High Cholesterol

Cholesterol consists of lipids, a fatty substance produced by the liver and derived from the fat in the food we eat. These lipids perform a very important function in your body, as they make up a big part of all the cell membranes as well as isolating nerve fibres. They are also vital in the production of sex and steroid hormones and bile acids, which are important in digestion and the absorption of fats.

Cholesterol can't move in the bloodstream on its own, but needs to be transported by molecules known as lipoproteins. There are two types of lipoproteins, namely high-density lipoprotein (HDL) and low-density lipoprotein (LDL), also known as the good and bad cholesterol.^[1]

HDL and LDL cholesterol

What makes cholesterol good or bad is dependent on the type of lipoproteins in your body they bond with. Cholesterol needs lipoproteins to move around your body; some take cholesterol to your cells where it can be used, and others take cholesterol back from the cells to the liver, where the body can excrete it.

There are two types of cholesterol in the body:

HDL cholesterol, or high density cholesterol ('good')

HDL (high density lipoprotein) particles work to transport cholesterol away from the body through excretion or re-utilisation in the liver. For this reason it's often described as the 'good' form of cholesterol. A higher level of HDL cholesterol in the bloodstream has been said to better cardiovascular health, whilst lower levels of HDL may increase the risk of heart disease. A HDL particle has a higher apoprotein build up compared to an LDL particle. Apoproteins are an important part of the HDL makeup as they help to remove fats and cholesterol from the artery walls, preventing the white blood cells from being overloaded, and reducing the risk of progressive atheroma.

Eating foods such as fish, stopping smoking, exercising and taking supplements such as fish oil capsules and niacin can all increase the levels of HDL cholesterol in the body. A lower HDL level can suggest a possible problem with the body's metabolism. HDL cholesterol levels of 60 mg/dL means it is at a good level. Levels below 40 mg/dL are not a good indicator and should be addressed as soon as possible.

LDL cholesterol, or low density cholesterol ('bad')

The LDL (low density lipoprotein) particles are tasked with carrying cholesterol and other nutrients to various cells around the body via the bloodstream. They don't only carry cholesterol, but are also responsible for transporting antioxidants, triglycerides and fat-soluble vitamins. The more triglycerides are in the bloodstream, the more LDL particles are required to transport them. If the cells in the body cannot fully utilise the LDL then there becomes a buildup, these in time are then deposited in the arteries causing a blockage which could results in heart related problems such as stroke, angina and heart attack. Higher than normal levels of LDL cholesterol in the body is what results in a diagnosis of high cholesterol.

The table below shows the recommended levels of LDL cholesterol in the bloodstream, and at what rate it is deemed as too high.

Foods that reduce high cholesterol

Any foods with low saturated fat can help lower high cholesterol including:

• Oats
• Vegetables such as aubergine and sweet potato
• Beans and pulses
• Fruits such as citrus fruits and mangos
• Soya and tofu
• Lentils
• Nuts such as almonds, walnuts, cashews and peanuts (unsalted)

Foods that can increase cholesterol

High saturated fat is a big no-no if you're looking to lower your cholesterol levels. The following foods should be avoided and the amount reduced significantly:

• Butter and hard margarines
• Fatty meat products, such as sausages
• Dairy produce, such as cheese and cream
• Coconut oils, butters, and creams

There are various factors that can increase your risk of developing high cholesterol, most of which are treatable, and even preventable.

Some of the main causes of high cholesterol levels are lifestyle factors including:

• Eating foods containing high levels of saturated fats such as red meat, pork sausages, hard cheese, butter, lard, pastry, cakes, biscuits and cream, etc
• If you are obese or overweight you are more likely to have higher levels of LDL in your blood
• Not exercising can also cause in increase in LDL levels
• Smoking; one chemical – acrolein – stops HDL from carrying the fat to your liver

Treating these conditions can often be helpful in reducing LDL levels. Some people may be genetically predisposed to high cholesterol, something that is known as hypercholesterolemia (FH), which affects every one in 500 people. Blood cholesterol levels also increase with age.^[2]

What should my cholesterol be?

In conjunction with other health and lifestyle factors, medical professionals use the following to determine whether your LDL numbers are too high:

Optimal - less than 5mmol/l Mildly high - 5 to 6.4mmol/l Moderately high - 6.5 to 7.8mmol/l Very high - above 7.8mmol/l

High cholesterol in men and women

The primary female sex hormone oestrogen has a protective effect against 'bad' LDL cholesterol, and raises levels of 'good' HDL cholesterol; so younger women do tend to be less prone to suffering from the condition than younger men. This may explain why premenopausal women tend to have much lower levels of heart disease. However, as women age and their oestrogen levels deplete, their risk of developing high cholesterol increases.

Also, during pregnancy an increase in cholesterol is normal, essential even. This is because it helps the body create oestrogen and progesterone, which are vital for carrying a pregnancy to term. These levels of cholesterol should drop within 4 weeks of giving birth. It is advised that the best way to maintain healthy levels of cholesterol whilst pregnant is to eat a balanced diet, keeping in mind that you only need an extra 300 calories a day to support you and the baby.

