Don’t fall into the choles­terol trap

Ir­ish ge­net­ics tend to give us high choles­terol — but there are some sim­ple life­style changes you can make be­fore el­e­vated lev­els of this dan­ger­ous fat take hold, writes Ailin Quin­lan

Irish Independent - Health & Living - - CHOLESTEROL SPECIAL -

DID you know that as a na­tion, we Ir­ish are pre­dis­posed to high choles­terol, which can re­sult in a stroke or heart at­tack? And also that we’re cul­tur­ally averse to tak­ing med­i­ca­tion to re­duce our lev­els of this dan­ger­ous fat? Four out of ev­ery five adults who come into Ir­ish hos­pi­tals tend to have high choles­terol lev­els, warns David Burke, Con­sul­tant Car­di­ol­o­gist and Head of Car­di­ol­ogy at the Bea­con Hos­pi­tal, who says he also finds that many pa­tients dis­like the idea of “tak­ing the tablet”.

We all need a cer­tain amount of choles­terol, which is a type of fat that’s found in the blood, but when too much of it builds up in the sys­tem, it can cause sig­nif­i­cant prob­lems. “Choles­terol builds up grad­u­ally and ul­ti­mately forms plaque, which in turn causes nar­row­ing of the blood ves­sels, which can lead to heart at­tack and stroke,” ex­plains Dr Burke.

If the af­fected artery is bring­ing blood to the brain, plaque build-up may re­sult in a stroke. If it’s an artery that leads to the heart, the dam­age can come in the form of a heart at­tack. El­e­vated choles­terol lev­els over a long pe­riod can also put a pa­tient at higher risk of other con­di­tions such as pe­riph­eral vas­cu­lar disease and kid­ney im­pair­ment.

There are two kinds of choles­terol — HDL choles­terol (high den­sity lipopro­tein) is of­ten re­ferred to as ‘good choles­terol’ be­cause it mops up choles­terol left be­hind in your ar­ter­ies and car­ries it to your liver, where it is bro­ken down and passed out of the body. Reg­u­lar phys­i­cal ex­er­cise can help im­prove your HDL level — high lev­els of f HDL choles­terol can pro­tect you against hav­ing a heart at­tack or a stroke.

LDL choles­terol (low den­sity lipopro­tein) is of­ten re­ferred to

as the ‘bad choles­terol’. This sticks to the walls of your ar­ter­ies, caus­ing plaque, mak­ing the ar­ter­ies nar­rower and re­duc­ing the blood sup­ply to the heart or brain. Eat­ing too many foods which are high in sat­u­rated fat can raise your LDL choles­terol, in turn height­en­ing your risk of heart disease and stroke.

The re­duc­tion of LDL is ac­tu­ally the pri­mary tar­get of all treat­ments — Dr Angie Brown, Med­i­cal Di­rec­tor of the Ir­ish Heart Foun­da­tion, says that for those in a ‘high risk’ cat­e­gory of, for ex­am­ple, de­velop-

A fatty, un­healthy diet, seden­tary life­style, al­co­hol and smok­ing are fac­tors

ing car­dio­vas­cu­lar disease, the tar­get LDL would be 1.8. Gen­er­ally speak­ing, how­ever, says Dr Burke, we should aim for a ball­park to­tal choles­terol fig­ure of below 5.0, and an LDL of half that.

So how do we tackle the prob­lem of high choles­terol?

The se­cret is ac­tu­ally to pre­vent it hap­pen­ing, says Dr Burke, who warns that once high lev­els of choles­terol have be­gun to form plaque in the veins, it’s not pos­si­ble to re­verse it.

“Most peo­ple are not aware of the fact that once choles­terol builds up in the blood ves­sels, you can­not re­verse it.

“Med­i­ca­tion is de­signed to hold it steady, but you can­not get rid of it. The trick is preven­tion.”

A healthy diet and reg­u­lar ex­er­cise is the way to go in terms of pre­vent­ing high choles­terol lev­els, ac­cord­ing to Sarah Noone, di­eti­tian with the Ir­ish

Heart Foun­da­tion, who says the ad­vice is to eat a Mediter­ranean-style diet high in fruit, vegeta­bles, sal­ads, whole­grains and oily fish, with modest amounts of dairy prod­ucts and lean meats and a low in­take of foods high in fat, salt and su­gar.

Don’t smoke — and make sure to take mod­er­ate ex­er­cise reg­u­larly.

