Cholesterol. What it is. What is the recommended level. What to do about it. Take a test to determine your risk.

Takeheart Health Check       [Cholesterol - Heart Attack Prevention]

Cholesterol and Heart Attack Prevention

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People with high cholesterol values tend to have clogged up arteries which lead to heart attacks. Looking after your cholesterol helps to prevent this and can even unclog your arteries. For a succint resumé of the cholesterol story.

The incidence of coronary heart disease is very high in the United Kingdom, but elsewhere in the world it is often much lower. Epidemiological studies show a strong correlation between the average serum cholesterol of a population and its rate of CHD. (479)

Large clinical trials have demonstrated that lipid-lowering therapy reduces cardiovascular morbidity and mortality, and overall mortality, in both patients with established coronary heart disease and those at high risk of developing it. The debate about cholesterol lowering has, therefore, moved from the questions of efficacy and safety to those of cost, cost-effectiveness and patient selection. (478). For a readable summary of the evidence for the use of statins see 503.

A normal cholesterol is taken as below 5·2 mmols per litre. It is wise for you to aim for a level somewhat below this. If your level is consistently high it can usually be reduced by dietery measures and by desisting from smoking.

Cholesterol Targets in current UK guidelines (2008)
 Total cholesterol
LDL cholesterol
Joint British Societies guidelines<4.0<2.0;
National Service Framework for CHD<5.0<3.0
SIGN Guideline 2007<5.0<3.0

The National lnstitute for Clinical Excellence (NICE) has recently (2008) recommended that 4mmols/l (156 mgs/100mls) be the upper limit for those with a history of coronary heart disease - secondary prevention. (575)

About 55 per cent of the UK population have cholesterol concentrations above 5.5mmol/l, 25 per cent have levels above 6.5mmol/l and 5 per cent have levels above 7.8mmol/l.

Mean cholesterol level of young adults in London is 5.8, in South Italy it is 4.7 and in South Japan 3.9 (The Oxford Textbook of Medicine).

There is no normal range for lipids, but a continuous gradation of risk.

High levels resistant to diet may require medication under the supervision of your physician.

Some families have a tradition of very high cholesterol levels. They should be under medical supervision. For a succint resumé of the familial hypercholestyerolaemia story.

Favourable changes in the lipid profile of Finnish MPs indicates that national cholesterol campaigns have impacted even on decision makers. (466)

In the United Kingdom cholesterol is usually expressed as so many mmols per litre. In other places it is sometimes expressed as mgs per decilitre. 5·2 mmols per litre is the same as 200 mgs per decilitre (multiply or divide by 39 to convert from one to the other).

Total cholesterol and high density lipoprotein cholesterol (HDL) can both be measured on a random (ie non-fasting) specimen of blood. The patient should have been on their habitual diet for two weeks, have no major illness, operation or injury for 2-4 weeks and no febrile illness for one week (The Oxford Textbook of Medicine).

Some misconceptions about bad cholesterol

The Statins

Statins are effective and are well tolerated - only 2% stopped their simvastatin on account of side effects in the 4S trial.

Sounds Good?


The Effects of Statins on Lipids (512)
Dose 40mgs/dayLDL CholesterolTriglycerides
% change
HDL Cholesterol

New (2013) guidelines from the USA

Web sites.

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