Cholesterol is a fatty substance that is present in your blood. High cholesterol, also known as hypercholesterolemia, occurs when there are raised levels in your body. Cholesterol is carried in the blood by particles called lipoproteins, and there are two types of these – low density and high density. When low-density lipoproteins (LDL cholesterol) carry cholesterol this is often called 'bad' cholesterol because high levels of LDL cholesterol increase your risk of heart disease. In contrast, HDL cholesterol is viewed as 'good' cholesterol because higher levels help to prevent cardiovascular disease.
Fatty substances build up in your blood mainly as a result of diet and lifestyle choices. Eating unhealthy fatty foods and not exercising enough puts you at risk of developing high cholesterol. If you smoke or drink alcohol or are overweight, your risk increases further. Too much cholesterol can cause a blockage in the blood vessels and there is a link between increasing blockage of blood vessels and a higher risk of having a heart attack or a stroke.
If someone in your family has high cholesterol then you are also more likely to suffer from it. There are no symptoms of high cholesterol, the only way to confirm this is with a blood test.
If you are overweight, have a poor diet, or are over 40 years old and have never had the test, it is recommended to check your cholesterol levels. If anyone in your family has suffered from high cholesterol or heart problems it is also recommended to get testing.
The doctor will likely take your cholesterol blood test alongside a few other routine blood tests too. Your doctor may take your blood pressure, calculate your BMI score and take into account other lifestyle factors that allow them to calculate your risk of developing cardiovascular disease in the next 10 years (called a Qrisk score). If your cholesterol level is raised, you have a Qrisk score above 10% or you are not improving your levels with lifestyle changes alone, then your doctor may recommend cholesterol-lowering medication.
Statins are the most commonly prescribed medication to reduce the amount of cholesterol in your body. These medications are often well tolerated but in some, they can cause muscular aches and pains and affect your liver. Your doctor will guide you on how to start this medication appropriately.
Other possible medication includes bile acid sequestrants, fibrates, ezetimibe and bempedoic acid – which may be used if other treatments have failed to lower cholesterol levels satisfactorily.
The National Institute for Health and Care Excellence (NICE) has recently recommended the drug inclisiran as a treatment option in some people. It is only recommended if you have had a heart attack, stroke or other cardiovascular event and your LDL cholesterol remains above 2.6 mmol/L on maximum treatment with other lipid-lowering therapies, including statins (or you’re unable to take other treatments).
There are usually 4 different measures for the cholesterol level. The total cholesterol is the overall amount of cholesterol in your blood and should be 5 mmol/L or below. (About two thirds of adults in the UK have a level above 5). HDL (good cholesterol) should be 1.2 mmol/L or above, and LDL levels should be 3 mmol/L or less. Your total cholesterol divided by your HDL cholesterol should be 4.5 or less 9in other words, the more HDL the better).
Optimising your cholesterol blood results reduces your risk of developing heart attacks or stroke.
If your cholesterol level is raised, the first and most important step is to address your diet. It is important to reduce the amount of microwaveable, junk, processed, and takeaway foods that you consume. It is important to increase your good fats and nutrient-dense healthy foods; for example nuts, seeds, fruit and vegetables and oily fish like mackerel. It is advised to switch your dietary intake of pasta, rice and bread to wholemeal varieties.
It is also advised to exercise regularly; 150 minutes of moderate exercise or 75 minutes of intense activity a week. If you smoke or drink alcohol, it is advised to stop smoking and drink less than 14 units of alcohol a week to reduce your risk of cardiovascular disease.
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