Cholesterol and heart health explained
Dr Arjun Ghosh, renowned consultant cardiologist, offers his expert insight into cholesterol and its role in heart health, including what is cholesterol and how is high cholesterol treated.
What is cholesterol?
Cholesterol is a fatty substance, found in the cells of the body and some foods, which is essential for various physiological functions, especially within the neurovascular system.
If certain cholesterol levels are too high, however, it can result in serious health problems such as heart attack or stroke.
What are the different types of cholesterol?
There are many different types of cholesterol, but the two main ones are:
- low-density lipoprotein (LDL), or "bad" cholesterol
- high-density lipoprotein (HDL), or "good" cholesterol
LDL and HDL cholesterol are different parts of the total amount of cholesterol in the blood. Ideally, you want to have a lot more HDL cholesterol than LDL cholesterol.
When you have a blood test, the total cholesterol, the level of HDL cholesterol, the level of LDL cholesterol, and the other parts of cholesterol are measured. We then look at all these to decide whether treatment is required or not.
What are the causes of high cholesterol?
There are two main causes of high cholesterol:
- Diet: A diet which is very rich in fatty foods and oily foods can cause cholesterol levels to go up.
- Genetic factors: A family history of high cholesterol can affect how efficiently the body metabolises or breaks down cholesterol. Cholesterol levels can be high as a result.
What are the symptoms of high cholesterol?
Unfortunately, high cholesterol in itself is unlikely to cause any symptoms.
The normal value for total cholesterol, if you haven’t had a previous cardiac event, is 5 mmol/L or less. However, even if total cholesterol increases to 6/7/8 mmol/L, it may not necessarily cause any symptoms unless cholesterol has also built up in the heart arteries (where it may cause chest pain) or built up in the neck arteries (where it may cause some form of stroke).
The other indicative feature of high cholesterol may be a deposition of cholesterol in the skin, which can sometimes be seen in the face or around the eyes.
For this reason, it is very difficult to make a diagnosis without performing a blood test and we must have a high suspicion of high cholesterol based on other factors, such as lifestyle factors.
How is high cholesterol diagnosed?
High cholesterol is diagnosed through a blood test, and this is usually ordered if there is a suspicion of cholesterol build-up somewhere. For example, if you complain about chest pain that might be related to the heart, often this is due to a build-up of cholesterol in the arteries, so we will order a blood test. If you have a stroke, for example, your cholesterol will also be checked.
In Western societies, cholesterol can also become high with age due to diet and lifestyle factors. For this reason, if you are over the age of 40, you will be getting cholesterol health checks once every few years to monitor your cholesterol levels, even if you don’t have any symptoms.
How is high cholesterol treated?
There are different ways in which cholesterol can be treated.
The first line of treatment is lifestyle modification, which involves removing foods from your diet which are high in cholesterol and engaging in regular physical exercise.
If lifestyle modification doesn’t lower cholesterol levels significantly, the next line of treatment is medication. There are different cholesterol-lowering medications that can be tried, including statins, placebo, and other agents. In major studies, we find that patients often have more side effects with placebo than with statins, showing that statins are extremely well-tolerated and very effective drugs to lower cholesterol, and then lower the risk of heart attack and stroke as a result.
If you are worried about cholesterol and your heart health, don’t hesitate to schedule an appointment with Dr Arjun Ghosh via his Top Doctors profile today.