High cholesterol is a major health issue around the world and can increase the risk of stroke, mini strokes, peripheral arterial disease, coronary artery disease and cardiovascular disease.
It causes 2.6 million deaths annually and causes 29.7 million disabilities worldwide each year. In Australia, around half of all adults have cholesterol levels higher than recommended.
Australian Integrative Cardiologist Jason Kaplan recently spoke to Starts at 60 about the important information over-60s need to know when it comes to lowering cholesterol.
While everyone naturally has high-density lipoprotein (good cholesterol) and low-density lipoprotein (bad cholesterol) in their bodies, it can be difficult to understand when cholesterol is a problem for health.
Higher levels of high-density lipoprotein are actually good for health, but it’s when levels of low-density lipoprotein (LDL) get too high that the body’s cells can’t handle them. This can cause cholesterol to build up in the walls of the arteries, leading to an array of serious health problems.
“High cholesterol is an established risk factor for the development of coronary artery disease, which is basically the major form of heart disease we see in Australia, along with hypertension and stroke for that matter,” Kaplan explained. “It’s one of your most important risk factors for the development of coronary disease and blockages to the blood supply of the heart, which then subsequently lead to a heart attack.”
High cholesterol can impact people of all ages, but it is particularly common in people over the age of 50 and 60.
“Genetics play a big part and that’s something that is very difficult to change,” Kaplan explained. “Some people have an inherited genetic form of high cholesterol and for some people, cholesterol has a greater effect.”
This means that if these people consume cholesterol through their diet, it can have a bigger impact on their overall health and cholesterol levels than someone without the disease. Similarly, pre-existing health conditions including diabetes and high blood pressure can play a role.
For others, cholesterol is actually caused by modifiable lifestyle factors including smoking, unhealthy diets high in trans fats and a lack of exercise.
“Trans fat is the fat that’s produced in a lot of processed foods and a lot of processed baked goods and foods that have a longer shelf life in supermarkets,” Kaplan explained. “These are fats that are added to food so they stay longer on the shelf and to make them taste better.”
Like many health conditions, there generally aren’t any visible signs or symptoms that point to high cholesterol. Talking to a GP or a health professional is the best way to get a proper diagnosis.
“Seeing your cholesterol level is as easy as going to your general practitioner,” Kaplan said. “You get a blood test and that gives you an idea of how high your cholesterol is.”
In most cases, a GP will ask about lifestyle factors and family history, while blood pressure will also be measured. If unsure about anything being recorded or asked, it’s important to get the GP to clarify what they mean.
Similarly, preventative cardiologists have new non-invasive imaging techniques that can be used to detect high cholesterol in at-risk patients.
“Without putting wires or catheters into people, I can actually do a low-dose CAT scan of the heart and I can see if that cholesterol has been deposited in peoples’ arteries and is likely to cause them a heart attack,” Kaplan said. “The test is widely available at any large radiology practice and your general practitioner can send you for it. It’s called a coronary calcium score. I would recommend anyone over the age of 60 getting one of these tests.”
In people with no other risk factors, cholesterol levels should be less than 5.5 millimoles per litre of blood. In those with risk factors such as high blood pressure, or other forms of cardiovascular disease, the level should be less than 2 mmol/l. A health professional will be able to determine levels through a blood test.
Unfortunately for people with a genetic disease, changing lifestyle factors will do little to decrease levels of high cholesterol. More often than not, these patients will be prescribed statins or cholesterol-lowering medication to manage the condition.
In others where diet or lifestyle is causing LDL to increase, there are small changes they can make.
“My guidance to people is to first increase the amount of fibre in your diet,” Kaplan said. “So plenty of vegetables, plenty of foods like oats, flaxseed, psyllium husks are also very helpful as well. You need a reasonable amount of soluble and non-soluble fibre in your diet.”
Similarly, decreasing red meat and increasing levels of plant-based foods can help, while nuts, walnuts, almonds and pecans can also help.
Just as diet is important, physical exercise can also do wonders in lowering cholesterol levels. It’s not about running marathons or doing exercises that could impact existing health conditions such as arthritis or knee problems, but rather finding an exercise that works for the individual and sticking to it.
While there is conflicting information relating to statins, the truth is there is more than 30 years of experience in using them.
“The people who stand to benefit most from the cholesterol lowering drugs called statins are the people that are in the higher risk categories,” Kaplain said. “In some people, they’re also able to stabilise some of the plaque in the arteries, which makes it less likely to cause a heart attack. They become an essential tool in our prevention of coronary artery disease.”
Kaplan will only prescribe statins to patients he feels require them and there will be a benefit. This includes patients who are at high risk of having a stroke or heart attack, or patients who have had a heart attack.
The most common surgery to remove a blockage in the arteries is for health professionals to insert a stent.
“If people have a blockage due to coronary disease they can get a stent which treats the blockage or some people need bypass surgery, which is open heart surgery to bypass the blockage with another artery,” Kaplan said.
These patients are already at high risk of cardiovascular disease and will typically already be on statins before their surgery. Similarly, they will remain on statins following their operation.
It’s always important to talk to a health professional or GP about high cholesterol, the best tests to undergo and if required, the best treatment to manage the condition.
Important information: The information provided on this website is of a general nature and information purposes only. It does not take into account your personal health requirements or existing medical conditions. It is not personalised health advice and must not be relied upon as such. Before making any decisions about your health or changes to medication, diet and exercise routines you should determine whether the information is appropriate in terms of your particular circumstances and seek advice from a medical professional.