arrange to get tested now?
For more information
- British Heart Foundation – Reducing your high cholesterol
- NHS – Statins