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Cholesterol

What is cholesterol and why can it be bad for us?

We all have cholesterol in our blood but a high level may lead to furring up of the heart arteries (coronary artery disease) and cause angina or a heart attack (myocardial infarction). We should therefore all be careful with our diet but if patients already have established coronary artery disease then it is even more important that the cholesterol level is controlled. It is not just the total cholesterol level in the blood that is important but also the levels of bad (LDL - low density lipoprotein) and good (HDL - high density lipoprotein) cholesterol, which are important. A simple blood test will assess each of these cholesterol fractions.

The current targets for cholesterol lowering are to achieve a total cholesterol level less than 4.0 mmol/l with an LDL less than 2.0

Can diet alone reduce cholesterol levels?

Diet alone can reduce total cholesterol levels by as much as 10%. Saturated fats should be avoided and are found in butter, hard cheese, lard, biscuits, crisps and cakes. A high fibre diet may be helpful in reducing the cholesterol level. Porridge may also be helpful. The use of spreads with plant sterol extracts may reduce the cholesterol level but on their own are not that effective. A high intake of oily fish (high in omega 3 fatty acids) is recommended. Oily fish include herring, kippers, mackerel, sardines and salmon.

What tablets are there to lower cholesterol levels?

It may not be possible to reduce the cholesterol level by the desired amount with diet alone and your doctor may recommend that you take statins. These drugs interact with the metabolism of fat in the liver and reduce the level of cholesterol in the blood. Recent media coverage has suggested that these drugs are associated with significant side effects but this still represents a reasonably small proportion of patients considering the total number on statin therapy. The main symptom that patients may experience is muscle ache, typically in the shoulders or the thighs. There are a variety of different statins, which may be used by your doctor. Alternatives to statins include drugs called fibrates, which similarly interact with the metabolism of fat and cholesterol in the body. Ezetimibe is a drug that reduces the uptake of cholesterol from the gut.