Your Health

Cholesterol control

Lifestyle changes are key to managing this life-threatening condition

Cholesterol control

Winnipeg Health Region
Wave, September / October 2010

What is cholesterol?

Cholesterol is a waxy, fat-like substance that is found in the lipids (fats) in the bloodstream and the body's cells. Cholesterol is essential to life, as it is used to form cell membranes, certain hormones and other vital substances. Cholesterol does not dissolve in blood, so it is carried by lipoproteins to the cells of the body.

When does cholesterol pose a health risk?

Most of the cholesterol in the bloodstream is manufactured in the body, primarily by the liver. The body makes all the cholesterol it needs, so additional consumption is not necessary. Too much cholesterol is not beneficial. It can build up in the bloodstream, accumulating in the walls of blood vessels causing atherosclerosis (plaques). Plaques decrease the size of the arteries, decreasing blood flow, which then leads to the formation of blood clots. This may ultimately cut off the flow of blood in the coronary arteries leading to a heart attack, or in the cerebral arteries causing a stroke.

How does one develop high cholesterol?

Cholesterol is created naturally by the body and consumed in certain types of food, including meat (especially organ meats such as liver, kidney, brain), poultry, eggs (mostly in the yolk), and dairy products. Fish generally contain less cholesterol than other meats, but some shellfish are high in cholesterol. Plantderived foods do not contain cholesterol. High cholesterol is primarily affected by factors such as heredity, one's weight control, alcohol consumption and lack of exercise. Consumption of foods high in cholesterol and transfats plays only a minor role (about 10 to 15 per cent) in high blood cholesterol levels.

What is good cholesterol?

Low-density lipoproteins (LDL) are commonly referred to as "bad cholesterol." LDL carries cholesterol through the body, dropping it off where it is needed for cell building and leaving the unused residues of cholesterol in the arterial walls. High-density lipoproteins (HDL) are called "good cholesterol." HDL transport cholesterol to the liver for reprocessing or excretion. HDL helps to keep the cholesterol from building up in the blood vessels. Simply stated, LDL brings cholesterol into the system, so it is often termed the "bad cholesterol," and HDL called "good cholesterol," clears cholesterol out of the system.

What are triglycerides?

Triglycerides are a form of fat that is transported through the blood stream by very low-density lipoproteins (VLDL), produced by the liver, and deposited in tissue and muscle. Triglycerides are a storage form of energy. They are released gradually from the tissue and muscle to be metabolized between meals according to the energy needs of the body.

Why do they matter?

Elevated triglyceride levels are an independent coronary heart disease risk factor and very high triglyceride levels can lead to pancreatitis. High levels of triglycerides are often associated with high levels of cholesterol.

What causes high triglyceride levels?

Factors that contribute to elevated triglyceride levels include: obesity, physical inactivity, cigarette smoking, excess alcohol intake, high carbohydrate diets (more than 60 per cent of energy intake), several diseases (type 2 diabetes, chronic renal failure, and nephrotic syndrome), certain drugs (corticosteroids, estrogens, retinoids, and high doses of beta blockers), and some genetic disorders.

How is high cholesterol managed?

High cholesterol can be managed in two ways. The first goal is to raise HDL and reduce LDL levels through intensive weight management and increased physical activity.

The main way one can raise HDL levels is by regular aerobic physical exercise (brisk walking, running, cycling, cross country skiing, etc.). There are some drugs that can have a modest effect of raising HDL, but the most important factor is exercise. Treatment decisions are based on coronary heart disease risk factors and the LDL cholesterol. The American Heart Association recommends that everyone, of any age, with high LDL cholesterol be treated with therapeutic lifestyle changes that can lower the LDL. These lifestyle changes include decreasing intake of saturated fat (especially trans fats) and cholesterol, increasing physical activity, and controlling weight. Diabetes is considered a coronary heart disease risk equivalent, so a person with diabetes is treated the same way a person with known coronary heart disease is treated.

If lifestyle changes do not bring the LDL cholesterol to the expected levels, drug therapy may be started. It must be emphasized that cholesterol-lowering drugs cannot be effective without lifestyle changes. The main class of drugs used to lower LDL levels is the "statins."

What are statins?

Statin drugs are the most commonly used drugs to lower cholesterol. For every one per cent reduction in LDL cholesterol levels, the relative risk of coronary heart disease is reduced by one per cent. Individuals with high LDL cholesterol may not be able to reduce the LDL cholesterol more than 50 per cent.

What about triglycerides?

Treatment of elevated triglyceride levels depends on the severity and the cause. For borderline-high triglyceride levels, therapy includes weight reduction and increased physical exercise. If triglycerides are in the high range, drug therapy may be considered.

How can I guard against high cholesterol?

All male adults 40 years or older should have a fasting lipoprotein profile done. The fasting lipoprotein profile includes total cholesterol, LDL, HDL, and triglyceride level. If the results are normal, the test should be repeated every two to three years. For adult females, routine testing is usually done after menopause or age 50, whichever occurs first. Again, if this is normal, it is repeated every two to three years. In males and females, testing may be done earlier if there is a strong family history of heart disease or if there is a family history of high cholesterol or triglyceride levels.

Prevention of elevated triglycerides is very similar to the treatment of high LDL levels, but without the drug therapy. Eating a wellbalanced diet that is low in fat, with moderate intake of carbohydrates, along with regular moderate exercise is advocated. Regular moderate exercise is considered 30 to 45 minutes of walking most days of the week.

Linda Coote is a registered nurse with Health Links - Info Santé, the Winnipeg Health Region's telephone health informatin service.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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