Hypercholesterolemia - Managing High Blood Cholesterol: Tips and Recommendations

Hypercholesterolemia refers to the presence of high levels of cholesterol in the bloodstream, also known as high blood cholesterol or hyperlipidemia. Cholesterol, a fatty substance similar to wax, can accumulate on artery walls, leading to heart disease and stroke. Two types of cholesterol exist: low-density lipoproteins (LDL), often referred to as "bad cholesterol," and high-density lipoproteins (HDL), known as "good cholesterol." High levels of LDL increase the risk of heart disease, while high levels of HDL provide protection. The accumulation of LDL on artery walls restricts blood flow, potentially depriving the heart or brain of oxygen-rich blood.

The two primary types of lipoproteins are:

1. High-density lipoprotein (HDL) - Referred to as "good cholesterol," higher levels are considered better.
2. Low-density lipoprotein (LDL) - This cholesterol can build up in artery walls, leading to arterial disease. It is often called "bad cholesterol."

Blood tests can measure the amount of cholesterol present, including both HDL and LDL.

Several factors contribute to high cholesterol levels, increasing the risk of heart problems or stroke:

• Unhealthy diet, especially consuming high levels of saturated fat.
• Smoking.
• Having diabetes or hypertension (high blood pressure).
• If there is a history of heart disease or stroke in your family.
• Inherited conditions that cause high cholesterol, even with a healthy lifestyle and no other risk factors.

High cholesterol is typically defined as LDL cholesterol greater than 190 mg/dL, greater than 160 mg/dL with one major risk factor, or greater than 130 mg/dL with two cardiovascular risk factors. Important risk factors include:

• Age: For males, individuals aged 45 years or older, and for females, individuals aged 55 years or older.
• Positive family history of premature atherosclerotic cardiovascular disease (in males younger than 55 years, in females younger than 65 years).
• Hypertension.
• Diabetes.
• Smoking.
• Low HDL-cholesterol levels (less than 40 mg/dL in males, less than 55 mg/dL in females).

Hypercholesterolemia can have genetic or acquired causes, but the most common cause is polygenic hypercholesterolemia, resulting from a combination of unidentified genetic factors, sedentary lifestyle, and increased intake of saturated and trans-fatty acids. Secondary causes include hypothyroidism, nephrotic syndrome, cholestasis, pregnancy, and certain medications such as cyclosporine, thiazide, and diuretics. These causes can be determined through medical history, physical examination, and laboratory tests.

Treatment of hypercholesterolemia

The primary treatment for hypercholesterolemia involves adopting a healthy lifestyle, maintaining an optimal weight, not smoking, engaging in 150 minutes of exercise per week, and following a diet low in saturated and trans-fatty acids while incorporating fiber, fruits, vegetables, and fatty fish. Plant stanols at a dosage of 2 g/day can help reduce LDL cholesterol levels. Statins are the preferred medication class for lowering LDL cholesterol. Niacin, when combined with the aforementioned approaches, can be used to further lower LDL-C in primary prevention but not in patients with atherosclerotic cardiovascular disease. It is advisable to seek medical advice in order to identify the most appropriate course of treatment.

The primary risk associated with hypercholesterolemia is adverse cardiac events. However, since the introduction of statins, mortality rates associated with hypercholesterolemia have significantly decreased in numerous trials. Lowering cholesterol levels is now a beneficial strategy for the primary prevention of heart disease.

Quitting smoking reduces the risk of heart disease and helps lower cholesterol levels. The most effective way to quit smoking is through a combination of stop-smoking medications (such as nicotine replacement therapy) and support from a service. Speaking to a general practitioner (GP) is an excellent initial step.

Alcohol consumption does not provide any health benefits. It contributes unnecessary calories and lacks nutritional value. Alcohol is not necessary or recommended for a heart-healthy eating pattern. If consumed, healthy women and men should limit alcohol intake to no more than 10 standard drinks per week and no more than four standard drinks on any given day to reduce the risk of alcohol-related harm.

Managing high cholesterol involves several strategies to control it and reduce the risk of coronary heart disease:

Regularly check cholesterol levels as part of an assessment of overall heart, stroke, and blood vessel disease risk. Higher risk individuals should have more frequent checks.

Limit saturated fat intake, as it is the type of fat that clogs arteries and raises blood cholesterol levels. Switching from butter to margarine, opting for reduced-fat dairy products, and trimming visible fat from meat can reduce saturated fat consumption.

Embrace healthy eating by primarily selecting plant-based foods like vegetables, fruits, legumes, and wholegrain products such as bread, pasta, noodles, and rice.

Consume moderate amounts of lean meats, poultry, fish, and reduced-fat dairy products, along with moderate amounts of polyunsaturated or monounsaturated fats.

Look for products with the Heart Foundation Tick, indicating healthier choices with lower saturated fat content, when concerned about saturated fat levels in foods.

A heart-healthy eating pattern plays a crucial role in managing cholesterol levels and reducing disease risk. It involves consuming a wide variety of fresh and unprocessed foods while limiting highly processed options like takeaways, baked goods, chocolate, chips, lollies, and sugary drinks. This approach not only maintains a healthy and diverse diet but also provides essential nutrients.

A heart-healthy eating pattern includes:

• Abundant vegetables, fruits, and wholegrains.
• A variety of healthy protein sources such as fish, seafood, legumes, nuts, and seeds. Limited amounts of eggs and lean poultry can also be included. If opting for red meat, choose lean cuts and limit consumption to one to three times a week.
• Unflavored low-fat milk, yogurt, and cheese. Individuals with high cholesterol should choose reduced-fat options.
• Incorporate nourishing fats and oils such as nuts, seeds, avocados, olives, and their respective oils into your cooking.
• Flavoring foods with herbs and spices instead of adding salt.
• A high-fiber diet, as it helps reduce levels of LDL cholesterol in the blood.
• Portion control is also essential to manage cholesterol levels and decrease the risk of heart disease. Over time, portion sizes have increased, leading to excessive calorie intake and elevated cholesterol levels.

An ideal healthy plate should consist of ¼ healthy proteins, ¼ wholegrains, and ½ colorful vegetables. Serving sizes may vary based on age, gender, and specific nutritional needs.

In addition to a balanced diet, the following tips can help manage cholesterol:

• Follow a heart-healthy eating pattern, focusing on plant-based foods like vegetables, legumes, fruits, wholegrains, nuts, and seeds.
• Include legumes and beans in at least two meals per week, opting for lower-sodium products.
• Substitute tofu or lentils for meat in stir-fries or curries.
• Choose wholegrain options for bread, cereals, pasta, rice, and noodles.
• Snack on plain, unsalted nuts and fresh fruit.
• Use healthy unsaturated fats and oils such as canola, sunflower, soybean, extra virgin olive oil, sesame, and peanut oil for cooking.
• Consume plant sterol-enriched foods (e.g., margarine, yogurt, milk, and cereals) daily, especially for individuals at high risk of heart disease (2-3 grams per day).
• Enjoy fish two to three times per week (150 grams fresh or 100 grams tinned).
• Limit processed meats like sausages and deli meats (e.g., ham, bacon, and salami).
• Limit egg intake to a maximum of seven per week for individuals with high cholesterol, type 2 diabetes, or heart disease. Choose lean meats and poultry without skin, and restrict unprocessed red meat to less than 350 grams per week.
• Opt for unflavored, reduced-fat milk, yogurt, and cheese, checking labels for added sugars. Non-dairy alternatives with added calcium are also suitable.
• It is advisable to restrict or eliminate the consumption of processed meats, such as sausages, deli meats (ham, bacon, salami), and similar products.