Coronary Heart Disease

What is Cholesterol?

Cholesterol is a waxy form of fat held in suspension in the blood. Cholesterol being taken to the cells for use is known as LDL (Low Density Lipoprotein) or 'Bad' Cholesterol.

Cholesterol being returned to the liver is known as HDL (High Density Lipoprotein) or 'Good' Cholesterol. These have distinctly different properties as the 'bad' and 'good' suggest.

What Can Go Wrong

High levels of LDL (Bad Cholesterol) can lead to plaque forming on the arterial walls of blood vessels. Build up of this plaque can block or reduces blood flow and may cause atherosclerosis, that is a hardening of blood arteries and increased blood pressure.

Ultimately if Cholesterol levels remain high this can lead to heart attacks, strokes and the other complications of diabetes (eye and kidney problems) that are made worse by high blood pressure.

HDL (Good Cholesterol) will normally remove some or most of this plaque. If HDL levels are low however, little of any plaque build up will be removed.

The worst case is where LDL Cholesterol is high and HDL Cholesterol is low. Treatments aim to reduce LDL 'Bad' Cholesterol levels and increase HDL 'Good' Cholesterol levels.

Cholesterol Levels

UK Typical Cholesterol Levels
  • Total Cholesterol 5.5-5.8 mmol/l
  • LDL 'bad' Cholesterol 3.5-4.0 mmol/l
Note: HDL Cholesterol levels are not the difference between these two figures.

Recommended Cholesterol Levels for the general population
  • Total Cholesterol less than 5.0 mmol/l
  • LDL 'bad' Cholesterol less than 3.0 mmol/l

If you don't have your LDL level it can be calculated from HDL and other figures as -

LDL = Total Cholesterol - HDL - (Triglycerides/2.2)

Note that high triglyceride levels can make this calculation inaccurate.

Targets for Diabetics

The risk of having a heart attack or stroke is increased when you have diabetes. To balance this increased risk, tighter control of cholesterol levels is recommended.

Recommended Cholesterol Levels for diabetics (type 1 and 2)
  • Total Cholesterol less than 4.0 mmol/l
  • LDL 'bad' Cholesterol less than 2.0 mmol/l

When a diabetics levels are higher than these targets levels. Dietary measures to reduce cholesterol are suggested first.

Where dietary changes fail to reduce cholesterol sufficiently, cholesterol lowering drugs such as the Statin group of drugs may be prescribed.

Other Risk Factors

High cholesterol is a major factor in coronary heart disease but other factors also increase the risk of developing CHD.

These are factors like gender (males are at greater risk in certain age groups), family history of heart disease, age and some types of diabetic complications already shown.

When other risk factors apply, the advice is to be especially strict with your cholesterol levels.

Some of the other risks too, relate to lifestyle choices that are wholly or partially in the diabetics control - these are shown in the minimising the risks section at the top of this page.

Minimising the Risks

  • Stop Smoking! Smoking is the largest risk factor in developing Heart Disease, its well worth stopping if you can.

  • Change what Fats you eat to keep LDL 'Bad' Cholesterol levels low and HDL 'Good' Cholesterol levels high.
  • Eat Oily Fish one or more times a week.
  • Keep your weight within the recommended range for your height. Not sure what your recommended weight is? See the Body Mass Index Pop-up.
  • Exercise regularly.
  • Try to keep your blood pressure less than 130/80. High blood pressure (Hypertension) is another risk factor.

How to Improve Cholesterol Levels

Cut down on Saturated Fat and Hydrogenated Fat. Lowers LDL
Include soluble fibre and whole grain products in the diet. Lowers LDL
Eat one or more portion of oily fish a week. Increases HDL also improves blood flow (reducing blood stickiness).
Exercise Regularly Increases HDL
Use fats that are high in Monounsaturated Fats like Olive Oil to replace other fats. Lowers LDL

A further reduction of 25%+ (some sites say up to 50%) in LDL may be achieved with drugs.

Statin type drugs

Statins are generally used to lower Cholesterol Levels.

Some of the statin group of drugs are - Lipitor (atorvasatin), Zocor (simvastatin), Provachol, Lescol, Mevacor and Baycol.

Triglycerides (or Triglicerides)

Triglycerides are another form of fat held in the blood. High levels are undesirable and they are another risk factor for Heart Disease but generally considered less significant than cholesterol levels. High Triglyceride levels (above 4.0 mmol/l) can also make LDL Cholesterol readings less accurate.

Triglyceride Level:

  • Normal: 0.5 to 1.8
  • Borderline: 1.9 to 4.5
  • High: More than 4.5

Options to Reduce Triglycerides

Changes in diet take between 3 to 6 weeks to reduce Triglyceride levels.

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