We all need some cholesterol: it helps make new cells and keeps us healthy. The challenge is to have the right amount of cholesterol in your system. Too much of the wrong type of cholesterol and you’re at risk of developing cardiovascular disease (CVD). 

What Is Cholesterol?

Cholesterol is a type of fat or lipid that circulates in your blood, helping to build cell membranes, aiding in the production of hormones and in the absorption of fat from food. Particles called lipoproteins move cholesterol through your blood. It’s very easy to have too much cholesterol in your blood, which can lead to artery damage and CVD. 

There are three main components of cholesterol to be aware of: LDL, HDL and Triglycerides. 

• LDL (low-density lipoprotein): The L could stand for “lousy” cholesterol, because of its potential to damage your cardiovascular system. LDL carries most of the cholesterol in the blood to be stored away for future use.
• HDL (high-density lipoprotein): This is the “healthy” cholesterol that carries cholesterol from the body to the liver, where it is eliminated.
• Triglycerides: The most common type of fat in your body, triglycerides transport and store fat in the blood. When you eat excess calories, especially sugar and alcohol, they are stored as triglycerides.
  • Watch this video for an overview of cholesterol. 

How Does Cholesterol Influence Heart Health?

Cholesterol’s components — LDL, HDL, and triglycerides — work together for the healthy functioning of your body. But too much or too little of these fats can spark a destructive process that can lead to cardiovascular disease.

Too much LDL can lead to a buildup of plaques on the walls of blood vessels, causing them to narrow or harden and restrict blood flow. This is known as atherosclerosis. 

Narrowing of the blood vessels that lead to the heart can cause coronary artery disease, angina, and heart attack. When plaques break away from the wall of a blood vessel and block an artery, that’s called a heart attack. Narrowing of the blood vessels leading to the brain can cause stroke.

Too little HDL enables harmful LDL to linger in the arteries instead of moving to the liver, where it would naturally be eliminated from the body.

Too many triglycerides increase the likelihood of hardening of the arteries, which raises the risk for heart disease, stroke and heart attack.

Not only does high cholesterol strongly increase your chances of having a heart attack or developing cardiovascular disease, it also increases your chances of developing other serious health problems, such as coronary artery disease, stroke, high blood pressure, diabetes and obesity.

Who Is at Risk for High Cholesterol?

If you eat, you’re at risk of having unhealthy cholesterol levels. This risk increases significantly when any of the following factors are present. Talk to your healthcare provider if even one of the following risk factors applies to you.¹

• Over the age of 40 or postmenopausal 
• Family history of pre-mature heart disease  
• Family history of dyslipidemia (high cholesterol) 
• You’ve experienced a previous heart attack or stroke 
• Diabetes, obesity, high blood pressure (hypertension) and/or kidney disease  
• Current cigarette smoker 
•  Inflammatory disease 
•  HIV infection  
• Chronic obstructive pulmonary disease (COPD) 
• History of hypertensive disorder of pregnancy (hypertension, pre-eclampsia, HELLP syndrome) 
• Erectile dysfunction 

What Causes High Cholesterol?

A variety of factors can affect your cholesterol levels. Some risk factors for high cholesterol cannot be controlled. High cholesterol can be hereditary, and levels of LDL naturally rise as people get older. Cholesterol levels also tend to rise for women after menopause. However, your cholesterol levels can also be influenced by factors that can be modified. Here are a few to consider: 

• A diet too high in saturated fat, trans fat, and cholesterol 
• Excess weight around the abdomen 
• Lack of exercise 
• Smoking 
• High blood pressure 
• Diabetes 

How Do I Know If I Have High Cholesterol?

Based on your risk factors, your healthcare provider will determine when it is necessary for you to be tested and how often. The blood test to measure your cholesterol levels is called a lipid assessment. Blood cholesterol is measured in millimoles per litre (mmol/L).  It measures your total cholesterol, triglycerides, LDL, and HDL levels.  Total cholesterol/HDL (TC/HDL) is a ratio used to measure your cardiovascular risk. TC/HDL is calculated by dividing your total cholesterol number by your total HDL cholesterol number.

The following chart illustrates the target cholesterol ranges: 

• Coronary Artery Disease and Recovery After a Heart Attack
• A Guide to Women’s Heart Health 

What If My Cholesterol Levels Are Too High?

