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Overview

High total 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 total 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.

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.

There are two types of blood cholesterol:

• High density lipoprotein or HDL: helps flush out your arteries and sends unhealthy material back to the liver for further processing. HDL cholesterol is good for your heart.
• Low density lipoprotein or LDL: if you have too much LDL cholesterol it 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 can further increase your risk if you eat foods high in saturated fat and/or trans fat are overweight or physically inactive.

Symptoms

Just like high blood pressure high cholesterol can be 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 total blood cholesterol or who have diabetes should be checked more frequently. Your doctor can help you decide how often is best for you.

Ways to Improve Your Blood Cholesterol

1. Lifestyle Changes--include making healthy food choices being physically active on a regular basis not smoking and maintaining a healthy weight. .

2. Drug Treatment--if cholesterol-lowering drugs are needed they should be used in addition to lifestyle changes.

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.

Your doctor will take several risk factors into account such as your age blood pressure sex and whether you have diabetes or stroke when determining what the right blood cholesterol target is for you. The following are blood cholesterol targets based upon your doctor's assessment of your risk:

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

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

Low risk: 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.

Food: The good bad and ugly

Saturated fat and trans fat in the diet are important contributors 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. Many trans fatty acids are fats produced when unsaturated oils are hardened by hydrogenation or heated to high temperatures. They are found mostly in hard 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. Many manufacturers are now taking trans fatty acids out of their products but be sure to read the Nutrition Facts table on food labels to ensure that product is both trans fat free and low in saturated fat.

Prevention

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

• Losing weight
• Exercising regularly
• Choosing foods with little or no saturated and trans fat including lower fat dairy products lean meats fish and skinless poultry. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain zero trans fat (sometimes referred to as ·non-hydrogenated').
• Eating more fruit and vegetables whole grains and nuts (assuming you have no allergies).
• Eating foods high in soluble fibre which may help lower cholesterol such as oats oatbran psyllium apples pears citrus fruit and legumes (beans peas and lentils)
• If you drink alcohol discuss your level of intake with your doctor and reduce it if necessary.
• Having your doctor check your cholesterol and blood pressure regularly
• Not smoking

Managing your blood 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.

Additional Resources

Heart and Stroke Foundation of Canada

The Healthy Heart Kit