High Blood Cholesterol

Understanding High Blood Cholesterol

High Blood Cholesterol refers to high levels of lipids in the blood. It is one of the main risk factors for coronary heart disease and stroke. Understanding high blood cholesterol is important as coronary heart disease is the second leading cause of death in Singapore, after cancer. Lipids are fatty substances in our bodies which play an important role in all living cells. These include cholesterol, triglycerides, phospholipids and fatty acids. However, when there is too much cholesterol and/or triglycerides in our body, we are at risk of certain diseases such as coronary heart disease, stroke and diabetes. A person with high cholesterol level does not show any signs and symptoms. Hence, it is important for you to check for your blood cholesterol level especially if you are over the age of 40 or have a family history with high cholesterol level.

Symptoms

Too much cholesterol in the blood causes a build-up of fatty deposits on the inside walls of the blood vessels (atherosclerotic plaques). This results in blockage of the blood vessels, causing the blood flow through these blood vessels to decrease. When this occurs in the coronary arteries that supply blood to the heart muscles, the decrease in blood supply (and therefore oxygen and other nutrients) causes the damage of heart muscles. This condition is otherwise known as coronary heart disease. An individual may experience a heart attack if he or she faces a severe coronary heart disease. When the brain does not receive sufficient oxygen supply, the person will suffer a stroke. The risk of experiencing a heart attack or stroke increases when other factors such as smoking, high blood pressure, diabetes, obesity, sedentary lifestyle and family history are present.

Are you at risk?

You most likely face a high risk of having high blood cholesterol if you possess any of the below factors:

• Hereditary metabolic disorders
• Increased dietary intake of cholesterol and fat
• Certain illnesses
• Obesity
• Lack of physical activity, sedentary lifestyle

Diagnosis

It is important to check your cholesterol level regularly, to reduce your susceptibility to coronary heart disease. If your total cholesterol level is between 5.2 and 6.1mmol/L, you are at risk of coronary heart disease. If your total cholesterol level registers at 6.2 mmol/L and above, you could be having hypercholesterolemia, which is attributable to genetic factors, diabetes, obesity, and poor eating habits.

The desirable level of Low-Density Lipoprotein (LDL) depends on your pre-existing risk for coronary heart disease. If you already have coronary artery disease, peripheral vascular disease, or diabetes, you are in a high-risk group whereby the desirable level is more stringent. However, if you have none or only one risk factor, a higher value of LDL is acceptable before medical intervention is required.

High-Density Lipoprotein(HDL) protects against heart disease, so the higher the HDL levels, the better. A level less than 1.0 mmol/L is low and is considered a risk factor. The risk of heart disease is lower when HDL level is 1.0 mmol/L or more. Women usually have higher HDL cholesterol levels than men. In addition, higher than normal levels of triglyceride places you at a greater risk of developing cardiovascular disease. Elevated triglyceride levels are more common in people who are obese or those with poorly-controlled diabetes. Your triglyceride and cholesterol level will most likely increase as you get older and become obese.  

Treatment

If your blood cholesterol level is high and adjusting your diet does not help to reduce your blood cholesterol level, your doctor may start you on some lipid lowering medication. These are divided into 4 main groups:

• Statins such as simvastatin and lovastatin act on the enzyme to stop cholesterol being manufactured in the liver
• Bile acid sequestrants like cholestyramine bind bile acids at the intestinal level
• Fibrates like gemfibrozil help to stimulate the breakdown of the lipoproteins
• Niacin like nicotinic acid decreases the formation of Low-Density Lipoprotein(LDL) cholesterol in the liver

The suitability of various medications and their side effects varies for different people. Consult your doctor for a suitable prescription.

Prevention

High Blood Cholesterol can be prevented with controlling your blood cholesterol level. In order to reduce the risk of having high cholesterol level, adopt a healthier lifestyle to include regular exercise and practising dietary control. Avoid food with high saturated fat and cholesterol content and choose food that are high in fibre such as fruits, vegetable and wholegrain products. Food containing soluble fibre such as oats, barley, beans or peas is useful in reducing a person’s cholesterol level.

Resources

Find out more information from:

Health Promotion Board

Recipes

Download healthy recipes in English and Chinese. (Source: Health Promotion Board)  

1. What is High Blood Cholesterol?

High Blood Cholesterol means that there are high levels of lipids (fatty substances) in the blood. It is one of the main risk factors for coronary heart disease and stroke. Lipids play an important role in all living cells, and they include cholesterol, triglycerides, phospholipids and fatty acids. When there is too much cholesterol and/or triglycerides, one is at risk of certain diseases.

2. What are the different types of lipids?

The types of lipids are cholesterol, triglycerides, and lipoproteins. Lipoproteins are molecules of fat and cholesterol linked to protein.

• High Density Lipoproteins (HDLs) HDLs, also known as 'good cholesterol' remove excess cholesterol, prevent cholesterol build-up in the blood vessels, and lower your risk of heart disease.
• Low Density Lipoproteins (LDLs) The cholesterol and fat from LDLs are the main source of dangerous build-up and blockage in the blood vessels. That is why LDL-cholesterol is often called the 'bad cholesterol'.
• Triglycerides Triglycerides are another type of fat in your bloodstream, which is used by your muscles to provide your body with energy. Excess triglycerides put you at higher risk of a heart attack.

For a healthy individual, your blood cholesterol levels should be as follows:

• Total cholesterol < 5.2 mmol/L (200 mg/dL)
• HDL-cholesterol ≥ 1.0 mmol/L (40 mg/dL)
• LDL-cholesterol < 3.4 mmol/L (130 mg/dL)
• Triglycerides < 2.3 mmol/L (200 mg/dL)

(Above figures extracted from HPB)

3. Who can develop high blood cholesterol?

Anyone can develop high blood cholesterol. Those who are especially at risk are older adults, those with a family history of heart disease or stroke, and overweight individuals.

4. How can we prevent and treat high blood cholesterol?

You can adopt these lifestyle measures to reduce your risk of high blood cholesterol. Lifestyle changes are also important for those who already have high blood cholesterol.

• Lose weight if you are overweight Excess weight adds strain on the heart. In some cases, weight loss may be the only treatment needed.
• Adopt a healthy died Dietary adjustments may be beneficial, especially a decrease of fat and cholesterol in your diet. Reduce total fat intake to no more than 30% of total calories, 7% of saturated fats, and no more than 200 mg (5.18 mmol) of dietary cholesterol a day. Make sure you eat a diet rich in vegetables and fruit and low in fat.
• Stay active Engage in 30 minutes of physical activity on 5 or more days a week. You can break up the 30 minutes of exercise a day into 10- minute bouts. Remember to consult your doctor before you embark on any exercise plan.
• Quit smoking Smoking greatly adds to the risk of suffering a heart attack or stroke, so stop smoking if you are a smoker.
• Limit alcohol intake Keep your alcohol intake to less than 1 or 2 standard drinks a day.

5. If a product's package reads "Low Cholesterol," does that mean that the product is low in fat and safe to eat?

Not necessarily. Numerous foods marked "low cholesterol" can contain oils that may be high in saturated fats, which are not considered healthy. In addition, unsaturated fats like vegetable oil also can be high in calories. The total amount of fat in your diet should be kept to about 20-30 percent of your daily intake. (Above information is extracted from Medicinenet.)