Stop the build up to high blood cholesterol levels
What is cholesterol?1,2,3,4,5,6
Cholesterol is a waxy, fat-like substance found in your bloodstream and in all your body’s cells.1A,2A,3A Your body needs a limited amount of cholesterol in order to function properly.2A,3B Cholesterol is needed in order to produce hormones and the bile acids that help with digestive fat.1A
Too much cholesterol increases your risk of stroke or heart disease.2B,3B,4A,5A
When you have too much cholesterol in your blood, the cholesterol can build up in the walls of your arteries. Your doctor refers to the build up as plaque. Plaque is a thick, hard deposit that can cause the arteries to narrow or become completely blocked. The hardening of your arteries is referred as atherosclerosis. 2C,3C,6A
If the blood flow to a portion of your heart is completely blocked by the build up, you can have a heart attack. The build up can also rupture and cause a blood clot to form, which can also block the blood flow to your heart resulting in a heart attack, or to your brain causing a stroke. 1B,P,2D,3C,6B
Types of cholesterol 1,2,7,8
Cholesterol travels through blood attached to proteins, also called lipoproteins. 2
• Low-density lipoprotein (LDL) is “the bad kind” of cholesterol
– Can cause build-up of plaque on the walls of your arteries. The more LDL there is in the blood, the greater the risk of heart disease. 1B,C,D,2E,7E
• High-density lipoprotein (HDL) is “the good kind” of cholesterol
– Helps your body to remove harmful cholesterol from your arteries. High levels of HDL in your blood decrease your chances of heart attack or stroke. 1E,2F,7B
• Triglycerides are the most common type of fat in the body
– High levels of triglycerides are often found in people who have high cholesterol levels, heart problems and who are overweight or obese. 1F,2G,7C
What should your cholesterol and triglycerides levels be? 8A
Target values are: 8A
• Total cholesterol < 5.0 mmol/l
• LDL cholesterol (LDL-C) < 3.0 mmol/l
• HDL cholesterol (women) > 1.2 mmol/l
• HDL cholesterol (men) > 1.0 mmol/l
• Triglycerides < 1.7 mmol/l
Note: Your target levels might be different if you are at risk of heart disease. 8B,
Are you at risk?1,2,9,10,11,12,
A variety of factors can affect cholesterol levels, namely:
• Diet: saturated fats increase your blood cholesterol level 2H,11A
• Weight: overweight or obesity1G,11B
• Physical inactivity1G,11C
• Cigarette smoking1G,12A
• Diabetes Mellitus1G,9A
• Heredity: you can also inherit high cholesterol,(called familial hypercholesterolemia)1G,10A,12A
• Age: high cholesterol increases with age10B,12A
Cardiovascular disease, which has many risk factors including high cholesterol, is responsible for around 14 % of all deaths in South Africa. This is expected to rise as unhealthy lifestyle trends spread. 13A
How to test cholesterol levels1,12
Your cholesterol is tested via a blood test. Your doctor may ask you not to eat, drink or take any medication 9-12 hours before your blood test. Your test will demonstrate your cholesterol level in millimols per litre, mmol/l.1H,12B Your doctor will explain the test results and discuss treatment if necessary.
Adults 20 years and older should have a fasting lipoprotein profile.
A fasting lipoprotein profile measures:1H,12C
• Total cholesterol
• LDL cholesterol
• HDL cholesterol
You should test your cholesterol once every 4 to 6 years.1H,12C
How is high cholesterol treated?1,4,5,6,14,15
The goal of treating high cholesterol is to lower your LDL-C levels. Cholesterol can be lowered either through lifestyle changes or taking cholesterol-lowering medications or both.1I,4B,5B,6C
South Africans, unfortunately, do not fare well with achieving their cholesterol-lowering goals. This is mainly due to inadequate lifestyle changes, not taking their medication correctly or for long enough. 14A,15A
Lifestyle changes include:
• Reduce intake of saturated fat and cholesterol 1J,5C,16A
• Weight reduction 1J,4BC,5D,16A
• Increase regular physical activity 1J,4B,6C
• Cardioprotective diet (speak to a dietician) 4C,6C,16A
• Quit smoking 4C,5,16A
• Reduce alcohol consumption 4C,5G,16A
If you are unable to reach your LDL-C level with lifestyle changes only, your healthcare provider will prescribe LDL-C lowering medications to help you reach your goal.1I
LDL-lowering medications include:
• Considered to be first-line medication to help achieve LDL -C treatment goal 1K
• Highly effective in lowering LDL-C levels, easy to administer and have a good record of safety 1L
For every mmol/l reduction in LDL-C by statins, there is a:16B
• 10 % reduction in mortality
• 20 % reduction in all-cause morbidity
• 23 % reduction in major cardiac events
• 17 % reduction in stroke
Other cholesterol-lowering medicines 1,3,16
Statins: block a substance your liver needs to make cholesterol.1M,3D
Bile-acid sequestrants: add to the lowering effect of other drugs, for example statins by binding to bile acids.1N,16C
Nicotinic acid: lowers serum total, LDL-C and triglyceride levels and also raises HDL-cholesterol levels.1O,3E,16C
Fibric acid derivatives: these medications help your body to lower triglycerides and raise HDL-cholesterol.1P,3E
MONITORING YOUR TREATMENT IS VERY IMPORTANT
If you’ve just started with treatment, frequent visits to your healthcare professional are advised. For the first year of therapy, visit your healthcare professional every 4-6 months and thereafter, every 6-12 months in the long term.1Q
Speak to your healthcare professional if you start experiencing muscle pain, weakness, soreness and have brown urine.1R
1. National Institutes of Health. 2002. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. NIH Publication No. 02-5215.
