Dr. Shyam P Lohani

Millions of adults worldwide have high cholesterol levels in their blood. High cholesterol poses risks of heart disease and stroke that are leading causes of death globally. The risk of heart disease and stroke rises as the amount of cholesterol in the blood increases. Cholesterol is a waxy, fat-like substance produced by the liver. An appropriate level of cholesterol is essential for maintaining good health. It is essential for the synthesis of hormones, vitamin D, and digesting various fatty foods. The body makes the essential amount of cholesterol it needs. Therefore, it is recommended that people eat as little dietary cholesterol as possible.

Blood cholesterol
A healthy body makes a sufficient amount of cholesterol; however, certain foods also contain cholesterol. Each cell of our body needs cholesterol in order to form layers to control the transport of many substances in and out of the cell. Bile is produced by the liver with cholesterol that helps in the digestion of fatty foods. Our liver makes sufficient cholesterol to meet the body’s needs for these important functions.
Cholesterol is only found in foods that come from animals such as red meat, full-fat dairy, and margarine. Moreover, there are cholesterol-lowering foods that actively decrease cholesterol levels such as oats, barley, and whole grains, beans, eggplant and okra, nuts, vegetable oil (canola, sunflower), fruits (mainly apples, grapes, strawberries, and citrus), soy and soy-based foods, fatty fish (particularly salmon, tuna, and sardines) and foods rich in fiber.

Cholesterol doesn’t dissolve in water. So it does not circulate through the blood on its own. Lipoproteins synthesised by the liver help transport cholesterol. Lipoproteins are composed of fat and protein and carry cholesterol and triglycerides, another type of lipid, through the bloodstream. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are the two major forms of lipoproteins in our body.
LDL cholesterol is cholesterol carried by low-density lipoproteins. Our blood with high LDL cholesterol is diagnosed with high cholesterol. High cholesterol may lead to many health issues, including heart attack and stroke if remain untreated. LDL cholesterol is often called bad cholesterol. HDL cholesterol is sometimes called good cholesterol. It helps return LDL cholesterol to the liver to be removed from the body that aids in preventing cholesterol plaque from building up in the arteries.

Total cholesterol levels less than 200 milligrams per decilitre (mg/dL) in adults are considered healthy. A reading between 200 and 239 mg/dL is borderline high and 240 mg/dL and above is considered high. Ideal LDL cholesterol levels should be less than 100 mg/dL. A range of 100–129 mg/dL of LDL-cholesterol is acceptable for people with no health problems but maybe a concern for anyone with heart disease or heart disease risk factors. The range of 130-159 mg/dL is borderline high, 160-189 mg/dL is high and 190 mg/dL or higher is considered very high.

HDL levels should be kept higher. The optimal HDL levels is 60 mg/dL or higher. A reading of less than 40 mg/dL can be a major risk factor for heart disease and 41-59 mg/dL is considered borderline low. In most cases, high cholesterol is symptomless and a silent condition. Many people remain asymptomatic even with high cholesterol until serious complications, such as a heart attack or stroke develops. Therefore, it is important to carry out routine cholesterol for 20-year-old or older people.

Consuming too many foods high in cholesterol, saturated fats, and trans fats may increase the risk of developing high cholesterol. Obesity can also increase the risk of high cholesterol. Physical inactivity, smoking, and alcohol use are other lifestyle-related factors that potentially raise cholesterol levels in the blood. Hereditary is also linked to high cholesterol levels in the blood. Health conditions, such as diabetes and hypothyroidism, may also increase the risk of developing high cholesterol and related complications.

Lifestyle modifications
High cholesterol, if remain untreated, can cause plaque to build up in arteries. After some time, this plaque can narrow arteries giving rise to a condition known as atherosclerosis. Atherosclerosis is a serious condition. It can reduce the flow of blood through arteries raising the risk of developing dangerous blood clots. Atherosclerosis can result in many life-threatening complications, such as stroke, heart attack, angina, or chest pain, high blood pressure, peripheral vascular disease, and chronic kidney disease. High cholesterol can also create a bile imbalance, raising the risk of gallstones.

Healthy levels of HDL cholesterol help lower the risk of blood clots, heart disease, and stroke. People with high cholesterol levels should make four major lifestyle modifications in order to maintain normal cholesterol in the blood. They are advised to eat a heart-healthy diet, limit intake of foods that are high in cholesterol, saturated fats, and trans fats, carry out regular exercise, and quit smoking.

Lean sources of protein, such as chicken, fish, and legumes should be eaten. High-fiber foods, such as fruits, vegetables, and whole grains help lower LDL cholesterol. Baked, broiled, steamed, grilled, and roasted foods should be taken instead of fried foods. Similarly, fast food and sugary food should be avoided. Regular exercise, quitting tobacco products, and maintaining a healthy weight will lower the risk of complications from high cholesterol such as coronary heart disease and heart attack.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)