High Cholesterol: Lifestyle Management

What does the Cholesterol lab measurement actually mean.

The measurement of total cholesterol level is a pretty blunt tool for working out your risk of cardiovascular disease. To properly estimate the threat that your cholesterol poses to your health, your doctor needs to take into account a wide range of factors including your smoking status, your blood pressure, your BMI, whether you have diabetes, even your post code. All these things, along with your ratio of ‘good cholesterol’ vs ‘bad cholesterol’ (see below), can be put into a calculator called the ‘QRISK’ calculator which can be found on this website. 

This estimates your individual risk of heart attacks and strokes over the next 10 years. This risk should be used to help you make a decision about starting medication. In the UK, statins are usually recommended for people with a QIRSK score above 10%.

As you might guess from the information that goes into the QRISK calculator, there are lifestyle changes you can make – stopping smoking, losing weight, and controlling your blood pressure – that have nothing to do with your cholesterol, but will influence your decision about starting medication because they all go into the risk calculator alongside your cholesterol levels.

Your total cholesterol can be broken down into HDL-cholesterol (‘good cholesterol’) and LDL-cholesterol (‘bad cholesterol’). HDL-cholesterol is small amounts of cholesterol bound to protein which carries the cholesterol back to the liver where it is processed. LDL-cholesterol is large amounts cholesterol bound to protein that circulates in the blood stream on its way to other parts of the body. It is LDL-cholesterol that builds up on the walls of your arteries and increases your risk of heart attacks and strokes.

The aim of treatment is not just to lower your overall level of cholesterol, but also to shift the ratio of LDL-cholesterol vs HDL-cholesterol in favour of HDL-cholesterol.

Much of the cholesterol in your body is made by the liver, the rest comes from your diet. Therefore, there are a number of dietary changes that you can make that will help lower your cholesterol and help you to shift that ratio towards the HDL-cholesterol.

Broadly speaking, the aim of a cholesterol lowering diet is to change from a diet high in saturated fats to one that contains more unsaturated fats. Saturated fats are found in foods such as red meat, processed meat, and full fat dairy products such as milk, cream and cheese. Palm oil, coconut oil and butter should also be avoided for cooking.

Foods that are high in unsaturated fats include oily fish, seeds and avocado. Some foods seem to be particularly effective in helping people to lower their cholesterol and these include oats and barley, soya foods and nuts which should ideally be eaten raw, with the skin on.

As you can see, there are many lifestyle changes that can be made that will help you avoid the need for medication but the starting point for making decisions about managing your cardiovascular risk, is knowing what that risk is. Understanding your blood lipid profile, and putting this into the context of your general health and lifestyle, will help you make these important decisions and allow you to see whether changes you have made are making a difference.

Despite implementing these changes, there may still be times when the benefits of medication are too clear to be ignored. This is particularly true for people who have already had a heart attack of stroke, or people with very high levels of cholesterol due to inherited conditions. For these people, the evidence suggests that taking medication, such as statins, can significantly reduce their risk of future cardiovascular events and improve their overall health outcomes. However, it is important to work closely with a healthcare provider to determine the best course of action and to regularly monitor the effectiveness and potential side effects of any medication.