UNDERSTANDING CHOLESTEROL TO BETTER CONTROL IT

In Canada, cardiovascular disease is the second leading cause of death after cancer. High cholesterol is one of the risk factors for cardiovascular events that can be controlled. Therefore, it is important to understand the role of cholesterol and what can be done to reduce high blood cholesterol levels.

WHAT IS CHOLESTEROL?

Cholesterol is a fatty substance primarily synthesized by the liver, with several vital functions in the body. It contributes to the production of essential hormones like estrogen and testosterone, plays a role in generating vitamin D, and aids in the digestion of fats and the absorption of nutrients through bile production.

To travel within the bloodstream, cholesterol attaches itself to transport proteins, forming lipoproteins. The two main types of lipoproteins are:

  • Low-density lipoprotein (LDL) cholesterol, often referred to as “bad” cholesterol, is responsible for carrying cholesterol from the liver to the body’s cells.
  • High-density lipoprotein (HDL) cholesterol, often called “good” cholesterol, assists in removing excess cholesterol by transporting it away from the cells.

WHAT ARE THE CONSEQUENCES OF EXCESS CHOLESTEROL IN THE BLOOD?

When an excess of LDL cholesterol is present in the bloodstream, it can accumulate on the inner walls of blood vessels, forming deposits known as plaque.

With time, persistent high levels of LDL cholesterol can lead to the progressive growth of this plaque, narrowing the blood vessel passages. It’s important to note that plaque can develop in multiple arteries simultaneously.

Furthermore, the plaque has the potential to break apart into fragments, forming clots that have the capacity to completely obstruct the blood flow. When such blockages occur in the coronary arteries, they can result in a heart attack, while blockages in the cerebral arteries lead to strokes.

WHY DO SOME PEOPLE HAVE TOO MUCH LDL-CHOLESTEROL?

Numerous factors can elevate the risk of high LDL-cholesterol, including:

  1. Unhealthy diet, particularly one rich in trans fats and saturated fats.
  2. Lack of physical activity or a sedentary lifestyle.
  3. Being overweight.
  4. Chronic stress.
  5. Smoking.
  6. Aging.
  7. Inherited genetic conditions in certain families may also cause elevated cholesterol levels.

It’s essential to recognize that the liver is responsible for producing the majority of LDL-cholesterol (approximately 80%), regardless of our lifestyle. In some cases, high cholesterol levels are attributable to a hereditary condition.

WHAT ARE THE SYMPTOMS OF HIGH CHOLESTEROL LEVELS IN THE BLOOD?

LDL-cholesterol itself does not cause any symptoms. It is usually discovered to be too high when blood tests are done as part of a check-up, or when the person has a cardiovascular event such as a heart attack or stroke.

WHAT CAN BE DONE TO LOWER CHOLESTEROL LEVELS?

Lifestyle modifications are crucial for managing high cholesterol, and here are some recommendations to improve your lifestyle:

  • Eat a Healthy Diet: The typical North American diet often includes foods high in animal products, processed meats, and processed foods, which can contain cholesterol, saturated fats, and trans fats. These fats can increase LDL-cholesterol production in the liver. To manage cholesterol, limit your intake of these fats and consume foods with high cholesterol but low saturated fat, like egg yolks, some seafood, and organ meats, in moderation. Making gradual changes in your diet, starting with eliminating processed foods and preparing your meals with healthy ingredients like fruits, vegetables, high-fiber foods, plant-based proteins, and small amounts of lean meats, can have a lasting impact. If you require dietary guidance, consider consulting a registered dietitian.
  • Engage in Regular Physical Activity: Research has shown that physical activity can raise levels of HDL-cholesterol, known as the “good” cholesterol, and benefit overall physical and mental health. Regular exercise can aid in weight management and stress reduction. You don’t need to become a professional athlete, as it’s recommended to engage in at least 30 minutes of daily physical activity, at least five times a week. Choose an activity that suits your routine, like walking, and consider doing it with a friend or joining a group to stay motivated. If you have a chronic health condition, consult your healthcare team for any necessary precautions.
  • Achieve and Maintain a Healthy Weight: Obesity is linked to higher LDL-cholesterol levels and lower HDL-cholesterol levels. Improving your diet and increasing physical activity can help with weight loss. For medical weight management, consult a healthcare professional.
  • Manage Stress: Extended periods of stress have been associated with elevated LDL-cholesterol levels. Learn stress-reduction techniques like meditation, mindfulness, deep breathing, or relaxation. Identify sources of chronic stress in your life and work on reducing or eliminating them, even if it requires questioning priorities. These changes can have a positive impact on your overall health and well-being.
  • Stop Smoking: Smoking lowers HDL-cholesterol and elevates the risk of cardiovascular disease. If you’re a smoker, seek assistance from your pharmacist. In most provinces, pharmacists can prescribe smoking cessation medications to help you quit. Don’t hesitate to seek advice and support for quitting smoking.

WHEN SHOULD PHARMACOLOGICAL TREATMENT BE CONSIDERED?

If you are not at high risk for a cardiovascular event (such as a heart attack or stroke), you will usually start with lifestyle changes before considering drug treatment. If LDL-cholesterol levels are still too high after a few months of lifestyle changes, drug treatment may be prescribed.

However, if your LDL-cholesterol is very high, or if you are at high risk for a cardiovascular event (for example, if you have had a heart attack or stroke, or if you have diabetes or chronic kidney disease), drug treatment should usually be started at the same time as lifestyle changes.

Several medicines can lower LDL-cholesterol. Your healthcare provider will prescribe the one that is best for you.

YOUR PHARMACIST, YOUR ALLY TO ACHIEVE YOUR GOALS

If you have questions about cholesterol or cholesterol-lowering medicines, see your pharmacist. In addition to answering your questions, your pharmacist can help you make lifestyle changes and refer you to other professionals, such as a registered dietitian or kinesiologist, if needed.

In some provinces, pharmacists may offer a service to help you achieve your cholesterol reduction goals. Check with the staff at your local pharmacy for more information.