Cholesterol

What is cholesterol?

Cholesterol is a waxy, fatty substance that your body needs to stay healthy, but when there is too much of it in the blood, it can cause health problems, as it starts to build up on the walls of the arteries.1,2,3

Over time, this build-up, called plaque, causes hardening and narrowing of the arteries so that blood fl ow is slowed down or blocked.2

If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.3

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CHOLESTEROL GRADUALLY BUILDS UP IN THE ARTERIES WHICH LESSENS OR MAY EVENTUALLY BLOCK THE FLOW OF BLOOD1

Blood flows easily

blood vessels

Blood flow low

blood vessels

Blood flow stops

blood vessels

HIGH CHOLESTEROL IS ONE OF THE MAJOR RISK FACTORS

FOR DEVELOPING HEART DISEASE AND HAVING A HEART ATTACK OR STROKE2,4

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WHERE DOES CHOLESTEROL COME FORM?

The liver and other cells in the body make about 75 % of the body’s cholesterol. The other 25 % comes from the food you eat.5

Many people inherit genes from their parents that increase cholesterol levels (i.e. familial high cholesterol).6

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GOOD VERSUS BAD CHOLESTEROL

There are two types of cholesterol:2

  • ‘Bad’ cholesterol or LDL-cholesterol – the main source of cholesterol build-up and blockage in the arteries.2

LOW LEVELS OF ‘GOOD’ CHOLESTEROL, AS WELL AS HIGH LEVELS OF ‘BAD’ CHOLESTEROL

INCREASE THE RISK FOR HEART ATTACK AND STROKE2,6

To check your cholesterol levels, your doctor can perform a blood test called a “lipoprotein profile”, which is usually done after a 9 to 12 hour fast and will provide information about your:2

  • Total cholesterol
  • LDL (bad) cholesterol
  • HDL (good) cholesterol
  • Triglycerides

The test report will show your cholesterol levels in millimoles per litre (mmol/L) of blood.6

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KNOW YOUR NUMBERS

High cholesterol itself does not cause any symptoms, so many people are unaware that their cholesterol levels are too high.2

HEALTHY CHOLESTEROL LEVELS7  
Total cholesterol < 5 mmol/L
LDL-cholesterol* < 3 mmol/L
HDL-cholesterol (women) > 1.2 mmol/L
HDL-cholesterol (men) > 1.0 mmol/L
Triglycerides < 1.7 mmol/L

*In patients at high risk of heart disease, the LDL-cholesterol goal should be lower (< 2.5 mmol/L).

  In patients at very high risk of heart disease, the LDL-cholesterol goal should be even lower (< 1.8 mmol/L).8

Your doctor will also take other risk factors like your age, family history, smoking habits and blood pressure into account when assessing your risks and advising you on an ideal cholesterol level for you.6

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Are you at high risk for a heart attack or stroke?

Very high-risk individuals include those with:6

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A history of heart attack, stroke or circulatory disease

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Diabetes mellitus

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Familial high cholesterol

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Kidney disease

In addition to high cholesterol, there are several other factors that can increase the risk of heart disease:6,9

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High blood pressure

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Smoking

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Overweight/obesity

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Family history of heart disease (male before 55 years of age; female before 60 years of age)

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Advancing age

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Male gender

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How can cholesterol be lowered?

Unhealthy cholesterol levels can almost always be lowered with a combination of diet, weight loss, exercise and medication.4

As cholesterol levels fall, so does the risk of developing heart disease, suffering a heart attack or having a stroke.4

LOWERING HIGH CHOLESTEROL IS IMPORTANT FOR PEOPLE OF ALL AGES,

WITH AND WITHOUT ESTABLISHED HEART DISEASE2

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HEALTHY FOOD CHOICES CAN HELP MANAGE CHOLESTEROL10

Limit saturated fats and trans fats.10

Foods high in saturated fats include fatty meat, chicken skin, processed meats, bacon, sausages, butter, cream and full-cream milk.10

Remove all visible fat before cooking and avoid deep-frying food.6

Trans fats are in hard margarine, shortening, fried foods and packaged foods that are made using hydrogenated oils.10

Eat fewer baked goods e.g. biscuits, cakes, pastries.10

Eat healthy fats (polyunsaturated and monosaturated)2,6,11

Choose fat-free or low-fat dairy products, lean meats, skinless chicken and fish.

Use soft tub margarines e.g. those approved by the Heart Foundation of South Africa.

Cook with oils such as olive, sunfl ower, canola and peanut oil.

Limit the amount of cholesterol you eat10

Foods high in cholesterol include egg yolks, fatty meat, full-cream milk, cheese, shrimp, lobster and crab.

Eat more omega-3 fats (heart-healthy fats)10

Aim to eat fish twice a week.

Good choices include salmon, tuna, mackerel and sardines.

Flaxseed is another source of omega-3 fats.

