So... what exactly is Cholesterol and how does it affect me or anyone? Cholesterol is a fat like, waxy substance that helps your body to function in its normal way. It is naturally present in the body’s cell walls or membranes everywhere in the body. Cholesterol forms part of the outer membrane that surrounds every cell, including the brain, heart, liver, intestines, nerves, muscles and skin.
Our body’s use this cholesterol to produce many hormones which carry chemical signals around the body, vitamin D, and bile, the acids that help to digest fat. Without cholesterol, your body would not work and is vital to ensure the body's normal function.
However, the body only needs small amounts of cholesterol in the blood to meet these needs. If we have too much cholesterol in our bloodstream, the excess can be deposited in our arteries, including the coronary arteries of the heart, the carotid arteries to the brain, and the arteries that supply blood to our legs. Cholesterol deposits can cause narrowing and blockage to the arteries, which affects the blood supply to our body.
Many of us thing that foods are laden with cholesterol but in fact, it is foods like eggs, offal and shellfish are the main causes. We need to be aware of the types of fat that we are putting into our bodies, especially saturated fats, as the liver converts this fat into cholesterol.
Too much cholesterol in the blood, however, increases the risk of coronary heart disease and disease of the arteries. Blockage to the leg arteries causes a condition known as claudication (see glossary) which is associated with pain and walking due to peripheral artery disease. Carotid artery blockage may a stroke which usually refers to such interruptions in the blood supply to the brain and blockage of the coronary arteries leads to angina (chest pain) and even heart attacks.
Special molecules called lipoproteins, transport cholesterol around the body. There are three main types of these lipoproteins:
- Low-density lipoprotein (LDL), this is often referred to as the bad cholesterol. LDL carries cholesterol from the liver to the body’s cells and, if the liver supplies too much, this can cause harmful build-up of cholesterol
- High-density lipoprotein (HDL), this is often referred to as good cholesterol. HDL takes excess cholesterol away from the cells and back to the liver, where it's either broken down or leaves the body as waste.
- Triglycerides, This is the greatest danger to someone who has high levels of LDL cholesterol and trigylcerides, and low levels of HDL cholesterol.
Coronary heart disease (CHD), this condition is caused by both cholesterol and fat being deposited in the walls of the arteries that supply nutrients and oxygen to the heart. The heart, like any other muscle, needs a constant supply of oxygen and nutrients, which are carried in the coronary arteries by the blood. If there is narrowing of the arteries, they will decrease that supply, which can cause angina when the heart muscle does not receive the much needed oxygen. Blood clots can form when the cholesterol plaques rupture and then completely block the artery, stopping all blood flow and causing a heart attack, in which heart muscle cells die from lack of oxygen and nutrients.
Countries in Western Europe like Andorra, Germany, Greenland, and Iceland are amongst the highest levels of cholesterol in the world, averaging at a 5.5 mmol/L while the UK is slightly lower at 5.4 and have shown one of the largest reductions from its average 6.2 mmol/L.
Greece has the lowest average cholesterol levels in Western Europe for both men and women, which are below 5 mmo/L. Canada, Sweden and the USA, also had low levels for high income countries, while eastern countries like China and Japan have steadily increased and are likely to be partly due to changes in diet. The lowest cholesterol in the world belongs to African countries, where some are as low as 4 mmol/L.
It is important that the diabetic should keep their cholesterol levels down, especially if you smoke as well. And the risk of high cholesterol increases in everyone as we age. We do not get symptoms so it is essential that we have our cholesterol checked regularly and if you are diabetic, you will be screened in your annual check-up.
So what are the first steps in managing your cholesterol levels?
Regular Physical activity
Manage your weight
Follow your cholesterol lowering diet
Cut out the saturated fats see Foods
Your GP or Physician may prescribe medication to lower your cholesterol levels. The medication may be one of the following types:
Statins: These lower LDL cholesterol levels by slowing down the production of cholesterol and by increasing the liver's ability to remove the LDL cholesterol already in the blood.
Bile acid sequestrants: These bind with cholesterol-containing bile acids in the intestines and allow them to be excreted in your bodily waste. Bile acid sequestrants can lower LDL cholesterol by about 10%-20% and can be prescribed alongside a statin..
Cholesterol absorption inhibitors: Are drugs that inhibit cholesterol absorption in the stomach and reduces LDL cholesterol by 18%-20%. These are often prescribed for those who cannot tolerate statins..
Nicotinic acid or niacin: Nicotinic acid lowers the total cholesterol, LDL cholesterol, and triglyceride levels, while raising the good HDL cholesterol levels in the body.
Fibrates: Are cholesterol lowering drugs that are effective in lowering triglycerides.
Your GP or Physician will invite you back to see how the drug is helping by again testing you cholesterol levels and may increase or reduce the dose if necessary.