How­ever, too many adults are not do­ing this, warns Dr Burke.

“The ma­jor­ity of the adult pop­u­la­tion com­ing into hos­pi­tal have high choles­terol,” he says. “Gen­er­ally speak­ing, Ir­ish ge­net­ics tend to give us high choles­terol — as a na­tion we’d be pre­dis­posed to it.”

And al­though peo­ple are be­com­ing much more aware about the longer term risk of high choles­terol lev­els, they re­main “very averse” to treat­ing it with med­i­ca­tion, warns Dr Burke, who says that most pa­tients are, how­ever, will­ing to try low­er­ing their choles­terol lev­els through changes to diet and life­style.

Ac­cord­ing to Ms Noone, this can be done through re­duc­ing ex­cess body weight, im­prov­ing di­etary habits in con­junc­tion with spe­cific diet and life­style ad­vice re­lat­ing to in­di­vid­ual risk fac­tors such as high blood pres­sure, cut­ting out smok­ing if you smoke, con­sum­ing only a mod­er­ate amount of al­co­hol if you drink — and get­ting 150 min­utes per week of mod­er­ate ex­er­cise, such as brisk walk­ing.

“Many peo­ple can re­duce their choles­terol num­bers down by be­tween 15pc and 20pc with a con­certed ef­fort, but that is very hard to main­tain,” warns Dr Burke.

“It’s like a New Year’s res­o­lu­tion — the good in­ten­tions can fiz­zle out.

“At the same time, many peo­ple are averse to tak­ing the nec­es­sary med­i­ca­tion to treat high choles­terol. I think it’s an Ir­ish or cul­tural thing — Ir­ish peo­ple are not keen on tablets.”

There are a num­ber of fac­tors in­volved in high choles­terol lev­els — and ge­net­ics and life­style play very ma­jor roles, says Dr Burke.

“Fam­ily his­tory, ge­net­ics, and life­style are huge fac­tors in de­vel­op­ing high lev­els of choles­terol.

“A fatty, un­healthy diet, seden­tary life­style, al­co­hol and smok­ing — these are fac­tors that crop up with my pa­tients over and over again,” he ob­serves.

If your doc­tor rec­om­mends you take med­i­ca­tion, he be­lieves, you should strongly con­sider com­ply­ing.

‘High lev­els can lead to heart at­tack & stroke’

“If you have per­sis­tently el­e­vated choles­terol and have any other car­dio­vas­cu­lar risk such as high blood pres­sure, fam­ily his­tory of heart at­tack and stroke, or di­a­betes, it would be ad­vis­able to treat your con­di­tion with choles­terol med­i­ca­tion.

“Doc­tors are not ped­dling med­i­ca­tion — when you need it, you need it!”

“The med­i­ca­tion is there and it’s safe,” he says, adding that the main treat­ment for choles­terol is statins.

“The big mes­sage about choles­terol is that it’s a very silent and in­nocu­ous-seem­ing con­di­tion,” he ob­serves, warn­ing that peo­ple of­ten un­der­es­ti­mate the risk high choles­terol lev­els can pose to their health.

“Peo­ple tend to push it down the road and say they’ll think about it when they get older. How­ever, if you have high choles­terol lev­els, you’re build­ing up a prob­lem over your life­time.”

Re­mem­ber, ad­vises Dr Angie Brown of the IHF, the only way to know if you have a high choles­terol is to get a blood test.

“It’s im­por­tant to get the full lipid profile, this in­cludes the to­tal choles­terol, the HDL —which is the ‘good’ choles­terol and pro­tec­tive — and the LDL, which is the bad choles­terol and is the one as­so­ci­ated with in­creased risk of de­vel­op­ing car­dio­vas­cu­lar disease.”

The test will also in­clude the triglyc­erides, she says, and if these are raised it is also as­so­ci­ated with a in­creased risk of de­vel­op­ing car­dio­vas­cu­lar disease.

Dr Brown em­pha­sises the fact that LDL lev­els, or bad choles­terol, tends to rise in women af­ter the menopause.

“If peo­ple be­come more seden­tary, if they are obese and if they take ex­cess al­co­hol it can also lead to wors­en­ing lipid lev­els,” she adds.

SEE OVER­LEAF — the statins con­tro­versy PLUS: diet ad­vice

Once high lev­els of choles­terol have be­gun to form plaque in the veins, you can­not get rid of it, doc­tors warn

A healthy diet and reg­u­lar ex­er­cise is the way to go — at any age

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