Your Health

Cholesterol a warning sign of heart trouble

Mediterranean diet.
Photo of Donna Alden-Bugden DONNA ALDEN-BUGDEN
Winnipeg Regional Health Authority
Published Friday, October 7, 2016

A stroke or a heart attack can sometimes appear to happen, without notice.
In truth, however, these kinds of events are often preceded by any number of warning signs.

For example, high cholesterol levels have long been considered an important risk indicator for heart trouble and stroke. In fact, the Centers for Disease Control in the United States estimates people with high cholesterol have about twice the risk for heart disease as those with lower levels of cholesterol.

As a result, many health-care providers make it a practice to routinely check cholesterol levels in their patients, starting at age 40. Routine checks for some patients may start even sooner, particularly if they have a family history of high cholesterol or other risk factors such as diabetes, obesity, previous heart attack or previous stroke.

To understand why health-care providers pay so much attention to cholesterol levels, it helps to have a basic understanding of what they are and what they do.

The first thing to remember is cholesterol is not an altogether bad thing. It is a type of fat that plays a role in the production of vitamin D and various hormones. In other words, cholesterol is important for the maintenance of healthy body function.

The tricky thing about cholesterol, though, is there are two types — good and bad.

Bad cholesterol, also known as low-density lipoprotein (LDL-C), is a waxy substance that can create plaque in your arteries, thereby reducing the flow of blood. Good cholesterol, known as high-density lipoprotein (HDL-C), helps keep the bad cholesterol in check. Problems can occur if your good cholesterol is too low and your bad cholesterol is too high. This combination of events is usually called high cholesterol.

Historically, health-care providers have sought to keep their patients’ cholesterol levels within certain ranges. For example, experts say good cholesterol should be greater than 1.0 millimole per litre (mmol/L) for males and 1.3 mmol/L for females. Bad cholesterol, meanwhile, should be kept below 2.0 mmol/L to below 5.0 mmol/L, depending on a person’s risk.

Your health-care provider can calculate your risk using something called the Framingham Risk Assessment. Essentially, this tool is an algorithm that calculates your chances of having a heart attack in a 10-year period by combining your measured cholesterol levels and other possible risk factors with some lifestyle information and your age.

Once the risk assessment has been calculated, your health-care provider will determine if you need treatment for high cholesterol. People at low risk (less than 10 per cent), are usually not treated, while those at high risk are generally treated with drugs called statins (e.g., rosuvastatin) and sometimes with other drugs such as Ezetimibe or fibrates (e.g., fenofibrate). People considered to have an intermediate risk (10 to 20 per cent) are usually assessed on an individual basis to determine if they need treatment.

It is worth noting people with high cholesterol should also pay attention to their triglyceride levels. Coupled with high cholesterol, triglycerides — which are another kind of fat — can also increase the risk for heart trouble and stroke. Eating too many refined carbohydrates, obesity, inactivity, diabetes and family history can cause high triglycerides.

Interestingly, most of the cholesterol in your body (about 80 per cent) is made in the liver, with the rest coming from dietary sources. However, this does not mean one should be fatalistic about cholesterol levels. Indeed, health experts say many people can keep their cholesterol in check through diet, exercise and other lifestyle choices. Here are a few tips:

  • If you drink, drink moderately. If you smoke, quit.
  • Watch your diet. Eat food that is low in saturated fat and trans fat. The Mediterranean diet is frequently recommended for people who are trying to control their cholesterol levels.
  • Get active. Most experts say adults need at least 60 minutes of moderate to vigorous exercise at least three times a week to maintain their health.
  • Reduce stressors in your life and make sure you get a good night’s sleep.

High cholesterol is a warning sign of potential trouble. The best advice is to have your cholesterol checked regularly and take action to control it.

Donna Alden-Bugden is a family nurse practitioner at the McGregor Quick Care Clinic. This column or originally published in the Winnipeg Free Press on Friday, Oct. 7, 2016.

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