Cholesterol is found throughout your body, including in your blood. It’s not bad unless you have too much of it, then it can cause serious problems like heart disease and strokes. You’re more likely to have high cholesterol if you’re overweight, smoke, drink alcohol, eat fatty foods and don’t exercise enough. The condition can also run in families. Making lifestyle changes can help to lower your cholesterol and keep you healthy. You may also need to take medication to keep your cholesterol at a safe level. At The Independent Pharmacy, we're here to support you in managing your cholesterol levels and promoting heart health. Let's take the right steps towards a healthier you.
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Cholesterol is a fatty, waxy substance found naturally in the blood. Cholesterol is also known as a lipid. Lipids are essential in maintaining good health and normal bodily functions. However, when the levels of cholesterol in the blood become too high, it can have a negative effect on our health. If cholesterol levels in the blood are too high then it can stick and build up in the artery walls. This build up can start to restrict the blood flow through the arteries, potentially starving the heart, brain and rest of the body of blood supply and hence, oxygen. This restriction can lead to heart disease, such as a heart attack or stroke.
Cholesterol is transported around the body by proteins in your blood. Combined they are called lipoproteins. The two main types of lipoproteins are known as:
High cholesterol (which actually refers to high levels of LDL) can be caused by a number of factors. These include:
High cholesterol itself doesn’t cause any symptoms. If you’re over the age of 40 it is recommended to have your blood cholesterol levels tested every few years, especially if you are male or have one or more of the above risk factors.
Signs that you are suffering with high cholesterol would only be apparent from symptoms produced by other medical conditions that come about as a result of high cholesterol, such as angina (chest pain).
Blood cholesterol tests are quick and simple. All that’s required is a small sample of blood to determine the amount HDL, LDL and triglycerides that are present in your blood. This will usually require not eating for 12 hours prior to the test. This will ensure all food has been completely digested, so as not to affect the outcome of the test. The test can be performed by a practice nurse, pharmacist, or GP. They will either use a needle and syringe or a small finger-pricking lancet to acquire the necessary blood sample.
The recommended levels of cholesterol in the blood (LDL and HDL) will vary between those with a higher or lower risk of developing arterial disease. The levels generally applicable to normal healthy adults should be:
The recommended level will differ if you possess a higher risk of contracting cardiovascular disease. These levels will be:
The cholesterol test should also highlight the triglyceride levels in the blood. Triglycerides are the fats in the body that are used for energy. You get them from fatty foods and store what isn’t being used as fatty tissue. Having an excess amount of triglycerides in the blood can also lead to heart problems, which is why these levels are monitored and associated with the levels of cholesterol. The recommended level of triglycerides should be 1.7mmol/L or less.
If you’ve been diagnosed as having high cholesterol you will first be advised to make lifestyle and dietary changes. This will include eating a healthier diet, low in saturated fat and increasing your levels of exercise. If you are a smoker it will be strongly advised to kick the habit, as smoking can inhibit the amount of good cholesterol in your blood. If after a few months, your cholesterol levels are still high, despite these lifestyle changes then it will probably be deemed necessary to start taking cholesterol-lowering medication (statins).
There are different types of cholesterol-lowering medication. It will be up to your doctor to decide which one is the most suited to you. The most commonly prescribed cholesterol-lowering medicines are known as 'Statins'.
Statins work by blocking the enzyme in your liver that helps produce cholesterol. This will lead to a reduction of your overall blood cholesterol levels. Examples of statins include:
Of all the statins available, simvastatin and atorvastatin are the most commonly prescribed. Once you begin taking statins they are usually taken for life as If you were to stop taking your statin then your cholesterol levels would again begin to rise.
Statins are prescribed for individuals who:
Most statins are taken every night as this is when the body produces the most cholesterol. If you’re taking Simvastatin or Atorvastatin it is recommended to avoid consuming grapefruit or grapefruit juice as they can increase your risk of experiencing side effects.