There are two main tools for managing cholesterol and many patients require both:

1. Medication
2. Lifestyle changes

Making recommended lifestyle changes can improve your cholesterol by 5% to 10% but medications have been shown to lower LDL cholesterol by 20% to 55%. ² As a result, medication is often required in combination with lifestyle changes, such as quitting smoking and increasing exercise.

Several types of drugs are available to lower your cholesterol. Your healthcare provider will help you decide which one is best for you. Keep in mind, these medications do not cure high cholesterol, nor will they replace a healthy lifestyle. 

Cholesterol-Lowering Drugs 

All patients who already have coronary heart disease or diabetes should be treated with a statin. Statins are safe and effective drugs for lowering cholesterol. Some patients may require the addition of a second medication. Statins, such as Lipitor® or Crestor®, are the most common types of medications used to treat high cholesterol. Resins (Questran®, Ezetrol®), fibrates (Bezalip®, Lipidil®), and niacins (Niaspan®) are other types of cholesterol-lowering medications available. 

If you’ve been prescribed medication, be sure to follow the prescription plan your healthcare provider has set up for you. Remember to: 

• Never stop taking your medication just because you are feeling better. 
• Write down any symptoms you may experience so that you can remember to discuss them with your healthcare provider. 
• Keep track of your medication, especially if you are taking multiple pills. A pocket medication card can help. 
• Be on time and consistent with your medication so that it remains effective. 

Lifestyle Changes 

For most people, medication alone isn’t enough. Every 1 mmol/L reduction in LDL is associated with a 20 to 25% decrease in cardiac death and heart attack (3).

Here are some strategies to consider:   

Choose heart-healthy foods  

Eating a healthy diet high in fiber and low in saturated fat, trans fat, and cholesterol can help. Consuming saturated fats found in animal foods, such as red meat, cream, and full-fat dairy products, and in plant foods, like palm oil, raises your total cholesterol and LDL. Instead, choose leaner cuts of meat, low-fat dairy products, and monounsaturated fats (found in nuts or olive and peanut oils) for healthier options.  

Avoiding trans fats, called partially hydrogenated oils, is another way you can reduce your LDL. Trans fats can be found in fried foods and many processed or packaged products, such as frozen pizza, crackers, and baked goods. If you see “partially hydrogenated oil” on a food label, you know the product contains trans fats 

Limiting cholesterol in your diet is important for lowering LDL. Choosing lean cuts of meat, egg whites, and skim milk to replace organ meats (liver, kidney, and heart, for example), egg yolks, and whole milk is a strategy worth applying.  

Upping your dietary fiber intake helps reduce cholesterol and improve digestion. Whole-grain bread, whole-wheat pasta and flour, and brown rice are better options. Fruits and vegetables are also rich in dietary fiber.  

Eating foods rich in omega-3 fatty acids can help lower your LDL. Some types of fish, such as salmon and sardines, are rich in omega-3s. Other good sources include walnuts, almonds, and flaxseeds. Limiting your alcohol consumption is beneficial as well. 

Be More Active 

Moderate-intensity physical activity, such as taking a brisk walk or riding your bike, can help raise HDL, the “healthy,” cholesterol. Aim to engage in at least 150 minutes (about two and a half hours) of moderate to vigorous exercise each week.  

Quit smoking 

Quitting smoking will improve your HDL cholesterol level and help lower your triglycerides and LDL. Quitting smoking is the single most beneficial thing you can do for your heart. It’s never too late to quit. 

Achieve and Maintain a Healthy Weight 

If you are overweight, losing as little as 5 to 10 percent of your body weight can help reduce your cholesterol.⁴

Limit your Alcohol Intake  

Limiting your alcohol consumption is beneficial to lowering your cholesterol, especially your triglycerides. If you choose to drink alcohol, less is best; No more than 2 standard drinks per day or 6 standard drinks per week. 

Knowing your cholesterol level is an important step to good heart health. High cholesterol affects 28% of Canadians aged 18 to 79 and is more prevalent in the older population (60% of Canadians 60 to 79 years old. (5) However, many people with high cholesterol have no idea their levels are high.

Talk to your healthcare provider to see if you should have your cholesterol measured, and for advice on managing your cholesterol. 

Resources 

• The Portfolio Diet  
• Mediterranean Diet  
• Heart & Stroke – How to Manage Your Cholesterol