EDP column by Dr Ketan Dhatariya

“My doctor has told me that I have high cholesterol levels and that I need to be on tablets. Can I not just cut down on my chips and biscuits?"

Thanks you for your very topical question. Cholesterol is essential for life. All of the cells in your body need it to make the membrane around itself. Cholesterol is also the basis for many of the important hormones in the body. Thus we all need some. However, it has been known for several years now that too much cholesterol is bad for us. High cholesterol levels are associated with increased risks of strokes and heart attacks. The important word there is risk.

It is often hard to try and convey what is risk. But if, for example, you were to cross a road, there is a risk that you may be knocked down. However, the chance of that happening on any given day is very low indeed. But if I asked 100,000 people to all cross the road once a day for a year, then maybe, a few of those may tragically be hit. It is the same with high cholesterol. Any one individual is at low risk of having problems, but if I looked at 100,000 individuals and measured their cholesterol levels and then followed them over a year, then there would be more heart attacks and strokes amongst those who had the highest levels of cholesterol compared with those who had the lowest levels. That is why we try and reduce risk by asking people to lower their cholesterol – like reducing the risk of being knocked over by using a zebra crossing.

There are several different types of cholesterol. The ‘bad’ cholesterol is known as LDL (low density lipoprotein). When the blood vessels of those who have heart attacks and strokes are looked at, the arteries are often narrowed by collections of material containing lots of LDL cholesterol. The ‘good’ cholesterol is HDL (high density lipoprotein). This takes LDL cholesterol away from areas of narrowing back to the liver where it was made. Thus the ideal would be to have low LDL and high HDL levels.

About 15% of your blood cholesterol levels are derived from your diet, so it can make a big difference by cutting down on fatty foods. If after a low fat diet, your cholesterol levels are still high, then your doctor may decide to put you on cholesterol lowering tablets called statins. These tablets are especially important if you are at increased risk of having strokes and heart attacks, such as in people with diabetes, or who have already had a stroke or heart attack, to try and prevent another. If you feel you are at increased risk, discuss this with your doctor.

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