Eat more plant-based foods

Use beans and soy foods for protein.10

Eat at least 5 servings of fruits and/or vegetables daily.6

Replace all refined carbohydrates with food high in fibre6,10,11

Avoid eating products made from white flour, such as white bread, pizzas, vetkoek and samoosas.

Eat more wholegrain foods such as oats, barley, crushed wheat, samp, brown rice, whole-grain breakfast cereals, health and seed breads.

Avoid foods that are high in sugar6

Limit treats such as sweets, chocolates, fizzy drinks, fruit juices, flavoured and sweetened waters and low-fat sweetened milk drinks.

Avoid adding sweeteners such as sugar, honey, syrup and fructose to your food and drinks.

If you consume alcohol, do so in moderation6

Women should limit their intake of alcohol to 1 drink per day and men should have no more than 2 drinks per day.

Limit your intake of salt6

Choose and prepare foods with little or no salt by using more herbs and spices.

IT IS A GOOD IDEA TO CONSULT A REGISTERED DIETICIAN

WHO CAN HELP YOU TO ACHIEVE AND MAINTAIN A HEALTHY WEIGHT10

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LIFESTYLE CHANGES CAN HELP REDUCE CHOLESTEROL LEVELS2,4,7

Besides eating a heart-healthy diet, everyone with high cholesterol should:

Achieve and maintain a healthy weight.

Exercise regularly (at least 30 minutes on all or most days of the week).

Stop smoking.

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MEDICINES USED TO LOWER CHOLESTEROL

There are many medicines available to help lower elevated cholesterol levels. Your doctor may prescribe a medicine, or a combination of medicines based on your cholesterol level and other individual factors.4

Medicine What it does
Statins Decrease the body’s production of cholesterol.4 Can reduce LDL-cholesterol levels and triglycerides.4 Can slightly increase HDL-cholesterol levels.5
Cholesterol absorption inhibitors Reduces the body’s ability to absorb cholesterol from food as well as the cholesterol that the body makes.4 Can reduce LDL-cholesterol levels.4
Bile acid sequestrants Binds to bile acids in the intestine, reducing the amount of cholesterol absorbed from foods.4
Fibrates Can lower triglyceride levels and raise HDL-cholesterol levels.3

MAINTAINING HEALTHY CHOLESTEROL LEVELS IS A LIFELONG PROCESS.

ONCE THE GOAL IS ACHIEVED IT IS IMPORTANT TO CONTINUE WITH THE LIFESTYLE

CHANGES AND YOUR DOCTOR‘S ADVICE IN ORDER TO MAXIMISE THE HEALTH BENEFITS4

References:

1. Centers for Disease Control and Prevention (CDC). About Cholesterol. Available at: https://www.cdc.gov/cholesterol/about.htm. Accessed: 12 August 2019.

2. National Heart, Lung, and Blood Institute (NHLBI). National Cholesterol Education Program. High Blood Cholesterol. What you need to know. Available at: https://www.nhlbi.nih.gov/files/docs/public/heart/wyntk.pdf. Accessed: 12 August 2019.

3. American Heart Association (AHA). About Cholesterol. Available at: https://www.heart.org/en/health-topics/cholesterol/about-cholesterol. Accessed: 12 August 2019.

4. Rosenson RS. Patient education: High cholesterol and lipid treatment options (Beyond the Basics). Available at: https://www.uptodate.com/contents/high-cholesterol-and-lipid-treatment-options-beyond-the-basics/print?search=Patient%20information:%20High%20cholesterol%20treatment%20options%20(Beyond%20the%20Basics).%20&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed: 12 August 2019.

5. Scirica BM, Cannon CP. Treatment of Elevated Cholesterol. Circulation. 2005;111:e360-e363. Available at: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.105.539106?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed. Accessed: 12 August 2019.

6. Klug EQ, Raal FJ, Marais AD et al. South African dyslipidaemia guideline consensus statement: 2018 update. SAMJ. 2018;108(11)part2:975-1000.

7. The Heart and Stroke Foundation South Africa. Cholesterol. Available at: http://www.heartfoundation.co.za/cholesterol. Accessed: 12 August 2019.

8. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315-2381.

9. Rosenson RS. Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics). Available at: https://www.uptodate.com/contents/high-cholesterol-and-lipids-hyperlipidemia-beyond-the-basics?search=high%20cholesterol%20and%20lipids&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed: 12 August 2019.

10. American Dietetic Association. Eat Right. Nutrition Therapy for High Cholesterol. Available at: https://www.nhrmc.org/-/media/testupload/files/highcholesterolnutritiontherapy.pdf?la=en. Accessed: 12 August 2019.

11. Colditz GA. Patient education: Diet and health (Beyond the Basics). Available at: https://www.uptodate.com/contents/diet-and-health-beyond-the-basics/print?search=colditz%20diet%20and%20health&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4. Accessed: 12 August 2019.