Dear Readers,

Mr. C. St.J. writes Lifeline from Shortwood, Kingston 8. He is 54 years old and his doctor has told him that not only is he suffering from high blood cholesterol but that his 'good' cholesterol is low.

C. St. J. has been started on the medication Simvastatin to treat the high blood cholesterol and has been told to avoid oil and fatty foods. He is very concerned, however, that the doctor also told him that he is at an added risk of a 'cardiovascular event'. He writes asking Lifeline to provide him with a greater understanding of the risks of high blood cholesterol and how to prevent it.

Worrisome sign

The presence of high blood cholesterol is a worrisome sign in an individual and should not be taken lightly! It is considered to be a primary risk factor for heart disease and stroke.

A less recognised fact is that high blood cholesterol also places men at risk of impotence and both men and women at increased risk of gall stones.

It is often associated with obesity, hypertension and diabetes which, when all present, comprise the metabolic syndrome for which the five-year mortality (death rate) is significantly greater than that of a person diagnosed with cancer. It is therefore not a disorder to be ignored.

Necessary component

Cholesterol is a building block for steroids and is very necessary for the normal functions of the human body. It is a necessary component of all cells in the body.

Cholesterol is fat soluble and is transported in the blood stream by molecules called lipoproteins.

There are good lipoproteins, termed high density lipoproteins (HDLs) and bad lipoproteins termed low density lipoproteins (LDLs).

HDLs bind excess cholesterol in the blood and take it to the liver to be eliminated while LDLs take the cholesterol from the liver where it can be eliminated and instead releases it in other parts of the body. Mr. C. St. J's reference to low 'good cholesterol' would refer to low blood levels of high density lipoprotein.

Narrow blood vessels

The body usually manufactures all the cholesterol it needs and eliminates the rest, however, when excess cholesterol is present, it is deposited inside blood vessels making them narrow (atherosclorosis) and promoting blood vessel injury and blockage. An excess load of cholesterol can be contributed to by a diet high in cholesterol and saturated fats. This would include foods such as shellfish (lobsters and shrimp and crayfish), red and white meats, animal organs (liver and kidney) and dairy products. All plant-derived foods are cholesterol free.

Inherited defect

A significant number of persons with high blood cholesterol have an inherited defect in fat metabolism and have inherently high cholesterol levels, no matter how well they watch their diet and limit cholesterol and saturated fat intake.

When cholesterol levels are mildly elevated, dietary restrictions can be tried to control the problem. Reducing the consumption of animal fat to 10 per cent of total daily calories combined in the obese, with a weight loss programme, may result in control of the problem.

However, if after three months of a concerted effort at dietary fat restrictions, weight loss and exercise the cholesterol levels are not controlled, then drug intervention should be applied.

The drugs most commonly used in the control of high blood cholesterol are the statins of which simvastatin used by Mr. C.St.J. is an example. They are usually well tolerated and work by preventing the synthesis of cholesterol in the liver. Other examples of the statins are pravastatin, lovastatin and lipitor. These drugs can occasionally affect the liver function and therefore blood tests to check on the liver are required at intervals when these drugs are used.

High-density, lipoprotein cholesterol is associated with a decreased incidence of heart disease and atherosclerosis, while low density cholesterol is a significant risk factor for atherosclerosis, heart disease and stroke.

Exercise

Exercise is well documented to help increase the 'good' high density lipoprotein and decrease the 'bad' low density lipoprotein, so regular exercise can only benefit the person with high blood cholesterol.

Consulting a nutritionist (dietician) is also often very useful in helping to make healthy 'low-fat' food choices while still enjoying 'tasty' meals.

Their intervention becomes even more necessary when high blood cholesterol is complicated with hypertension and/or diabetes where salt and sugar (carbohydrate) restrictions are also necessary.