Did you know that as a nation, we Irish are predisposed to high cholesterol, which can result in a stroke or heart attack? And also that we’re culturally averse to taking medication to reduce our levels of this dangerous fat?
Four out of every five adults who come into Irish hospitals tend to have high cholesterol levels, warns David Burke, Consultant Cardiologist and Head of Cardiology at the Beacon Hospital, who says he also finds that many patients dislike the idea of “taking the tablet”.
We all need a certain amount of cholesterol, which is a type of fat that’s found in the blood, but when too much of it builds up in the system, it can cause significant problems. “Cholesterol builds up gradually and ultimately forms plaque, which in turn causes narrowing of the blood vessels, which can lead to heart attack and stroke,” explains Dr Burke.
If the affected artery is bringing blood to the brain, plaque build-up may result in a stroke. If it’s an artery that leads to the heart, the damage can come in the form of a heart attack. Elevated cholesterol levels over a long period can also put a patient at higher risk of other conditions such as peripheral vascular disease and kidney impairment.
There are two kinds of cholesterol – HDL cholesterol (high density lipoprotein) is often referred to as ‘good cholesterol’ because it mops up cholesterol left behind in your arteries and carries it to your liver, where it is broken down and passed out of the body. Regular physical exercise can help improve your HDL level – high levels of f HDL cholesterol can protect you against having a heart attack or a stroke.
LDL cholesterol (low density lipoprotein) is often referred to as the ‘bad cholesterol’. This sticks to the walls of your arteries, causing plaque, making the arteries narrower and reducing the blood supply to the heart or brain. Eating too many foods which are high in saturated fat can raise your LDL cholesterol, in turn heightening your risk of heart disease and stroke.
The reduction of LDL is actually the primary target of all treatments – Dr Angie Brown, Medical Director of the Irish Heart Foundation, says that for those in a ‘high risk’ category of, for example, developing cardiovascular disease, the target LDL would be 1.8. Generally speaking, however, says Dr Burke, we should aim for a ballpark total cholesterol figure of below 5.0, and an LDL of half that.
So how do we tackle the problem of high cholesterol?
The secret is actually to prevent it happening, says Dr Burke, who warns that once high levels of cholesterol have begun to form plaque in the veins, it’s not possible to reverse it.
“Most people are not aware of the fact that once cholesterol builds up in the blood vessels, you cannot reverse it.
“Medication is designed to hold it steady, but you cannot get rid of it. The trick is prevention.”
A healthy diet and regular exercise is the way to go in terms of preventing high cholesterol levels, according to Sarah Noone, dietitian with the Irish Heart Foundation, who says the advice is to eat a Mediterranean-style diet high in fruit, vegetables, salads, wholegrains and oily fish, with modest amounts of dairy products and lean meats and a low intake of foods high in fat, salt and sugar.
Don’t smoke – and make sure to take moderate exercise regularly.
However, too many adults are not doing this, warns Dr Burke.
“The majority of the adult population coming into hospital have high cholesterol,” he says. “Generally speaking, Irish genetics tend to give us high cholesterol – as a nation we’d be predisposed to it.”
And although people are becoming much more aware about the longer term risk of high cholesterol levels, they remain “very averse” to treating it with medication, warns Dr Burke, who says that most patients are, however, willing to try lowering their cholesterol levels through changes to diet and lifestyle.
According to Ms Noone, this can be done through reducing excess body weight, improving dietary habits in conjunction with specific diet and lifestyle advice relating to individual risk factors such as high blood pressure, cutting out smoking if you smoke, consuming only a moderate amount of alcohol if you drink – and getting 150 minutes per week of moderate exercise, such as brisk walking.
“Many people can reduce their cholesterol numbers down by between 15pc and 20pc with a concerted effort, but that is very hard to maintain,” warns Dr Burke.
“It’s like a New Year’s resolution – the good intentions can fizzle out.
“At the same time, many people are averse to taking the necessary medication to treat high cholesterol. I think it’s an Irish or cultural thing – Irish people are not keen on tablets.”
There are a number of factors involved in high cholesterol levels – and genetics and lifestyle play very major roles, says Dr Burke.
“Family history, genetics, and lifestyle are huge factors in developing high levels of cholesterol.
“A fatty, unhealthy diet, sedentary lifestyle, alcohol and smoking – these are factors that crop up with my patients over and over again,” he observes.
If your doctor recommends you take medication, he believes, you should strongly consider complying.
“If you have persistently elevated cholesterol and have any other cardiovascular risk such as high blood pressure, family history of heart attack and stroke, or diabetes, it would be advisable to treat your condition with cholesterol medication.
“Doctors are not peddling medication – when you need it, you need it!”
“The medication is there and it’s safe,” he says, adding that the main treatment for cholesterol is statins.
“The big message about cholesterol is that it’s a very silent and innocuous-seeming condition,” he observes, warning that people often underestimate the risk high cholesterol levels can pose to their health.
“People tend to push it down the road and say they’ll think about it when they get older. However, if you have high cholesterol levels, you’re building up a problem over your lifetime.”
Remember, advises Dr Angie Brown of the IHF, the only way to know if you have a high cholesterol is to get a blood test.
“It’s important to get the full lipid profile, this includes the total cholesterol, the HDL -which is the ‘good’ cholesterol and protective – and the LDL, which is the bad cholesterol and is the one associated with increased risk of developing cardiovascular disease.”
The test will also include the triglycerides, she says, and if these are raised it is also associated with a increased risk of developing cardiovascular disease.
Dr Brown emphasises the fact that LDL levels, or bad cholesterol, tends to rise in women after the menopause.
“If people become more sedentary, if they are obese and if they take excess alcohol it can also lead to worsening lipid levels,” she adds.