Cholesterol is a type of lipid or fat which is a waxy material that is manufactured in your liver and is also found in meat as well as dairy products. Your body necessitates at least some cholesterol to function at its optimum as cholesterol forms an indispensable part of your cell membranes and it is also necessary to synthesise vitamin D, bile acids as well as hormones. However, too much cholesterol is damaging. Cholesterol is a chief part of the plaque that is the cause of the hardening and the narrowing of the arteries in atherosclerosis and it is the underlying cause of strokes and heart attacks.

  • When blood cholesterol levels are tested, the total cholesterol, as well as the different kinds of cholesterol is determined.
  • Because lipids are incapable of travelling through the bloodstream on its own, cholesterol travels by fastening to a protein and forming a little package which is known as lipoprotein.
  • The thickness of a lipoprotein is determined by its lipid-to-protein quotient.
  • A low-density lipoprotein (LDL) has a high ratio of lipid-to-protein and is predominantly high in cholesterol.
  • A high-density lipoprotein (HDL) has more protein in relation to its lipid content.
LDL Cholesterol:

LDL cholesterol is considered to be the "unhealthy" or bad cholesterol that is found in the fatty deposits in the arteries and can cause heart disease and heart attacks; in other words, the higher the LDL level, the greater the risk of heart disease.

HDL Cholesterol:

HDL cholesterol is considered to be the "healthy" cholesterol that assists to clear excess cholesterol from the blood and arteries and then back to the liver. The lower the HDL level, the higher the risk for heart disease.

When there is too much cholesterol in your blood, it builds up in the walls of the arteries which in turn cause something that is called atherosclerosis which is a type of heart condition. The arteries then become narrowed and blood flow to the heart muscle is slowed down or completely blocked.

The blood carries oxygen to the heart and if enough blood and oxygen cannot reach the heart chances are you will suffer chest pains and if the blood supply to a portion of the heart is cut off altogether the end result will be a heart attack. Suffice to say, high blood cholesterol, particularly when the ration of LDL to HDL is high, is a predictor of cardiovascular disease.

A survey of high cholesterol levels in South Africa (total cholesterol greater than 5 mmol/L) revealed that the majority of our adult Coloured, Indian and White population suffer from high cholesterol.

In these population groups:

7 out of 10 men;

6 out of 10 women over the age of 20 suffer from high cholesterol.

High cholesterol increases the risk of a heart attack. The lowering of cholesterol is important for everyone: whether you are young or old, male or female, suffering from heart disease, or not.

The nasty fact is that in people over the age of 45, heart disease and stroke overtake HIV/AIDS as the leading cause of death among South Africans! It is important to remember that by lowering cholesterol that is too high you lessen your risk for developing heart disease and possibly dying from a heart attack.

Also remember, your cholesterol can be controlled.

Cholesterol is a fatty substance which means it does not dissolve in our bloodstream. Because of this, cholesterol needs a special way in which to move throughout the body. This 'transport' system consists of two types of carriers.

Low Density Lipoprotein (LDL)-cholesterol carries cholesterol from the liver (where it is manufactured) through the bloodstream to the cells. LDL-cholesterol is called the 'bad' cholesterol for good reason because as LDL-cholesterol moves through the body, excess LDL-cholesterol builds up on the inside of artery wall, which causes them to narrow and become less flexible. This is known as atherosclerosis and is what increases your chance of a heart attack, heart and blood vessel (cardiovascular) disease or stroke, which is why your LDL-cholesterol level has to be LOW.

High Density Lipoprotein (HDL)-cholesterol returns the excess cholesterol that is not needed from the bloodstream back to the liver. The reason HDL-cholesterol is called 'good' cholesterol is because HDL-cholesterol removes the bad cholesterol from the bloodstream.5B Some experts believe that HDL-cholesterol can even remove excess cholesterol from the artery wall, which is why your HDL-cholesterol level needs to be HIGH. A high HDL-cholesterol level seems to protect against heart disease.

