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The PHARMACIST talks about

Cholesterol

When we hear the word cholesterol we automatically think about hamburgers, thickshakes, heart attack and an early death. But what really is cholesterol and what are the important points we need to know?

Cholesterol is essential in the body, however too much of the wrong kind of cholesterol increases your risk of developing heart disease.

How do we keep our cholesterol levels healthy?

Cholesterol is a compound that occurs naturally in the body. It is manufactured by the liver and is essential for many of the body's metabolic processes. It helps make hormones like oestrogen, testosterone and adrenaline. It is also used in the production of Vitamin D and in the production of bile acids, which aid digestion and the absorption of fat-soluble vitamins in the small intestine. The trouble usually starts when we get too much cholesterol and this is usually a result of having a high intake of fat in our diet, causing the levels of cholesterol in our blood to rise to more than we need. If our cholesterol rises above normal levels, it can form fatty deposits on the inside of our arteries, which can develop calcium plaques. These deposits cause narrowing of the arteries, which limits the flow of blood and eventually can result in blood clots, leading to heart disease, stroke and other conditions. This condition is known as atherosclerosis. High cholesterol is one of the risk factors of atherosclerosis along with smoking, being overweight and having high blood pressure.

About half of all adult Australians have high blood cholesterol. For this we can thank our fondness for dairy foods, red meat, takeaway foods and processed foods rich in fats.

There are two major types of cholesterol, Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL). In other words, LDL is known as "bad" cholesterol and HDL is known as "good" cholesterol. The bad cholesterol is the cholesterol that deposits into our arteries causing the fatty deposits. Therefore you want to have a higher ratio level of good cholesterol to bad cholesterol within your body.

How much good and bad cholesterol we have in our bodies is influenced by the types of fats we eat. When we are talking about cholesterol we commonly hear the words saturated, monounsaturated and polyunsaturated fats. …getting a bit too scientific?? Here is a breakdown of the definitions of these terms. Saturated fats are basically fully saturated with hydrogen atoms. Eating lots of saturated fat tends to elevate the levels of the bad cholesterol in the blood. Foods high in saturated fats include, full fat dairy products, process meats like salami and sausages, snack foods like chips, takeaway food, cakes, biscuits and pastries, coconut oil and palm oil. If you want to avoid artery disease, limit consumption of these foods. Monounsaturated and polyunsaturated fats on the other hand tend to increase the levels of good cholesterol. Eating these foods reduce your risk of artery disease. Foods high in monounsaturated fats include olive oil, canola oil, avocadoes and most nuts. Foods high in polyunsaturated fats include oils of seeds and grains such as sunflower, safflower, corn, soybeans and walnuts.

How do you efficiently lower your cholesterol?

There are numerous was to effectively lower your cholesterol and prevent future related disease states. In the long term it is worth taking the steps to lower your cholesterol, because lowering your cholesterol by 10 per cent reduces the risk of heart attack by 20 per cent.

• One of the first steps your health care professional will recommend to lower your cholesterol will be to change your diet so it is low in saturated fats and high in monounsaturated and polyunsaturated fats.
• The second step is exercise. Regular exercise, at least 30 minutes of brisk walking daily, can increase your good cholesterol levels and reduce you bad cholesterol levels in the body.
• The third and final step is cholesterol lowering medications. These are usually only indicated once the first 2 steps have been tried and have not successfully worked in lowering your cholesterol.

There are currently a number of medications available through the PBS to lower your cholesterol. These medications work effectively and depending on how high your cholesterol is, will determine the type of medication that will be used.

One of the mostly commonly used class of medications are Statins, these include brand names like Lipitor and Crestor. It is important to note though that each individual is different and will require their own personalized medication regimen for their cholesterol.

How effective are these lifestyle changes?

Data has shown that by undertaking regular physical activity reduces your cardiovascular risk in healthy people and it improves your survival after a heart attack. Modifying your dietary fat reduces your bad cholesterol by 16%. Including a fish oil supplement can reduce your triglycerides…which is another form of fat found in food that increases your cholesterol…by 20% to 30%, they also increase your good cholesterol by about 1 to 3%. Including plant sterols into your diet for example margarine, can reduce your bad cholesterol by 10%.

The main class of medications and the drug of choice are Statins. Statins work by blocking the enzyme used in the production of cholesterol. They also accelerate the turnover of cholesterol by the liver. Common statins are Lipitor, Pravachol, Crestor, Lipex and Zocor. These medications can drop bad cholesterol levels by anywhere between 30 and 50 per cent and increase good cholesterol by 5 to 15 per cent. The additional benefits of statins are that they help stabilize existing cholesterol plaques within blood vessels. This consequently prevents the plaque from breaking off and drifting further up stream preventing heart attacks and strokes.These medications are expensive but they are on the PBS.

Bile acid binding resins are useful for isolated high cholesterol. They typically reduce the bad cholesterol by 15 to 25%. These are older medications and bind to the bile acids in the intestine, preventing them from being absorbed into the body. The liver needs bile acids to make cholesterol, so less bile acid means less cholesterol. The most common bile acid binding resin is Questran Lite. It comes in a sachet of powder that needs to be mixed with water, juice or other fluid.

Nicontic acid has good bad and triglyceride cholesterol lowering effects and produces a marked increase in good cholesterol. It typically reduces bad cholesterol by 15 to 30% and triglycerides by 25 to 40%. Its use is limited as it has unwanted and troubling side effects.

Ezetrol is a new drug in a class called the cholesterol absorption inhibitors. It works by reducing the absorption of cholesterol from the intestine into the bloodstream. It reduces bad cholesterol by about 18% and is well tolerated. Further studies are needed to demonstrate its safety and effect on clinical outcomes when used alone and with other lipid lowering drugs.

Fibrates are another class of medication, and these medications are used when the others don't work or when levels of triglycerides are high. Gemfibrozil generally reduces bad cholesterol by 5-15% and reductions of up to 25% are reported for fenofibrate. Examples of these medications are Lipidil and Jezil or Lopid.

Combination treatments may be appropriate if a single agent is inadequate. It is difficult to assess the potential benefit versus harm for various combination treatments, as there are few studies with clinical outcomes data. Combined use of a statin and a fibrate is often effective in improving high cholesterol, but may increase the risk of serious adverse effects.

Please Note: The advice on this website is to be used as an educational aid only. It is not intended to replace advice from your qualified GP or medical practitioner. Please ensure that you speak to them in relation to all of your health issues.