High Cholesterol

What is high cholesterol?

Cholesterol is a natural fatty wax-like substance naturally produced by the liver that is vital to creating healthy cells. Although it is needed in the body, like most things, an excessive amount can lead to health problems such as the risk of heart disease, heart attacks and strokes.

There are two ways cholesterol travels around the body in the blood. High-density lipoprotein (HDL or good cholesterol) that transports excess cholesterol back to the liver. Low-density lipoprotein (LDL or bad cholesterol) transports cholesterol around the body and in excess, is responsible for cholesterol that deposits on blood vessel walls.

The health risks arise from excess cholesterol depositing in the blood vessels resulting in the vessel, narrowing them over time. The reduced ability for blood to move through the vessel can cause blockages or result in the cholesterol deposit breaking away from the vessel wall, forming a clot. These clots are what can be responsible for blocking blood flow in the brain (stroke) or in the heart (heart attacks).

High cholesterol is exceedingly common in Australia with the Australian Bureau of statistics reporting 6.1% or 1.5 million Australians had the condition in 2018. Typically high cholesterol will increase in prevalence with age with most being diagnosed being over 45. At 65, over 21% of Australians had the condition.

What causes high cholesterol?

A large portion of what causes high cholesterol are factors within your control such as:

• Diet - consuming foods high in saturated and trans fats.
• Exercise - Low levels of activity can result in low good cholesterol.
• Weight - Obesity can result in a greater risk of high cholesterol and health complications.
• Smoking - Reduces good cholesterol and worsens bad cholesterols effect
• Alcohol consumption - excessive consumption can worsen total cholesterol levels.

Some of what can result in high cholesterol are out of your control, such as your genetics and age. Having a family history of high cholesterol or getting older may mean your body is unable to remove LDL (bad cholesterol) as effectively as others. This puts you at a high risk of developing high cholesterol, particularly if modifiable factors are also increasing your risk.

Certain medical conditions may also make you more prone to getting high cholesterol. These can include diabetes, hypothyroidism, HIV, kidney disease and liver disease.

Symptoms

High cholesterol is a condition that typically has no symptoms until it causes a devastating health event such as a heart attack or stroke. As there are no symptoms, it is important that cholesterol screening is undertaken in general health screens periodically with your doctor. For adults under 45, this may be every 5-6 years. Adults over 45 should have annual to bi-annual screening for their best chance at identifying the condition early and potentially avoiding serious health complications.

Diagnosis

High cholesterol is diagnosed with a blood test. This blood test looks at total cholesterol, LDL cholesterol, HDL cholesterol and fat in the blood called triglycerides. Together these numbers give a doctor a good idea of cholesterol levels and whether you should be treated with lifestyle changes, cholesterol medication and the appropriate strength of the medication. 

If you have a substantial number of risk factors that puts you at high risk of coronary heart disease, strokes or high cholesterol, speak to your doctor about how often your screening should occur.

High cholesterol treatment

Depending on when high cholesterol is diagnosed and its severity will guide what treatment is most suitable for you. If detected early or at low levels, the most suitable treatment may be lifestyle changes as recommended by your doctor rather than cholesterol lowering drugs.

If high cholesterol is discovered at high levels or after an adverse event such as heart attack, stroke or mini-stroke, often doctors will straight away prescribe high cholesterol treatment.

The goal of cholesterol medications is the long term reduction of the risk of heart attacks, heart disease, stroke and other related conditions. Typically, unless modifiable risk factors are sufficient for controlling cholesterol levels, treatment is long term.

Statins

This treatment is typically the first choice for treatment for high cholesterol by doctors. Statins work by blocking the production of cholesterol in the liver as well as drawing out cholesterol from plaque in blocked vessels. Over long periods they have been shown to lower the risk of the adverse events associated with high cholesterol.

They are typically taken once per day. They do require monitoring through blood tests every 6-12 months to monitor cholesterol levels and liver function.

Like all medicines, they do have the potential to cause side effects in some people. Side effects can include muscle pain, tiredness, soreness and sleeping problems. If you experience any of these, consult your doctor or pharmacist.

Other Cholesterol Medicines

Other cholesterol medicines are typically used either with statins if further cholesterol reduction is required or instead of statins if statins cause too many side effects. Cholesterol-lowering medications of these types can work in a number of different ways. Some limit the absorption of cholesterol from your diet, while others use more cholesterol for body functions such as bile acid sequestrants and others will prompt the liver to absorb blood cholesterol.

Each of these medicines can cause side effects or may not be suitable for some people. It is important that a doctor prescribes you treatment after blood tests and monitors your condition regularly to ensure the best possible cholesterol therapy for you is used.

Lifestyle treatment

Improving the modifiable risk factors for high cholesterol is one of the most important steps to avoid long term risks of high cholesterol. To do this you attempt to follow the following lifestyle advice:

• Eat a balanced diet - Foods high in saturated fats and trans fats such as dairy products, fatty meats and processed sugary foods can raise bad LDL cholesterol in the body. The body does need fats as part of a balanced diet but try to get these fats from monounsaturated and polyunsaturated fats from foods such as avocados, olive oil, nuts and fish.
• Exercise - attempt to exercise 30 minutes a day. Doing so can improve HDL (good cholesterol). Exercise will also improve your general heart health and general wellbeing.
• Maintain a healthy weight - Similar to the first two points, having a healthy body weight can decrease LDL (bad) cholesterol and increase HDL (good) cholesterol through exercise. If you require assistance with weight loss, consult a doctor.
• Quit smoking - Lowers HDL cholesterol (good cholesterol) and makes LDL cling to blood vessel walls.
• Lower alcohol consumption - Excessive drinking can increase total cholesterol.

Applying these lifestyle tips all at once can be difficult. It is important to take small but regular steps toward better health. Doctors are available to assist in making these positive lifestyle choices and should be consulted if you are having difficulty with any of them.

Frequently asked questions

What are the worst foods for high cholesterol?

Foods high in trans and saturated fats are the worst foods for bad cholesterol. These include full-fat dairy, fatty meats, processed sugary foods, fried foods, pastries

How do I lower cholesterol?

To lower cholesterol attempt to eat a balanced diet low in saturated and trans fats, exercise, maintain a healthy weight, quit smoking and lower alcohol consumption.

How quickly can you reduce your cholesterol levels?

Cholesterol-lowering medicines can take up to 6 weeks to change LDLs while lifestyle changes may take up to 3 months to show a discernible difference.

What is LDL cholesterol?

LDL stands for low-density lipoprotein which is a protein that transports cholesterol around the body. A large number of these is what indicates what is known as bad high cholesterol.

How much cholesterol is in an egg and does it matter?

The average egg contains around 182mg of cholesterol which is about 60% of the daily recommended value. Eggs have a bad reputation for being a high cholesterol food however it has been studied and found that eggs can make up a balanced diet if around 6 are consumed a week even by a person at risk. It is rather foods that are high in saturated or trans fats that are a greater risk.

Written by Clinical Pharmacist Tyson Wilkman