Ezetrol (ezetimibe) is another medicine that can be used to treat high cholesterol. It is normally a second-line treatment that is used if statins are inappropriate or if another medicine is required in addition to a statin to lower cholesterol. Ezetrol lowers cholesterol by blocking the absorption in the small intestine and blocks the amount of cholesterol available to the liver. This results in more cholesterol being removed from the bloodstream, lowering your cholesterol levels and reducing the chances of fatty plaques building up.
There are many ways in which to reduce your risk of developing high cholesterol. The most effective being;
When talking about dietary fat it’s important to distinguish the difference between saturated fat and unsaturated fat. Saturated fat will increase the levels of LDL cholesterol in your blood. Foods containing the bad saturated fat include:
However, unsaturated fat has been shown to increase the levels of HDL in your blood, which will help decrease any blockages in your arteries. Foods that are rich in good unsaturated fat include:
Increasing the dietary fibre intake has been shown to help lower cholesterol when done as part of a low-fat diet. High fibre foods include wholegrain bread, rice and pasta as well as plenty of fruit and vegetables.
Regular exercise is proven to increase the amount of HDL or ‘good cholesterol’ in your body. Exercising will stimulate the body to break down the fatty deposits. It will also make you lose weight which will decrease the amount of LDL or ‘bad cholesterol’ in your system.
Quitting smoking will decrease the amount of bad cholesterol in your body. The chemical acrolein is found in cigarettes and is known to inhibit the performance of HDL transporting fatty deposit back to the liver to be broken down.
Non-prescription alternatives for treating high cholesterol are;
You should be aiming for:
The most important measurement is the 'bad' LDL cholesterol. You should always aim to keep this below 3 mmol/L, even if your total cholesterol is above the recommended limits.
It is often useful to keep a track of your cholesterol levels every time they are tested so you can see the progress you are making.
Blood cholesterol is measured in units of millimoles per litre of blood (mmol/L). In healthy adults, the total cholesterol level should be 5 mmol/L or less. For those at high risk of developing arterial disease, a total cholesterol level of 4 mmol/L or less is recommended.
As a general guideline, a healthy adult should have an LDL level of no more than 3 mmol/L, while those at high risk should keep their LDL level to 2 mmol/L or less.
An ideal HDL level is recommended to be above 1 mmol/L. If the HDL level is any lower than that, then there could be an increase in the risk of heart disease.
You can also calculate the ratio of total cholesterol to HDL by dividing your total cholesterol level by your HDL level. Generally, this ratio should be below four, as a higher ratio means increased risk for heart disease.
Cholesterol is a fat-like substance that travels in your bloodstream. They are carried by little particles called lipoproteins that are made up of fats and protein. There are two types of lipoprotein: HDL and LDL.
HDL and LDL levels can both be measured with a blood test. The recommended cholesterol levels in the blood vary depending on whether the person is at high risk of developing arterial disease.
Research has proven that people with high cholesterol are at higher risk for an array of medical conditions, including:
Cholesterol can build up in the artery wall. Too much build-up will eventually restrict blood flow to the brain, heart, and the rest of your body. This increases the chances of a blood clot developing in the body.
The risk of developing coronary heart disease also increases with higher cholesterol levels. This can cause pain in your chest or arm (known as angina) during physical activity or when stressed.
Your lifestyle choices play a big role in whether you become at risk for developing high blood cholesterol, including:
People with high blood pressure (hypertension) and diabetes often have high cholesterol as well. Other medical conditions that can also cause cholesterol levels to increase include liver disease, kidney disease, and an underactive thyroid gland (hypothyroidism).
There are also a number of “fixed factors” associated with high cholesterol that increases your likelihood of having a heart attack or stroke. These are factors that cannot be changed. They include:
If any (or maybe several) of the above-fixed risk factors apply to you, it is even more important to assess your lifestyle and evaluate any underlying conditions you may have.
High cholesterol can only be correctly diagnosed through a blood test. Upon a diagnosis, your doctor will be able to determine an appropriate medication depending on your personal circumstances. If at any time, you feel that the medication is not right for you, it is important to discuss it with your doctor so he can prescribe a more suitable treatment.
Statins are one of the most widely reported medicines in the news and have acquired fairly bad reputation with the public.
