Cholesterol Management
Why is Too Much Cholesterol a Problem?
Cholesterol has developed a bad name for itself over the years. The truth is that we need cholesterol to survive. It is in every cell of the body, but if we have too much of the wrong type of cholesterol in our blood it can greatly increase our risk of heart disease.
The liver makes about 80 percent of the cholesterol in our bodies. We get the rest from eating fat in our diet. Blood cholesterol levels can become a problem if our usual diet is too rich in fat and/or if the liver begins making too much cholesterol as a result of inherited factors.
Cholesterol (also known as lipid) is transported around the body attached to proteins. The combination of cholesterol and protein is called 'lipoprotein'. There are two basic types of lipoprotein:
Low density lipoprotein (LDL) is also known as 'bad cholesterol' because over time it can build up on the sides of blood vessels with other substances to form plaques. This condition is called 'atherosclerosis' or 'hardening of the arteries'. If a plaque comes free from the side of a blood vessel it can cause a blockage in an artery, preventing a tissue from receiving the oxygen-rich blood that it needs. This is what causes heart attack and stroke.
High density lipoprotein (HDL) is also known as 'good cholesterol' because it carries excess cholesterol in the blood back to the liver where it won't do any harm.
Triglycerides are another form of fat in the blood. High levels of triglycerides can increase the risk of heart disease.
How Can I Reduce My Bad Cholesterol Levels Without Medication?
Diet - It is important for anyone with unhealthy cholesterol levels to eat a 'heart healthy' diet. The Heart and Stroke Foundation of Canada recommends that no more than 25% of the day's calories come from fat.
Different types of fat affect cholesterol levels in different ways:
- Saturated fats (found in meat fat, dairy fat, lard, shortening, palm oil, and coconut oil) and trans-fatty acids (found in french fries, cookies, crackers, and potato chips) tend to raise cholesterol levels the most
- Polyunsaturated fats (found in safflower, sunflower, corn, and soy oils) as well as fish oils and
- monounsaturated fats (found in olive, canola, and peanut oil) may help to reduce cholesterol levels if used in place of saturated fats
Weight - Being overweight tends to increase the levels of LDL (bad cholesterol) and triglycerides while lowering your HDL. Losing just 5 kg can have important benefits for your health that include reduced risk of heart disease.
Physical activity - Regular physical activity can help lower your LDL (bad cholesterol) and raise your HDL (good cholesterol) levels. Health Canada recommends daily exercise ranging from 60 minutes of light activity (e.g. light walking, easy gardening) to 30-60 minutes of moderate activity (e.g. brisk walking, biking) or 20-30 minutes of vigorous activity (e.g. aerobics, jogging). 'Canada's Physical Activity Guide' is available on the worldwide web at www.paguide.com or by phoning 1-866-225-0709.
Medication
Medications are prescribed to reduce cholesterol so that 'target levels' set according to your own personal risk for heart disease are met (see back panel).
Medications are chosen based on their ability to reduce the levels of the type of cholesterol that is not within target range (usually LDL or triglycerides).
Statins - These medications are used most frequently for cholesterol lowering because they are the most effective for reducing levels of LDL (bad cholesterol). They also increase levels of HDL (good cholesterol) to varying degrees. Statins work in the liver to block a substance your liver needs to produce cholesterol. Statins can reduce LDL cholesterol by up to 40% or more. Some common statin drugs include atorvastatin, simvastatin, pravastatin, lovastatin and fluvastatin. Drinking grapefruit juice can increase your risk of side effects with statins (except pravastatin and fluvastatin). Talk with your PROfile® Pharmacist if you have any concerns about this or any potential drug interaction.
Fibrates - These medications are used mostly for their triglyceride-lowering effects. They also help to increase HDL levels. Examples of fibrates include fenofibrate and bezafibrate.
Niacin - This medication is used in large doses to lower LDL, raise HDL, and reduce triglycerides. Facial flushing is a common side effect of this medication.
Resins - These medications lower cholesterol by binding with bile acids in the intestinal tract. Since bile acids are tied up, the liver is required to take cholesterol out of the blood to make more of this digestive substance. Resins can interact with many medications. Your PROfile® Pharmacist can recommend a schedule for taking your medication that best suits your needs and lifestyle.
Ezetimibe - This medication blocks the absorption of cholesterol ingested from food. It can be used alone, but is usually combined with a statin.
Hitting Your Cholesterol Targets
Many scientific studies have shown that the risk of heart attack and stroke are significantly reduced by reaching 'target' LDL (bad cholesterol) levels.
According to the most recent Canadian Guidelines, your target depends on your particular risk for heart disease. Risk factors such as smoking, high blood pressure, and advanced age all contribute to heart disease risk. People with diabetes who are over the age of 30 or who have a history of heart disease are classified as having 'high' risk for heart disease events in the future. Your doctor can help you to determine your heart disease risk category.
LDL (bad cholesterol): The following are targets for LDL values according to risk of heart disease:
- High risk: less than 2.0 mmol/L
- Moderate risk: less than 3.5 mmol/L
- Low risk: less than 5.0 mmol/L
Triglycerides: People at low risk of heart disease (e.g. less than 40 years of age with no risk factors) should keep their triglyceride levels below 3.0 mmol/L. All others should keep their triglyceride levels less than 2.0 mmol/L.
It is important for you to know your LDL level and target. If you aren't aware, you can ask your doctor at your next appointment. This can help keep you motivated towards reaching your targets.
Make sure you keep up your healthy diet and exercise routines even if you are taking medication.
Your heart health depends on it!
Where to Find More Information
The Heart and Stroke Foundation of Canada
222 Queen St., Suite 1402
Ottawa, Ontario K1P 5V9
Phone: 613-569-4361
Check your local phone listings for the regional office nearest you or visit their website.
ww2.heartandstroke.ca
Canadian Lipid Nurse Network
e-mail: info@lipidnurse.ca
www.lipidnurse.ca
Heart Center Online
Canadian Health Network
Canada's Physical Activity Guide
Canada's Food Guide to Healthy Eating
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