High cholesterol: a silent threat of heart attack or stroke

When you hear the word “cholesterol”, chances are you assume it’s bad for you. What you may not know is that some cholesterol is needed for good health. Your body actually produces cholesterol. It’s found in all of your cells and it’s essential for digesting food, producing hormones and generating vitamin D.

Cholesterol only becomes dangerous when there is too much in your blood. That’s when it increases your risk of having a heart attack or stroke. When you have too much cholesterol in your blood, it gets stored in your arteries and can narrow or block these large blood vessels completely. If an artery to your heart is blocked, it causes a heart attack. A blocked artery to the brain causes a stroke.

There are a number of reasons why some people have high levels of cholesterol in their blood but it is most often related to diet, exercise and family history. Cholesterol is a type of fat produced by the liver. When you eat foods that are high in fat, your cholesterol level is likely to increase. Lack of physical activity, being overweight and smoking also contribute to above-normal concentrations of cholesterol in the blood. For others, it may be genetic or a combination of an unhealthy lifestyle and a family history of high cholesterol.

No matter the cause, the real concern is that high cholesterol doesn’t usually cause any signs or symptoms so you don’t even know you have it. It can only be detected through routine blood tests. That’s why it’s so important to speak to your family doctor to find out if you should have your cholesterol tested. If you have no risk factors, routine screening usually starts at age 40 for men and age 50 for women.

So what’s the difference between good and bad cholesterol?

Cholesterol is an oil-based substance that does not mix with blood and is carried around the body by proteins. The combination of proteins and cholesterol is called a lipoprotein. You’ve probably heard that there are two types of cholesterol:

HDL (high-density lipoprotein) is the GOOD ONE because it carries cholesterol from parts of your body back to your liver, which then removes it from your body, thereby protecting your heart.

LDL (low-density lipoprotein) is the BAD ONE because it transports cholesterol particles throughout your body. When LDL levels are high, the liver can’t remove all of the cholesterol from your blood and it leads to a buildup of plaque in your arteries, making them hard and narrow.

How to prevent high cholesterol

The most recommended and effective ways to prevent or reduce high cholesterol are related to lifestyle:

  1. Eat a heart-healthy diet
    • Foods high in saturated and trans fats can increase LDL cholesterol
  1. Get regular exercise
    • Lack of physical activity is linked with lower levels of HDL cholesterol 
  1. Don’t smoke
    • Smoking lowers HDL, particularly in women, and increases LDL
  1. Maintain a healthy weight
    • Losing excess weight can reduce LDL and increase HDL

These lifestyle changes are achievable with knowledge, will power and the determination to reduce your risk of coronary heart disease, heart attack and stroke. However, if following a healthy lifestyle doesn’t help to lower your cholesterol levels, your doctor may prescribe lipid-lowering drugs such as statins.

Tips for a heart-healthy diet

The food you eat has a big impact on your health. Cholesterol only comes from animal-based foods such as cheese, eggs and meat. There is no cholesterol in plant-based foods such as fruit, grains and vegetables.

The Heart and Stroke Foundation of Canada recommends that you:

Eat a variety of whole and minimally processed foods at every meal, i.e. foods that are either not packaged or have few ingredients. Fill half your plate with vegetables and fruit at every meal. Choose vegetables and fruit for snacks.

Choose whole grain breads, barley, oats, quinoa, brown rice, bulgur, farro, etc.

Eat lean meat, remove skin from poultry and have fish twice a week. Choose fatty fishes such as salmon, tuna and sardines. Limit portion sizes. Include vegetarian options as often as possible.

Choose lower fat dairy products or alternatives with no added sugar. Select 1% or skim milk, plain yogurt and lower fat cheeses.

Try healthy snacks such as hummus and carrots, apple wedges with lower fat cheese or plain yogurt with berries.

Drink water or lower-fat milk to satisfy thirst. Avoid sugary drinks including 100% fruit juice.

Reduce the amount of sugar, salt and solid fats in your favourite recipes.

Check the ingredients and Nutrition Facts Tables on packaged foods.

Which fats to eat and which fats to avoid

We need dietary fats and oils for energy and to absorb vitamins such as A, D, E and K. The different types of fat are: monounsaturated; polyunsaturated (Omega 3); saturated; and trans fats.

Avoid trans fats: found in shortening; hard, hydrogenated margarine; commercial baked goods; fast foods; and deep-fried foods.

Reduce saturated fats: found in processed meats such as sausages, bologna, salami, hot dogs, liver, meat pate; prepared foods; snack foods; chocolates; and sugary drinks.

Eat monounsaturated fats in moderation: found in olive, peanut, safflower, sunflower and corn oils; almonds, pecans, hazelnuts, peanuts, pine nuts and sunflower seeds; and avocados.

Choose polyunsaturated fats more often: found in salmon, trout, mackerel, sardines and herring; canola, soy and flaxseed oils; walnuts, flaxseeds (ground) and chia seeds; soybean and tofu; Omega-3 fortified soy beverage, yogurt and eggs.

Other risk factors for high cholesterol

High cholesterol is most commonly caused by unhealthy lifestyle choices, however, genetics can also be responsible, as can some medical conditions and medications.

Medical conditions that can cause high cholesterol include: diabetes; liver or kidney disease; polycystic ovary syndrome; pregnancy and increased levels of female hormones; and underactive thyroid gland.

Medicines that increase LDL and reduce HDL include progestins, anabolic steroids and corticosteroids.

Your age can also play a factor. Normal age-related changes to your body’s metabolism and chemistry could increase your risk of high cholesterol.

Race is another consideration. Black people have higher LDL and HDL levels than Caucasians.

See your doctor

If you think you are at risk for high cholesterol or have had a heart attack or stroke, speak to your doctor. Even if you are prescribed medication to lower your cholesterol, be sure to also make positive lifestyle changes to improve your overall health and well-being.