LDL-cholesterol level:
  • 'Bad' cholesterol
  • Carries cholesterol from the liver to the cells.
  • Level needs to be LOW
HDL-cholesterol level:
  • 'Good' cholesterol
  • Accumulates inside artery walls.
  • Carries excess cholesterol away from the arteries and back to the liver.
  • Level needs to be HIGH

If you are eager to increase high density lipoprotein, otherwise known as HDL cholesterol which is the "good' cholesterol in your blood, there are some things that you should incorporate into your lifestyle. HDL assists in removing the LDL - low density lipoprotein which is the "bad' cholesterol build-up in your blood.

Here are a couple of things that you should be doing to increase the HDL levels in your blood:

Stop Smoking - even second-hand smoke is bad for you. Quitting entirely improves HDL cholesterol and lowers your blood pressure.

Get Moving - regular aerobic exercise can help raise HDL cholesterol. With the go-ahead from your medical practitioner, work out for up to 30 minutes a day. Have your workout monitored. Any and every activity can help - even small things such as gardening and house work.

Eat Wisely - up your grains especially if you are overweight. Shedding as little as 4, 5 kg can increase the HDL cholesterol in your blood and can lower your blood pressure. Eat whole grains and vegetables and fruits. Did you know that the potassium in bananas can help to lower your blood pressure? Cut back on saturated animal fats, commercial products with partially hydrogenated vegetable oils, alcohol and salt. Rather use herbs, celery, garlic and onions to flavour your food as well as salt-free spices. Also counter cholesterol with soluble fibre such as that found in oats and legumes. Get protective omega-3 fatty acids from oily fish such as pilchards and sardines as well as salmon at least twice a week, or a tablespoon of flax seeds sprinkled on your food and a few raw walnuts or almonds and drink plenty of water every day.

Get into the habit of eating a balanced diet, stop smoking and do exercise every day to increase the "good" cholesterol, or HDL cholesterol in your blood. A lack of positive factors in your life is a bigger stress than the presence of negative ones.

If you are a healthy person, your cholesterol levels should be:
  • LDL-cholesterol less than 3 mmol/L
  • Total-cholesterol less than 5 mmol/L

Once you have had your cholesterol tested and it is found that your levels are too high, the next step is to determine your risk of developing major heart disease (e.g. a heart attack).

High cholesterol itself does not cause any symptoms; so many people are unaware that their cholesterol levels are too high. It is therefore of the utmost important to find out what your cholesterol numbers are.

According to the South African Heart and Stroke Foundation, the resulting are target values:

Total cholesterol: less than 5.0 mmol/l (millimols per litre)

LDL cholesterol: less than 3.0 mmol/l

HDL cholesterol: greater than 1.2 mmol/1

If you are not certain whether you have high cholesterol, a simple test carried out by a clinic or your doctor will soon determine the levels of cholesterol in your bloodstream. Your doctor will diagnose high blood cholesterol by checking the cholesterol levels in your blood by means of a test which is called a lipoprotein panel which is specifically designed to measure the cholesterol levels in your blood.

It is important to fast for between nine to twelve hours prior to having a lipoprotein panel test carried out - this means absolutely no eating or drinking beforehand.

This is what the lipoprotein panel will be able to tell your doctor about your cholesterol levels:
  • Total cholesterol - this is a measure of the entire amount of cholesterol detected in your blood, which includes both HDL and LDL levels.
  • LDL cholesterol, which is the "unhealthy or bad" cholesterol, is the main reason of cholesterol that causes blockages in your arteries.
  • HDL cholesterol which is the "good" cholesterol assists in the removal of the cholesterol build-up in your arteries.
  • Triglycerides are fats that are found in the bloodstream - it is believed that a high level of these in the blood will increase the risk of heart disease, especially in females.

You can have your cholesterol tested at a pharmacy without having a lipoprotein panel test done; knowing your total cholesterol and HDL cholesterol will be able to put you in the picture as far as your cholesterol levels are concerned. Fasting is not required if you are having a total and HDL cholesterol test.

