Cholesterol is a waxy, fatty substance that is produced naturally by the liver and is therefore found in foods that come from animals. It's a normal part of every cell in our bodies and small amounts of it are necessary for good health but too much can cause serious health problems. It's one of the ingredients our bodies need to make hormones, vitamin D, nerve cells, and the bile acids that help to digest fat. When there is more cholesterol in the body than it needs to function properly, the excess builds up in the blood and attaches to the inside of the artery walls. These deposits, called plaques, harden and grow larger, decreasing blood flow resulting in a condition called Arteriosclerosis. Blood clots may form in these narrowed vessels, leading to chest pain (angina) and possible heart attacks (myocardial infarction). High cholesterol levels are linked to poor dietary habits, excess weight, smoking, physical inactivity, family history and age.

You can't judge your cholesterol levels by how you feel, because high cholesterol doesn't have any symptoms. Fortunately, there is a quick and simple blood test that measures blood cholesterol levels. You should have your blood cholesterol checked periodically if you are over 20 years of age.

In a healthy adult, a blood cholesterol level of less than 5.2 millimoles per litre (mmol/L) is considered normal. Levels in the range of 5.2 to 6.2 mmol/L are considered borderline, and anything above 6.2 mmol/L is unhealthy. In people with heart problems, the cholesterol level should be 4.1 mmol/L or below.

Only One Part of the Picture
A total blood cholesterol reading is a helpful guide, but it shows only part of the picture. The best type of cholesterol test is one that provides not only the total cholesterol level but also breaks down the reading into components.

Cholesterol is carried in our blood in chemical packages called lipoproteins. One type of lipoprotein is known as low-density lipoprotein or LDL. It is often called "bad cholesterol." Our bodies need normal amounts of LDL for cell growth and repair. However, if LDL levels are too high, they cause a gradual increase of plaque development on the arterial walls. A level of less than 3.4 mmol/L of LDL-cholesterol is desirable in a healthy adult. Levels between 3.4 and 4.1 mmol/L require monitoring and levels above 4.2 mmol/L should be treated because they put a person at high risk of developing heart disease. In someone who already has heart disease, the LDL level should be no higher than 2.6 mmol/L.

Another type of lipoprotein is known as HDL, or high-density lipoprotein. This is sometimes called "good cholesterol" because it helps clear LDL from the bloodstream and return it to the liver where the body can process and remove it. HDL levels of 0.9 mmol/L and higher are the healthiest.

Triglycerides, although not a cholesterol, are another fatty substance found in the bloodstream. Triglycerides do not stick to blood vessels, but cause an increase in the likelihood of blood to clot. High levels of triglycerides raise a person's risk of developing heart disease and they should be measured as well. To get an accurate triglyceride measurement, you must fast for 12 hours before the blood test. High triglyceride levels are associated with excess alcohol consumption, excess body weight or poorly controlled diabetes.

Our cholesterol levels change throughout our lifetime due to a number of factors including changes in our eating habits and activity levels. So it is important to have your cholesterol checked periodically. If you are a healthy adult, your total cholesterol level is below 5.2 mmol/L and your LDL-cholesterol level is below 3.4 mmol/L, one test every five years is probably often enough, unless your doctor recommends a more frequent schedule. If your total cholesterol level is above 5.2 mmol/L or if your LDL level is above 3.4 mmol/L, wait a few weeks and have the test repeated to confirm the results. If your cholesterol levels remain high, you and your doctor should work out a treatment program that includes periodic retesting and monitoring to make sure your cholesterol levels decrease. For every 1% reduction in cholesterol level, the risk of heart disease is reduced by 2%.

If you have a history of previous heart disease and your total cholesterol level measures 4.2 mmol/L or higher or if your LDL level is above 2.6 mmol/L, you should see your doctor to discuss a treatment program to bring down your cholesterol levels.

Quick Facts
People who have heart disease risk factors in addition to high cholesterol should aim for cholesterol levels that are lower than the ones established for people without additional risk factors. If you answer "yes" to one or more of the following questions, consult your physician to determine what your cholesterol levels should be and how best to reach or maintain those levels.

• Do you have diabetes?
• Do you smoke?
• Are you a man or a postmenopausal woman?
• If you are a man, do you have more than two alcoholic drinks daily?
• If you are a woman, do you have more than one alcoholic drink daily?
• If you are a man, are you over the age of 50?
• If you are a woman, are you over the age of 40?
• Do you have high blood pressure?
• Are you physically inactive?
• Do you have a family history of heart disease, especially in a first-degree relative (mother, father, sister, brother or grandfather)?

