What is Cholesterol ?

Cholesterol is the waxy, fat-like substance present in every cell and the blood stream in our body and in all animals. Some cholesterol is essential for the proper health and the liver already produces enough of it for the body. Certain foods that come from animal sources like meat, eggs and dairy products provide additional amounts of cholesterol which may make it more than what the body needs.

Are there different kinds of Cholesterol ? :

Yes, there are different types of cholesterol and fats which have different effects on the body. The most common ones of these are:

Low density Lipoprotein Cholesterol : LDL : This is also called the "bad cholesterol." Excess LDL builds up in the arteries causing a blockage and leads to obstruction of blood circulation to heart, Kidneys and brain causing heart disease, heart attack and brain stroke. The higher the LDL levels, the higher the chance of a heart attack.

High Density Lipoprotein Cholesterol : HDL : This is also called the "good cholesterol" as it helps remove the LDL cholesterol blockages and reduce the risk of heart attack.

Triglycerides : It is the chemical name for FATS. These are the fats that exists in the blood stream. In a person with high LDL, high triglycerides may increase the risk of heart attack even further.

Why is High Cholesterol a health risk ?

High levels of Total cholesterol and LDL cholesterol are associated with a higher risk of heart attacks than the general population of similar persons. They also get higher incidence of blockages of arteries [blood vessels] in other areas like the brain, neck, kidney and the legs. High levels of Triglycerides also increase the risk of Heart attacks and other health problems. HDL or good cholesterol if it is low also increases that risk while a high HDL reduces the risk.

What can you do to control or prevent these problems?

Unlike other aspects of your health and other risk factors, high cholesterol is something you can change and control. Most people, with a proper diet low in cholesterol and fat and regular exercise, can bring down the cholesterol and triglyceride levels to the desired range to reduce their risk of heart attack and stroke. This is also useful in controlling high blood pressure and diabetes, which are the other risk factors. However, it may be necessary to take cholesterol lowering medications in addition to diet and exercise to help achieve the desired goal. They may need to take these medicines along with the diet plan & regular exercise for a very long period without stopping.

What are the risk factors for heart attack and stroke?

[ see risk factors for heart diseases ]

Your doctors will look at all risk factors to determine the desired level of cholesterol for you and what you need to do to reduce the cholesterol levels. The common risk factors are:

* High total cholesterol levels, * Very high triglyceride levels,

* High LDL levels,* Low HDL levels,

* High blood pressure; * Diabetes Mellitus, * Cigarette smoking;

* Family history of heart disease, * Physical inactivity, * Obesity,

* Men aged 45 years or older, * Women aged 55 years or older,

* Women with premature menopause and without estrogen replacement.

For many - now Diabetes is considered equivalent to Coronary Heart Disease

If you have following:

Your goal for LDL cholesterol should be:

Coronary heart disease - [CHD] and/or Diabetes Mellitus [DM]

Two or more risk factors with no CHD or DM

Less than two risk factors with no CHD or DM

Usually, diet & exercise will be the initial plan of management, if the LDL-C levels are less than 30 mg/dl above the target levels as listed above and medicines are started above this level of if it is not controlled in 3 to 6 months of diet program. However, for persons of South Asian / Indian origin, often drug therapy is started much earlier even at lower levels due to higher prevalence of heart disease in this subgroup of population. Cigarette smoking is a major risk factor that can be avoided by quitting the habit.

Making Lifestyle Modifications and Medical treatment work for you :

[ See lifestyle modification and Diet plans ]

Properly planned diet, regular exercise and other lifestyle choices along with any drug therapy as necessary play a very important role in achieving your goals for cholesterol levels and reduction of risk of heart disease and stroke.

A healthy diet can weigh in your favor

You can see that it is important that you need to choose foods low in cholesterol and saturated fats. Most meats and animal fats contain cholesterol. None of the Vegetable foods, nuts and oils contain any cholesterol. But, some vegetable oils contain high amounts of saturated fats. It is found in greatest amount in foods from animals, such as fatty cuts of meat, poultry with skin and whole dairy products such as whole milk, butter, cheese and ice cream. You should learn to read nutrition labels carefully so that you understand the cholesterol, saturated fats and unsaturated fat contents of the foods you eat.

Eating foods low in fat will help you eat less saturated fats and eat fewer calories. Foods high in starch and fiber - such as breads, cereals, pasta, grains, fruits and vegetables - are excellent substitutes for foods high in saturated fats and cholesterol. Extra weight and obesity may increase your risk of heart attack and stroke. Then, low calorie and low fat diet will help a weight reduction. Your doctor may prescribe a low calorie weight reduction diet in addition to the low fat and low cholesterol diet. The diet contains all the daily essential nutrients you need and emphasizes eating foods that are low in saturated fats, total fat and cholesterol and high in starch and fiber. They are also good sources of vitamins and minerals.

Take action by staying active with regular exercise.

Physical inactivity is a major risk factor for heart disease. Activities such as gardening, yard work, house work, dancing and walking at leisurely pace can reduce your risk -- just be sure to do something every day. More strenuous exercise, such as brisk walking, jogging and swimming, is excellent if approved by your doctor. Exercise helps to burn calories, reduce extra weight and can help lower LDL-C [bad] and increase HDL-C [good] cholesterol.

Other factors

Cigarette smoking and tobacco are major risk factors for heart attack and stroke. It lowers levels of HDL-Cholesterol and increases blockages of blood vessels with cholesterol. Similarly, uncontrolled High blood pressure and Diabetes can also increase the risk in the presence of cholesterol problems. So, these conditions must be under good control with regular and effective treatment and diet program.

As family history plays a part as a major risk factor -- like those with several blood relatives getting heart attack or stroke at an early age, before the age of 50 or 55 years -- these persons also will need check up for cholesterol levels and necessary management with diet, exercise and medical therapy as needed. So also male gender is a risk factor by itself. Women who had early menopause and / or had no hormone replacement also have a higher incidence. They also need cholesterol check up, diet and exercise and if necessary medical treatment. For similar reasons, persons of South Asian, Indian origin and ancestry who have a higher incidence even with lower LDL-C but low HDL-C will need to get the check up.

When to begin cholesterol lowering drug therapy?

When the healthy lifestyle modifications, regular exercise and proper dietary changes alone does not reduce your LDL-cholesterol and triglycerides [fat] and/or raise HDL-cholesterol enough, cholesterol lowering drug therapy may be the best alternative. If cholesterol levels are very high, the drug therapy may need to be started immediately, along with diet and exercise plans. The drug therapy may need to be continued for a ling time -- may be life time and be sure to understand that diet and weight reduction alone may not be enough for many people. This is a choice many people -- in fact millions of adults -- face. The drug therapy prescribed works by reducing the amount of cholesterol your body makes, and reduces re-absorption also, thereby reducing the LDL-C levels and some reducing the triglycerides and increasing HDL-C levels. However, it is still important to follow the proper diet and exercise program. You will need periodic blood tests to recheck tour cholesterol levels and also liver functions.

Like many other medicines, the drug therapy chosen for you may have some minor or major side effects in few individuals. This may include liver abnormalities, nerve or muscle weaknesses or minor stomach ailments. It is important that you report to your doctor any muscle pains, tenderness or weakness, general discomfort or unexplained fever.

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