DR. JAYARAM LINGAMANAICKER

MBBS, LRCP (Edin), LRCS (Edin),
LRCP&S (Glas), MRCP (UK),
FRCP (London), FACA (USA),
FAMS (Cardiology), FACC (USA)

Lifeline Heart Centre
#11-10 Mount Elizabeth
Medical Centre
3 Mount Elizabeth
Singapore 228510

Tel: (65) 6836 2611 /
  (65) 6836 9038 /
  (65) 6836 1990

Fax: (65) 6836 9037

E-mail:    

lifelineheart@gmail.com /
lifelineheart@singnet.com.sg



Patient Guide > Cholesterol
Patient Guide > Cholesterol


Introduction

Every cell in our body contains cholesterol and it is an important component of cell membranes and a building block in the formation of some hormones. But your body makes all the cholesterol it needs. Any cholesterol in your diet is extra and it's up to no good.

Excess cholesterol in your blood will lead to develop fatty deposits in your blood vessels- called atherosclerosis. Eventually, these deposits narrow the arteries and restrict the blood flow to the heart muscles leading to angina and heart attack. Decreased blood flow to your brain can cause a stroke. A healthy diet, regular exercise and other lifestyle changes can go a long way toward reducing high cholesterol. Sometimes you may need medication.

Types of Cholesterol

Cholesterol in your blood is attached to proteins. The cholesterol-protein bondage is called a lipoprotein. The main types of lipoproteins are:
  • Low-density lipoprotein (LDL)
    LDL, or "bad," cholesterol transports cholesterol throughout the body. The LDL cholesterol builds up in the walls of your arteries making them hard and narrow.

  • High-density lipoprotein (HDL)
    HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.
Various factors such as inactivity, obesity and an unhealthy diet contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control - your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce excess cholesterol.

Risk factors

High cholesterol can lead to heart disease; however other factors compound the risk:
  • High blood pressure
    High blood pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.

  • Diabetes
    High blood sugar contributes to high LDL cholesterol and low HDL cholesterol. High blood sugar also damages the inner lining of your arteries.

  • Smoking
    Cigarette smoking leads to atherosclerosis- accumulation of fatty deposits inside the blood vessels. Smoking lowers your level of HDL cholesterol.

  • Family history
    If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.
Screening and diagnosis

Blood test to check cholesterol levels is done after 12 hours fast and typically it reports:
  • Total cholesterol

  • LDL cholesterol

  • HDL cholesterol

  • Triglycerides a type of fat in the blood

  • TC/HDL ratio
Blood Cholesterol Result

The following general guidelines can be used to interpret your test results.

Total cholesterol
Below 200 mg/dL Desirable
200-239 mg/dL Borderline high
240 mg/dL and above High


LDL cholesterol
Below 70 mg/dL Desired level for people at very high risk of heart disease
Below 100 mg/dL Desired for people at risk of heart disease
100-129 mg/dL Near optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high


HDL cholesterol
Below 40 mg/dL Poor
40-59 mg/dL Normal
60 mg/dL and above Best


Triglycerides
Below 150 mg/dL Desirable
150-199 mg/dL Borderline high
200-499 mg/dL High
500 or above Very high


LDL targets not the same

LDL cholesterol is closely associated with heart disease; it's the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.

One is considered very high risk if you've had a heart attack or if you have diabetes. In addition, two or more of the following risk factors might also place you in the very high risk group:
  • Smoking

  • High blood pressure

  • Low HDL cholesterol

  • Family history of early heart disease

  • Age older than 45 if you're a man, or older than 55 if you're a woman
Treatment

Lifestyle changes can help improve your cholesterol level. Despite all these if particularly your LDL cholesterol remains high, you may need medication.

Common drugs include:
  • Statins
    Statins the most commonly prescribed medications for lowering cholesterol blocks an enzyme needed by your liver to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from accumulated deposits on your artery walls, potentially reversing coronary artery disease.

    Some commonly used statins are as follows: Atorvastatin (Lipitor), Pravastatin (Pravachol), Rosuvastatin (Crestor) and Simvastatin (Zocor).

  • Bile-acid-binding resins
    The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications like cholestyramine (Questran), lower cholesterol indirectly by binding to bile acids.

  • Cholesterol absorption
    The small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. It can be used in combination with any of the statin drugs. E.g.: ezetimibe-simvastatin (Vytorin).
If you also have high triglycerides, your doctor may prescribe:
  • Fibrates
    The medications fenofibrate and gemfibrozil decreases triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.

  • Niacin
    Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. Dietary supplements containing niacin are not effective for lowering triglycerides.
Side Effects

Most of these medications are well tolerated, but effectiveness varies from person to person. If you start taking cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver.
Self-care Self-care

Lifestyle changes are the first line of defense against high cholesterol.
  • Weight Reduction
    Excess weight contributes to high cholesterol. Losing even a few Kg of excess weight can help lower total cholesterol levels.

  • Healthy Eating
    A diet rich in fibre and other cholesterol-lowering foods may help lower cholesterol for some people.

    • Healthier fats
      Saturated fat and Trans fat raise your total cholesterol and LDL cholesterol. Try to avoid trans fat completely. Monounsaturated fat found in olive, peanut and canola oils is a healthier option. Almonds and walnuts are other sources of healthy fat.

    • Cholesterol intake
      Aim for no more than 300 milligrams (mg) of cholesterol a day or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include internal organs, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead.

    • Whole grains
      Nutrients found in whole grains promote good health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices.

    • Fruits and vegetables
      Fruits and vegetables are rich in dietary fibre, which can help lower cholesterol.

    • Fish
      Some types of fish such as cod, tuna and halibut have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote healthy heart.

    • Drink in moderation
      Moderate use of alcohol has been linked with higher levels of HDL cholesterol but the benefits aren't strong enough to recommend alcohol for anyone who doesn't drink already. Moderation usually means no more than one drink a day for women, and one to two drinks a day for men.

  • Regular Exercise
    Regular exercise can help improve your cholesterol levels. Try and exercise five days a week up to 30 to 60 minutes a day.

  • Quit smoking
    Quitting can improve your HDL cholesterol level. And the benefits don't end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker's. Within 15 years, your risk of heart disease is similar to that of someone who's never smoked.