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HEART HEALTH

Cholesterol

What is it?

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Cholesterols (lipids) are the fats found in your blood. To simplify things we talk about good cholesterol (HDL) and bad cholesterol (LDL). LDL is what we worry about because this is the kind of cholesterol responsible for causing plaques or fat deposits in your arteries that can block blood flow to your heart and brain, causing heart attacks and strokes. 

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HDL helps to remove excess cholesterols from your body. 

Signs and Symptoms

There are no symptoms!​

Diagnosis and treatment of high cholesterol 

The only way to know if you have high cholesterol is through a blood test ordered by your doctor. We don't test everyone's cholesterol regularly – we decide who to test based on the Canadian guidelines. Your doctor may suggest checking your cholesterol if you: 

 

  • Are a biological female aged 50+ and/or have reached menopause 

  • Are a biological male aged 40+ 

  • Are a smoker 

  • Have a diagnosis of diabetes 

  • Have high blood pressure 

  • Have known heart disease, peripheral vascular disease or have had a stroke 

  • Have a strong family history of vascular disease (heart attacks, strokes or blockages in the legs) in a first degree relative 

  • Have erectile dysfunction 

 

Ideally you will have high HDL and low LDL and non-HDL. We also look at Triglycerides which is another kind of cholesterol. The numbers alone don't tell us much - it is your RISK FACTORS that really determine if we should be worried about your cholesterol. When I get cholesterol results, the first thing I do is enter them into a risk calculator that takes into account the following: 

 

  • Your age and biological gender 

  • Your blood pressure 

  • Whether or not you have diabetes, heart disease or hypertension 

  • If you are a smoker 

  • If you have close family members with heart disease or stroke 

 

The risk calculator tells me if you are LOW, MEDIUM or HIGH risk. What does this mean? This gives us an estimate of your chances of having a heart attack or stroke within the next 10 years: 

 

  • LOW = <10% chance 

  • MEDIUM = 10-20% chance 

  • HIGH = 20% or higher chance 

 

Of course, these are just guestimates but they give us an idea of how to advise you. If you are LOW risk, we probably don't need to change anything and we do another blood test in about 3 years. If you are MEDIUM risk, we need to have a conversation about lifestyle changes and maybe medication depending on your other risk factors. If you are HIGH risk, we have that same conversation with a little more emphasis on the benefits of medication to decrease your risk. If you choose to start medication (called a statin – ex. Atorvastatin or Rosuvastatin), we may choose to check your cholesterol again in a few months.  

 

A lot of patients feel nervous about starting medication for their cholesterol and want to try lifestyle changes first to see if they can lower their LDL. We encourage lifestyle changes wholeheartedly but unfortunately they are not always enough to reduce your risk. The choice to start a medication is always YOURS. Your doctor can discuss the risks and benefits of taking/not taking medication in order to help you decide what is best for you. 

 

Familial hypercholesterolemia is high cholesterol that is genetic. People with genetic high cholesterol have much higher risk of heart disease and stroke and may need to be tested earlier in life. These patients almost always need medication to control their bad cholesterol level. 

Non-pharmacologic
treatment 

Lifestyle changes are the most important thing you can do for your cholesterol and your overall health. Here are some suggestions adapted from the Heart and Stroke Foundation of Canada: 

  1. Eat a healthy balanced diet 

    • Chose whole foods over processed foods 

    • Limit your portion sizes! You don't have to eat until you feel full 

    • Drink lots of water 

    • Choose low fat milk, yogurt and cheeses 

    • Fill half of your plate with vegetables and fruits at every meal and choose fruits and vegetables for snack time 

    • Choose whole grains for your breads and cereals – barley, oats, quinoa, brown rice 

    • Try to incorporate proteins that are not meat based like beans, lentils, tofu and nuts  

    • If you are eating meat, make sure it is lean meat – skinless chicken and fish are excellent choices 

    • Enjoy sugary drinks like soda, juice and sports drinks in moderation (it's not realistic to avoid them altogether) 

  2. Cook and eat more meals at home. Make eating out a special occasion! 

    • This gives you more control on the ingredients and preparation of your meals 

    • Eating out often results in consumption of large amounts of food containing more salts and sugars that you would use at home 

  3. When you do eat out, consider: 

    • Sharing appetizers rather than eating an entire portion 

    • Setting aside half of your entree to take home to enjoy as a meal the next day 

  4. Maintain an "optimal" weight 

    • Obesity increases your bad cholesterol - even a loss of a few pounds can be beneficial 

    • Do not aim for perfection! Losing weight is hard work and the numbers on the scale are not nearly as important as your overall physical health 

  5. Physical activity 

    • Even just a slight increase in your physical activity can be beneficial to your cholesterol and overall health 

    • Aim for 30 minutes a day of moderate intensity physical activity like a brisk walk, swimming or a bicycle ride 

    • Choose things you like to do – ex. don't start running if you hate it because you are less likely to follow through  

  6. Quit smoking (I know – this is easier said than done) 

    • Smoking is one of the top risks for heart disease, not to mention the harm it causes to your lungs 

    • Smoking decreases your HDL (good cholesterol); within a few weeks of smoking cessation your HDL starts to rise again 

    • If you can't quit, at least cut back on the number of cigarettes you smoke per day 

    • Quitting is HARD! See your doctor or nurse practitioner if you need help to quit smoking 

  7. Choose good fats 

    • Omega-3 

      • Fatty fishes such as trout, mackerel, herring, sardines and salmon 

      • Canola, soy, sunflower and flaxseed oils 

      • Walnuts, flaxseeds and chia 

      • Soybeans and tofu 

      • Omega-3 fortified foods and drinks 

    • Monounsaturated fats 

      • Olive, canola, peanut, safflower and sesame oils 

      • Non-hydrogenated margarines made from the oils listed above 

      • Salad dressings containing these oils 

      • Almonds, peanuts, pecans, hazelnuts, pine nuts and sunflower seeds 

      • Avocados 

  8. Consume the bad fats in moderation (or avoid if you can) 

    • Fatty meats 

    • Full-fat dairy products 

    • Butter, hard margarines, lard, coconut oil, ghee and palm oil 

    • Highly processed and prepared foods and snacks 

    • Processed meats like sausage, bologna, hot dogs, liver, salami and meat pates 

    • Chocolate 

    • Sugary drinks 

 

Are you confused and overwhelmed by all of this? You are NOT alone. Many people find all of these suggestions overwhelming and they respond by not making any changes at all. Here is what I tell my patients: 

 

If you do nothing else - eat more fruits and vegetables, drink more water and move your body. Bonus if you can also avoid fried foods. Let's start with that.  

 

Baby steps towards a heathier you! 

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