Everybody
has cholesterol in his, or her, body. It is a vital constituent
of cells, is particularly rich in the nervous system and is
a precursor of some of the body's essential chemicals and hormones.
Cholesterol is absorbed in food and is also manufactured in
the body. The problem with cholesterol, of course, is when there
is too much (hypercholesterolaemia) as an excess of cholesterol
is a major contributory factor in hardening of the arteries
(see Artherosclerosis). That is the simple picture, the actual
picture is much more complicated. A lot of people with quite
high cholesterol levels live long and healthy lives. On the
other hand, many people who have heart attacks do not have particularly
high cholesterol levels. There are a number of fatty substances
involved in the equation including the high density lipoproteins
(HDL) which seem to have a beneficial and protective role, and
the low density lipoproteins (LDL) which are a negative factor
in heart disease etc. High HDL = Good. High LDL= Bad. Nowadays
many physicians regard a high LDL as more significant than a
raised cholesterol alone. A raised cholesterol, however, is
a definite risk factor in atherosclerosis, more so when it is
in the presence of other risk factors such as smoking, raised
blood pressure etc. A high saturated fat diet can put up blood
cholesterol as can obesity, lack of exercise and such conditions
as hypothyroidism (see Thyroid problems). But those most at
risk seem to be the people who make an excess of their own cholesterol.
This often runs in families (familial hypercholesterolaemia) and in these families, heart attacks etc. at a young age can, unfortunately, be very common.
As has been said regarding atherosclerosis, you can't choose your parents. If one is in a family with a history of high cholesterol and premature heart attack, however, then all the other avoidable risk factors such as smoking, obesity, lack of exercise should be studiously avoided. A cholesterol low diet should be aimed for (see Atherosclerosis). Drugs are available, notably the statins, which will lower the blood cholesterol. A doctor should be consulted about these. They are usually prescribed to those with very high blood cholesterol, particularly those with familial hypercholesterolaemia. They are also given to those with cholesterols above the accepted safe maximum level of 5.2 who have already had some kind of vascular disease - angina, heart attack, stroke etc. This is called "secondary prevention". Primary prevention, giving statins to people with no illness who just have a cholesterol raised above 5.2, is a contentious matter. That it is not done routinely owes as much to the financial feasibility of the exercise as the medical suitability. Patients with an unsatisfactory blood fats picture are advised to keep their HDL as high as possible. Stopping smoking, taking more exercise, drinking a modest, regular amount of red wine, can all increase HDL levels. |