Statins are one of the most widely used groups of medicines in the UK. It is generally considered that the risk of side effects is far outweighed by the benefits they offer in reducing cholesterol levels and therefore the risk of heart and circulatory problems.
As with any medicine, there will always be a minority of people who have a bad reaction or side effects from statins. It is important to read your information leaflet carefully when you start your treatment and be aware of any effects that may need to be reported to your doctor. It is important to have blood tests 6-12 monthly whilst taking statins to test their effectiveness and for any adverse effects.
Statins are a type of medication prescribed to high cholesterol patients. Statins work by blocking the enzyme in your liver that helps produce cholesterol. Eventually, this will lower the total blood cholesterol level. The most common statin prescribed is Atorvastatin. Other statins include Simvastatin and Rosuvastatin.
Statins are safe to use, however, some people will find that they have an intolerance to this medication, which will then produce some side effects. Common side effects include muscle pain, headaches, and a range of stomach issues, from indigestion to constipation and/or diarrhea.
Statins need to be taken for life, so they will only be prescribed to people who are at extremely high risk of heart disease. As soon as a patient stops taking a statin, cholesterol levels will start to increase again.
With cholesterol-lowering medications, you won’t feel any different, so it is even more important to remember to take it every day and routinely follow up with your doctor or nurse. You will need to have a blood test to measure your cholesterol levels to check if your treatment is effective or not.
You will likely need to take statins on a long-term basis. If you stop taking your cholesterol medication, it’s likely your cholesterol level will rise.
There is a chance that you will be able to come off statins, or at least reduce your dose, if you make significant lifestyles changes to help reduce your cholesterol naturally.
It takes several weeks of taking a statin before your doctor can see a change in your cholesterol levels. Your doctor will monitor your cholesterol (to see if your treatment is effective) and your liver function (to make sure your aren’t experiencing any unnoticed side effects). You will not notice any difference as your cholesterol lowers; it is important to continue to take your medicine and take steps to lower cholesterol anyway.
Typically, you take one statin tablet per day as directed by your doctor.
The body manufactures more cholesterol at night than during the day, taking statins in the evening meal or at night is usually allows them to be most effective. Lipitor (atorvastatin), Crestor (rosuvastatin) and Lipostat (pravastatin) are longer acting statins and can be taken at
If a dose is missed, you can take it as soon as your remember if it is on the same day. Don't double up the next day; just take your usual dose as normal.
If you do miss a dose of your statin, there is no need to worry. Cholesterol levels are a long-term measure and will not drastically change with an occasional missed dose. That said, you should try to take your treatment regularly to keep your condition well managed and give you the best chance possible of achieving a healthy cholesterol level.
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All these statins can be taken during any time of day, with the exception of Simvastatin, which is only recommended to be taken at night right before sleeping.
Ezetimibe is another medication commonly prescribed for the treatment of high cholesterol. Usually, the cholesterol present in your intestines (from food and bile juices) will get absorbed into your blood. Ezetimibe works by blocking this absorption of cholesterol. Generally, it is not as effective as statins, but it is less likely to cause side effects.
Ezetimibe can be safely taken at the same time you typically take your statin if you find that the statin alone does not keep your cholesterol at the desired low level. When taken in this combination, the side effects are generally the same as if taking statin on its own (stomach problems and muscle pain).
Some people are unable to take a statin for whatever reason (maybe you experience side effects, are using other medications that conflict with a statin, or are diagnosed with a different medical condition), so in that case, ezetimibe is another option and can be taken on its own. Ezetimibe
Do not drink grapefruit juice if you are taking simvastatin. Grapefruit juice increases the level of simvastatin in your blood and makes side effects more likely.
Atorvastatin interacts with grapefruit juice if you drink large quantities, but an occasional glass is thought to be safe.
It is safe to drink grapefruit juice and eat grapefruit if you're taking other types of statins.
Authored by
Dr Don Grant is The Independent Pharmacy's original online prescriber and has advanced in his role to become the Clinical Advisor, using his wealth of experience to advise on our clinical polices and prescribing guidelines.
Reviewed by
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.
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