Taking Steps to Lower Your Cholesterol

If your test shows that your blood cholesterol levels are high, there are some lifestyle changes you can make that will help bring your levels back to normal. The first step is to start eating a healthier diet. Review the overall quality in your diet and ensure you are eating lots of fresh vegetables and fruit together with whole grain choices. Next, work towards limiting the total amount of fat, especially saturated fats. Here are some suggestions:

• It is acceptable to have up to 300 milligrams of cholesterol in the diet. Enjoy foods containing cholesterol in moderation. Egg yolks are high in cholesterol. Try to substitute egg whites for whole eggs and limit yourself to three egg yolks a week. Organ meats and shellfish are also high in cholesterol but low in fat, so enjoy 2 servings a week. Keep organ meats to 2 - 3 ounces a week.
• Saturated fat is usually the fat found in meat and dairy products; it becomes solid at room temperature. There are also some plant sources that contain saturated fats. For example, tropical oils (coconut and palm oil), macadamia nuts, cashews and pistachios. No more than 30% of your daily calories should come from fat and only 10% should be from saturated fat. Replace saturated fats with moderate amounts of monounsaturated and polyunsaturated fats. For example, limit the use of butter, margarine, shortening and tropical oils by substituting with sunflower, soybean or canola oils. Another recommendation is to remove the skin from chicken and turkey before cooking.
• Increase your intake of soluble fibre. Soluble fibre (which is found in oat bran, fruits and vegetables) helps the body eliminate excess blood cholesterol.
• Become more physically active. Regular physical activity may lower LDL and raise HDL cholesterol. Speak with your doctor before starting any new exercise program to ensure that it is appropriate for your age and physical condition. Remember to start slowly. If you overdo it and hurt yourself, you will not stick with the program.
• Work towards losing extra weight. Excess weight tends to raise LDL cholesterol. Losing weight not only helps reduce it, but also reduces triglycerides and raises HDL levels.
• Try to limit the amount of stress in your life. Long-term exposure to stress has been linked to higher cholesterol levels.
• Tobacco reduces your level of HDL and raises your total blood cholesterol levels, a powerful combination for increasing your risk of having a heart attack. If you smoke, it would be in your best interest to quit. Talk to our pharmacist for information on treatment options.

For many people, making these lifestyle changes will be enough to normalize cholesterol levels. Some people, though, will require medication as well. There are several drugs that can help reduce your cholesterol levels, but there are no "magic bullets"; you will still have to make healthy lifestyle changes. Medicines work with a healthy lifestyle; they are not a substitute for it.

What You Should Know About Cholesterol-Lowering Medicines
There are a variety of treatment options available, so you and your doctor can work together to find the best one for you. The main categories of cholesterol-lowering medications are statins, bile acid sequestrants, nicotinic acid and fibrates.

• Statins are the most commonly prescribed cholesterol-lowering medicines. They slow down the rate your body makes LDL-cholesterol and help your liver take out the LDL-cholesterol that's in your blood. They also lower elevated triglyceride levels and increase HDL levels. Statins are usually taken with evening meals or at bedtime, because your body naturally produces more cholesterol at night. Some examples of statins are atorvastatin, simvastatin and pravastatin.
• Bile acid sequestrants bind to bile acids (which contain cholesterol) in the intestines and are then removed from your body as a part of the stool. The main action of bile acid sequestrants is to lower LDL-cholesterol levels. Cholestyramine and colestipol are examples of this class of medication.
• Nicotinic acid (also know as niacin or vitamin B3) works by increasing the HDL levels and lowering the total cholesterol, triglycerides and LDL levels. Nicotinamide, another form of the vitamin, does not lower cholesterol and should not be used in place of nicotinic acid. It is very important to not self-medicate and to be monitored by your doctor because of the possibility of serious side effects associated with taking high doses of nicotinic acids.
• Fibrates lower triglyceride levels while increasing the levels of HDL-cholesterol. Variable results are seen with the effects on LDL levels. Examples of this class are clofibrate, gemfibrozil and fenofibrate.

Because cholesterol levels rise in postmenopausal women and because these women have an increased risk of developing heart disease, hormone replacement therapy is sometimes prescribed to reduce the risk of CHD. However, recent studies have questioned whether the benefits of this therapy outweigh the risks. Therefore, standard cholesterol-lowering drugs are generally recommended for postmenopausal women who are not already taking hormone replacement therapy for other reasons.

It is important to follow your doctor's and pharmacist's instructions on taking your medication. Some people may experience side effects from their cholesterol medications. If this happens to you, tell your doctor or pharmacist. There may be a different drug you can take that will not cause side effects. Do not simply decide on your own to stop taking the medication.

Seeking Information

The material in this patient information pamphlet has been supplied by a professional medical writer and reviewed by our licensed pharmacists, Gary Jung of Burnaby and Alnoor Suleman of Delta, and registered dietitian, Patricia Chuey. Overwaitea Food Group is not responsible for errors, omissions or inconsistencies with respect to the information contained in this pamphlet and does not accept any liability whatsoever for reliance by the reader on the information contained herein.