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Overview

High blood cholesterol is an excessive amount of cholesterol a fat-like substance found in your bloodstream and in your body's cells. Almost half of all adult Canadians have unhealthy cholesterol levels. If you have high blood cholesterol you are more likely to have a heart attack or a stroke. It is especially dangerous for people who smoke and for those with high blood pressure or diabetes.

Causes

Cholesterol plays a critical role in the formation and maintenance of healthy cells. It helps them resist changes in temperature protects and insulates nerve fibres and helps in the formation of sex hormones. Your body naturally produces all the cholesterol it needs.

The problem is that cholesterol is also found in certain foods. In choosing what to eat you need to know which foods contain bad cholesterol and which contain good cholesterol. Your overall cholesterol may be misleading as it may be high because of lots of good cholesterol or bad cholesterol. This is why when doctors assess your cholesterol they are usually interested in the ratio of your good cholesterol to your overall cholesterol.

Good cholesterol: Officially known as high density lipoprotein or HDL (think of the "H" as healthy this can help flush out your arteries and send the unhealthy material back to the liver for further processing. Increasing your physical activity can raise your HDL.

Bad cholesterol: Officially known as low density lipoprotein or LDL (think of the "L" as lousy). When you consume too much of this cholesterol in your diet your liver might fail to process all of it leaving it to circulate in your blood. This can narrow or clog your arteries. If your coronary arteries are blocked you could have a heart attack while a blocked blood vessel in the brain can lead to a stroke.

Most at risk are people with a family history of high cholesterol and those with certain medical conditions such as diabetes. Age plays a role too as your cholesterol tends to rise as you get older. Men are at a higher risk than women. You further increase your risk if you eat foods high in saturated fat and dietary cholesterol are overweight or physically inactive.

Symptoms

Just like high blood pressure high cholesterol is a silent killer. There are no obvious symptoms. All healthy adults should have their blood cholesterol level checked periodically. Those who have a family history of high blood cholesterol or who have diabetes should be checked more frequently. Your doctor can help you decide how often is best for you.

Treatment

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk the lower your LDL goal will be. There are two main ways to lower your cholesterol:

1. Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering diet (called the TLC diet) physical activity and weight management. TLC is for anyone whose LDL is above goal.

2. Drug Treatment--if cholesterol-lowering drugs are needed they are used together with TLC treatment to help lower your LDL.

When you have your blood cholesterol checked the lab will report on three types of cholesterol and also triglycerides. Triglycerides are the most common fats in the diet and in the blood. If you have a high reading of LDL or triglycerides or a low reading of HDL you may have a higher risk of having heart disease. Both cholesterol and triglycerides are measured in millimoles per litre or mmol/L for short.

High risk target: LDL level less than 2.5 mmol/L and ratio of total cholesterol to HDL of less than 4.0 mmol/L

Moderate risk target: LDL level less than 3.5 and ratio of total cholesterol to HDL of less than 5.0

Low risk target: LDL level less than 4.5 and ratio of total cholesterol to HDL of less than 6.0

New guidelines emphasize a more aggressive approach to lowering cholesterol levels and recommend that people at high risk - for example those with a history of heart disease or diabetes - be treated with lipid-lowering drugs immediately along with any necessary lifestyle changes.

Prevention

You can help control and possibly even prevent high blood cholesterol by:

Lowering your cholesterol reduces your risk of developing coronary artery disease or suffering a heart attack or stroke. Research has shown that your risk is cut by 2 per cent for every one per cent decrease in total cholesterol.

Food: The good bad and ugly

Saturated fat in the diet is an important cause of high cholesterol levels in the blood. Saturated fats are found especially in animal foods such as meat butter and cheese. They are also found in palm oil and coconut oil. Trans fatty acids are fats produced when unsaturated oils are hardened by hydrogenation or heated to high temperatures. They are found mostly in some margarines shortening and foods made from them. Most store-bought baked goods snack foods cake mixes and frozen dinners contain either saturated fats or trans fatty acids. You can see the fat in meats but not in these products so it is best to avoid these products.

The cholesterol we eat can also add to blood cholesterol levels. However since all foods that come from animals contain cholesterol we can't avoid getting some cholesterol if we eat meat or dairy products. Egg yolks and organ meats like liver are very high in cholesterol.

What to eat:

Foods low in saturated fat include fat free or 1% dairy products lean meats fish skinless poultry whole grain foods and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats egg yolks and full-fat dairy products.

Additional Resources

Heart and Stroke Foundation of Canada

The Healthy Heart Kit