2. American Heart Association. 2012. Answers by heart: Lifestyle + Risk Reduction Cholesterol. What Are High Blood Cholesterol and Triglycerides? Available at:
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300308.pdf Accessed on 12 January 2016.
3. Scirica BM, Cannon CP. Treatment of Elevated Cholesterol. Circulation 2005;111:e360-e363.
4. NHS National Institute for Health and Clinical Excellence (NICE). 2010. Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of
cardiovascular disease. NICE Clinical guideline 67.
5. National Institute for Health and Clinical Excellence (NICE). 2014. Cardiovascular disease: risk assessment and reduction, including lipid modification. Guideline (CG181). Available at: https://www.nice.org.uk/guidance/cg181/resources/cardiovascular-disease-risk-assessment-and-reduction-including-lipid-modification-35109807660997 Accessed 09 January 2016.
6. American Heart Association. 2012. Answers by heart: Lifestyle + Risk Reduction Cholesterol. How Can I Lower High Cholesterol? Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300460.pdf Accessed on 12 January 2016.
7. American Heart Association. 2012. Answers by heart: Lifestyle + Risk Reduction Cholesterol. What Do My Cholesterol Levels Mean? Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300301.pdf Accessed on 12 January 2016.
8. THE HEART AND STROKE FOUNDATION SOUTH AFRICA. 2013. Cholesterol. Available at: http://www.heartfoundation.co.za/cholesterol Accessed on 12 January 2016.
9. Centers for Disease Control and Prevention (CDC). Updated March 2015. Conditions That Increase Risk For High Cholesterol.
Available at: https://www.cdc.gov/cholesterol/ Accessed on 12 January 2016.
10. Centers for Disease Control and Prevention (CDC). Updated March 2015. Family History and Other Characteristics That Increase Risk For High Cholesterol. Available at: http://www.cdc.gov/cholesterol/family_history.htm Accessed on 12 January 2016.
11. Centers for Disease Control and Prevention (CDC). Updated March 2015.
Behaviors That Increase Your Risk for High Cholesterol. Available at: http://www.cdc.gov/cholesterol/behavior.htm Accessed on 12 January 2016.
12. American Heart Association. 2012. How To Get Your Cholesterol Tested. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/
SymptomsDia%E2%80%A6sterol/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp#.VpRqruJJdE4 Accessed on 12 January
13. Raal FJ, Blom DJ, Naidoo S, et al. Prevalence of dyslipidaemia in statin-treated patients in South Africa: results of the DYSlipidaemia
International Study (DYSIS). Cardiovasc J Afr 2013;24:330–338.
14. Raal F, Schamroth C, Blom D, et al. CEPHEUS SA: a South African survey on the under-treatment of hypercholesterolaemia. Cardiovasc J Afr 2011;22:234–240.
15. Rapeport N, Schamroth CL, Blom DJ. Gender and ethnic
differences in the control of hyperlipidaemia and other vascular risk factors: insights from the CEntralised Pan-South African survey on The Undertreatment of hypercholeSterolaemia (CEPHEUS SA) study. Cardiovasc J Afr 2013;24:238–242.
16. Klug EQ, Raal FJ, Marais AD, Taskinen M-R, Dalby AJ, et al. South Africa Dyslipidaemia Guideline Consensus Statement. A joint statement from South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA). S Afr Med J 2012;102:177-188.