Reasons for raising your triglyceride levels include being overweight or obese. If you are sedentary and never exercise this could cause high cholesterol. Smoking, excessive drinking, a diet high in carbs, genetics all contribute to high cholesterol.

It is only when there is too much bad cholesterol in your blood (hypercholesterolaemia) that your risk of a heart attack, heart disease and stroke are increased. Excess LDL-cholesterol, which is left behind in your arteries, including the small arteries supplying the heart, cause narrowing and blockages of the arteries (atherosclerosis).

When the heart arteries become clogged, not enough blood can flow through them to reach the heart. This results in chest pain (angina). When the artery is completely cut off by a total blockage (e.g. a blood clot forming on top of the cholesterol deposit), the result is a heart attack.

High cholesterol in itself does not cause symptoms (it shows no signs of its presence), leaving a lot of people UNAWARE of the fact that they actually do have high cholesterol. This is why it is important for you to find out what your cholesterol levels are, because by lowering cholesterol that is too high you can lessen your risk for developing heart disease and suffering from a heart attack or stroke.

You have been diagnosed with high cholesterol and would like to know how to treat this condition, the first step in the right direction is to start eating right to prevent heart disease and stroke. Even if you have many years of unhealthy eating behind you, by simply making a couple of changes to your diet, you can vastly reduce cholesterol and improve your health - here's how:

  • Choose unsaturated fats: saturated fats which are found in red meat and dairy products raise your total cholesterol and LDL cholesterol.
  • As a general rule, you get no more than 10% of your daily calories from saturated fat.
  • Instead, choose leaner cuts of meat, low-dairy and monounsaturated fats which are found in olive oil and canola oils which are healthier options.
  • Eliminate Trans fats: Trans fats can be found in fried foods and many commercially baked products - these include cakes, cookies, crackers and snack cakes.
  • Never rely on packages that are labelled "trans-fat-free".

You can usually tell if a food has trans-fat in it if it contains partially hydrogenated oil.

To limit the cholesterol in your food, you need to know where it comes from. Dietary cholesterol comes from poultry, meat, fish and daily products. Organ meats such as liver are particularly high in cholesterol, while foods of plant origin contain no cholesterol.

It is a good idea to aim for no more than 300 mg of cholesterol every day - this is less than 200mg if you have heart disease. Opt for lean cuts of meat, egg substitutes and skim milk.

Stock up on fruit and veg - fruit and veg are rich in dietary fibre which assists in lowering cholesterol.

The below are some common medications for lowering cholesterol:

Statins block the production of cholesterol in the liver itself. They lower LDL cholesterol and triglycerides and have a mild effect in raising HDL cholesterol. These drugs are the first route of management for most people with high cholesterol. Side effects could include intestinal problems, liver harm and muscle sensitivity or weakness.

Niacin is a B-complex vitamin. It is found in food, but is also available in high doses as a prescribed drug. It lowers LDL cholesterol and raises HDL cholesterol. These drugs also lower raised triglycerides. The chief side effects are flushing; itching, tingling and headaches; aspirin can decrease many of these symptoms. Niacin found in dietary supplements should not be used to lower cholesterol.

Bile acid sequestrants work inside the intestine where they bind to bile and stop it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol so these drugs work by decreasing the body supply of cholesterol, thus lowering total and LDL cholesterol. The most common side effects are constipation, gas and an upset stomach.

Fibrates lower triglyceride levels and can increase HDL and lower LDL cholesterol. The mechanism of action is not clear but it is thought that fibrates enhance the breakdown of triglyceride -rich particles and reduce the secretion of certain lipoproteins. In addition, they induce the synthesis of HDL.

Even with meds for the treatment of cholesterol you will need to augment your treatment with diet and lifestyle changes. Cholesterol-lowering medicine is most effective when combined with a low-cholesterol diet and an exercise programme.