Chronic Conditions

Cholesterol is a type of fat that is produced by your body and is also found in foods that come from animal sources (meat and dairy products, poultry, and fish). Your body's cells need cholesterol to function properly. However, it is common for excess cholesterol in the blood to build up inside your arteries (atherosclerosis), causing them to narrow. Atherosclerosis is the starting point for most heart and circulation problems.

Cholesterol travels through your bloodstream attached to protein, in a combination called a lipoprotein. Two lipoproteins are the main carriers of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

• LDL ("bad cholesterol") carries cholesterol from the liver to other parts of the body. Under certain conditions, LDL cholesterol can build up on the walls of the arteries. Having a high LDL cholesterol level increases your risk for coronary artery disease (CAD), heart attack, and stroke.

• HDL ("good cholesterol") helps clear LDL cholesterol from the body by picking up cholesterol from the bloodstream and taking it back to the liver for disposal. Increasing your HDL cholesterol level may reduce your risk for heart disease.

  What Do the Numbers Mean? Doctors don't agree on which cholesterol numbers are most useful in determining your risk for heart disease. The most commonly used values are listed here. The importance of these numbers varies from person to person, depending on whether a person has additional risk factors for heart disease. Desirable: All of the following: Total cholesterol (HDL plus LDL) below 5.2 mmol/L HDL cholesterol above 0.9 mmol/L in men or above 1.2 mmol/L in women LDL cholesterol below 3.4 mmol/L Borderline high-risk: 1 or more of the following: Total cholesterol between 5.2 and 6.2 mmol/L LDL cholesterol between 3.4 and 4.1 mmol/L High-risk: 1 or more of the following: Total cholesterol above 6.2 mmol/L HDL cholesterol below 0.9 mmol/L in men or below 1.2 mmol/L in women LDL cholesterol 4.2 mmol/L or higher

Triglycerides are another type of fat that can be found in the bloodstream. A high triglyceride level may also increase your risk of developing coronary artery disease and having a stroke.

Experts don't agree on the best schedule for cholesterol testing. You and your doctor can determine the schedule that is best for you based on your risk factors for coronary artery disease. One recommendation is to start cholesterol screening at age 35 for men and age 45 for women.

Basic cholesterol screening tests are easy, quick, and inexpensive. Call your local health unit or public health office to find out when free or low-cost cholesterol tests may be available.

If your total cholesterol is over 5.2 mmol/L (millimoles per litre), or if you have any of the following risk factors for coronary artery disease, you may want to have your cholesterol checked more often:

• Having a family history of early heart attack (before age 55 in father or brother; before age 65 in mother or sister).

• Being a cigarette smoker.

• Having high blood pressure (over 140/90) or taking high blood pressure medication.

• Having diabetes.

If your total cholesterol is over 5.2 mmol/L, and you don't know what your HDL and LDL levels are, more extensive testing can help you better estimate your actual risk.

For most people, a low-fat diet and exercise are all that are needed to lower cholesterol. People who have very high cholesterol or already have coronary artery disease (or who are at very high risk for CAD) may need medication as well as exercise and a low-fat diet to lower their cholesterol.

• Eat less total fat, especially saturated fat. Follow the guidelines for eating less fat on See Simple Ways to Reduce Fat.

• Attend a low-fat diet workshop or consult a registered dietitian to learn ways to lower your fat intake to 30 percent or less of total calories, based on your goal.

• Eat 2 to 3 servings (50 to 112 g or 3 to 4 oz) of baked or broiled fish per week. The safety and value of fish oil supplements is not yet known.

  Reversing Coronary Artery Disease There is some evidence that coronary artery disease can be reversed by making major lifestyle changes, including eating a strict low-fat diet. Other studies indicate that moderate restriction of dietary fat is probably as good as a strict low-fat diet. The Lifestyle Heart Trial found that people who followed a low-fat vegetarian diet, quit smoking, began exercising, and practised relaxation techniques daily actually showed some decrease in the amount of fat and calcium build-up in their arteries. Although this was a very small study, other studies have shown similar improvements with less severe diet restrictions. In the past, cholesterol-lowering drugs were only given to people with high cholesterol. Newer studies show that such drugs may also help people with normal or borderline high cholesterol levels who have signs of or risk factors for heart disease. In these people, cholesterol-lowering drugs may help prevent atherosclerosis from developing or getting worse. They also appear to lower the risk of heart attack and stroke.

• Eat more soluble fibre (fruit, dry beans and peas, oats). See Soluble fibre.

• Exercise more. Exercise increases your HDL cholesterol level.

• Quit smoking. Smoking increases the risk of heart attack and stroke, even in people with low cholesterol.

• Lose weight. Losing even 2.5 to 4.5 kg (5 to 10 lb) can lower LDL and triglyceride levels and raise HDL levels.

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