High cholesterol isn't an illness on its own, so there aren't usually signs that indicate whether your blood cholesterol is too high. Most people only realise they have a problem when their high levels of cholesterol start causing serious health problems.

This is why it is important for certain groups to get tested regularly to monitor the LDL numbers in your system. High cholesterol can be monitored and treated more effectively the earlier you detect it.

Who should be tested for high cholesterol?

Unless you are at risk or ask to be tested for high cholesterol, there is no reason why it will be tested. You may be tested if:

A high level of 'bad' cholesterol isn't a problem on its own but can cause many other health issues such as:

• The narrowing of your arteries (atherosclerosis)
• Heart attack or stroke
• Chest pain (angina)
• Blood clots or coronary heart disease (blockage of blood supply to the heart)

Those diagnosed with high cholesterol will understand the importance of taking active steps towards reducing their cholesterol levels to an acceptable range. There are various reasons and benefits of reducing high cholesterol levels, apart from the general health benefit, patients may also experience other benefits such as:

Diagnosing high cholesterol can be difficult due to the lack of symptoms, however one blood test can show whether you need to look at lowering your level or not. You BMI will also be taken into account before your GP will determine what you need to do.

For the blood sample, you may be asked to refrain from eating for 10-12 hours prior to the injection so many appointment can be scheduled fairly early in the morning to include your sleep time. If you are needle-phobic, the doctor can take a sample from a pin-prick in your finger.

It is possible to take these three methods together, but do consult your doctor:

Changes to your lifestyle

The best way to treat or prevent high levels of LDL in your blood is by watching your diet and exercise regimes – by becoming more active and eating foods that aren't high in saturated fat. Doing this can make a big difference in reducing high cholesterol levels by assisting the production of 'good' cholesterol in your system.

The NHS states that the average man should have no more than 30g of saturated fat every day, the average woman is 20g. Apps such as MYFitnessPal are free and can easily monitor your level to keep on track.

Prescription treatments

Prescription treatments known as statins are also available to treat high cholesterol in combination with healthy living. These treatments, such as Simvastatin, work to lower the concentration of LDL in your blood, but should only be considered if you've already made adjustments to your lifestyle and had little or no success, or if you have cardiovascular disease. These medications decrease the production of 'bad' LDL cholesterol by the liver, which lowers LDL cholesterol blood levels by up to 50%.

They are highly effective medications, and generally come with a very low chance of side effects.

These are some of the most popular statins available for the treatment of high cholesterol:

• Simvastatin
• Crestor
• Fluvastatin
• Lipitor
• Pravastatin
• Atorvastatin
• Lescol
• Lipostat
• Zocor

Over the counter treatments

Alternatively, aspirin and niacin may also be recommended. Aspirin works to prevent blood clotting, while niacin is a B vitamin that lowers dangerous cholesterol in the system and increases the lipoproteins that remove cholesterol. Ezetimibe is recommended to people who can't take statins or to use in conjunction with statins to lower their LDL levels.

The best way to prevent high blood cholesterol is to combat the lifestyle causes by eating a healthy diet and to remain active.

Altering your diet is the biggest potential change you can make to lower your cholesterol, and can decrease the level of triglycerides* in your bloodstream as well. Sodium (salt) levels should also be reduced, as increased levels in the blood stream can attract water and stretch the arteries and blood vessels. This in turn causes little tears in the vessel walls, making it easier for cholesterol to build up in these sections.

Exercise stimulates the amount of lipoproteins that take cholesterol away from the blood, while eating healthily can limit the amount of lipoproteins that increase cholesterol in your blood. It is advised to try and get 30 minutes per day of moderate to vigorous exercise. This can include activities such as walking, jogging, cycling, or even gardening. When observing patients who did very little exercise to begin with, some studies have shown that once they increased physical activity for a certain amount of time, they reduced LDL by 10-15% and increased their HDL numbers by up to 20%.^[3]

This however, isn't always effective, especially if the reason for the high LDL numbers in your blood is hereditary. Luckily, there is treatment to help manage your condition more effectively.

It is also strongly recommended to quit smoking for your overall health, as well as helping lower high cholesterol.

*Triglycerides is another fat found in the blood that thrives on fatty foods. It can also be found in certain foods that you will look to cut down on including meats and dairy.

HealthExpress offers a wide range of prescription medications, specifically formulated to lower cholesterol in a safe and effective manner: Simvastatin, Crestor, Fluvastatin, Lipitor, Pravastatin, Atorvastatin, Lescol, Lipostat, Zocor can all be purchased by completing our hassle-free online consultation, which will contain a few questions about your medical history. This will be reviewed by one of our partner doctors who will decide if your chosen medication is the most suitable one for you to purchase. You will then be able to place your order. If you live in London you can benefit from same day delivery, provided you purchase before 4pm

High cholesterol is becoming increasingly more common and can place a patient at risk of a number of health problems, including cardiovascular disease. Luckily it can be managed with lifestyle changes and medication.