All about cholesterol

Dr Morgan Mkhatshwa, clinical executive at Bonitas Medical Fund

What does this mean?

Dr Morgan Mkhatshwa, clinical executive at Bonitas Medical Fund takes a look at cholesterol: What it is and why it is used, together with other factors like lifestyle and medical conditions, to estimate your risk of cardiovascular disease. And why knowing your LDL and HDL numbers is important in managing your health.

What is cholesterol?

Cholesterol [kuh·leh·stuh·rol] is a waxy fat-like substance, made in the liver and found in the blood and cells of your body. We all have cholesterol. It is made naturally and helps to form cells, hormones, vitamin D and bile acid (that helps us digest food).

What is the difference between bad cholesterol LDL and good cholesterol HDL?

• LDL is low-density lipoprotein: It is called the ‘bad’ cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries which leads to a greater chance of developing a heart disease
  
• HDL is high-density lipoprotein: Is the ‘good’ cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

However, if someone has high levels of bad cholesterol, it means they have too much of this fatty substance in their blood and, over time, this could cause arteries to block and result in a heart attack or stroke.

Unfortunately, unlike most medical conditions, high cholesterol can go unnoticed and often doesn’t present any symptoms, unless it’s serious enough to cause problems.

What test is used to determine the levels of cholesterol in your body?

Called a fasting lipogram, it measures the exact amount of different types of cholesterol you have.

The SA Heart and Stroke Foundation maintain that healthy cholesterol levels should be:

• Total cholesterol: Less than 5.0 mmol/l (millimoles per litre)
  
• LDL cholesterol: Less than 3.0 mmol/l
  
• HDL cholesterol: Greater than 2.0 mmol/1
  
• If your triglycerides (fat stored in the body) are higher than 1.7mmol/l, this is also indicative of a possible cholesterol problem

Dr Mkhatshwa cautions that these are variables for the optimal LDL(bad cholesterol) count, according to your risk profile. "If you are very high-risk or high-risk, the LDL-C goal is 1.8 mmol/l and 2.5 mmol/l respectively. Your doctor will explain these to you, what they mean, and the steps you need to take to reduce your LDL count," he says. "You can then begin to play an active role in managing your own health."

How often should you be tested?

Most healthy adults should have their cholesterol checked every four to six years. People who have heart disease, diabetes or a family history of high cholesterol, need to get their cholesterol checked more often.

What diseases or conditions result from high cholesterol levels?

When you have too much ‘bad’ cholesterol in your blood, it can cause narrowing and blockages of the arteries – the blood vessels that carry blood to your heart muscle and to other parts of your body. In time, this narrowing can lead to a heart attack, while blockages in the arteries of your brain can cause a stroke.

What kind of illnesses or diseases can cause elevated levels of LDL?

People with high blood pressure (hypertension) and diabetes often have high cholesterol. Some other health conditions that can also cause raised levels of cholesterol include kidney disease and liver disease.

What role does genetics play in high cholesterol levels?

The medical term for high blood cholesterol is Familial hypercholesterolaemia. It is an inherited condition characterised by higher-than-normal levels of LDL blood cholesterol. It causes up to 10 per cent of early-onset coronary artery disease – heart disease that occurs before the age of 55 years. The cause is a mutation in a gene.

Can I lower my genetically high LDL cholesterol?

There is no cure for familial hypercholesterolaemia. Treatment aims to reduce the risk of coronary artery disease and heart attack and may include dietary changes, including reduced intake of saturated fats and cholesterol-rich foods, and increased intake of fibre.

Statins are the most common medicine for high cholesterol. They reduce the amount of cholesterol your body makes and you usually need to take them for life.

What lifestyle changes can help to lower cholesterol levels?

• Losing weight
  
• Eating a heart-healthy diet: Focus on plant-based foods, including fruits, vegetables and whole grains
  
• Exercising regularly
  
• Not smoking

Did you know?

• One third of adults have high cholesterol
  
• No one can live without cholesterol
  
• High cholesterol could be genetic
  
• Even children can have high cholesterol
  
• Sweating can raise your good cholesterol levels
  
• Supplements may work to lower cholesterol — but slowly