High Cholesterol and How to Lower it

What is high cholesterol?

Cholesterol is a fatty substance carried in your blood. The NHS describes high cholesterol simply as having too much of it. The problem is what it does over years: it narrows blood vessels, which raises the risk of heart disease and stroke.

What is the difference between "good" and "bad" cholesterol?

The American Heart Association separates them like this:

• LDL is the harmful one. It contributes to fatty build-up inside arteries. As arteries narrow, the risk of heart attack, stroke and peripheral artery disease goes up.
• HDL is the helpful one. It carries cholesterol away from the arteries to the liver, where the body breaks it down. A healthy HDL level may help protect against heart attack and stroke.
• Triglycerides are the most common type of fat in the body and store extra energy from food. High triglycerides along with high LDL or low HDL are linked to fatty deposits in the arteries.

How do you know if you have it?

You mostly cannot tell. The NHS states plainly that high cholesterol does not usually cause symptoms and that a blood test is the only way to find out. Waiting until you feel unwell is not a strategy, because the first sign for many people is a heart attack or stroke.

Who is more likely to have high cholesterol?

The NHS lists several things that raise your chances:

• Being over 50
• Being male, or being a woman after menopause
• Being of South Asian or sub-Saharan African descent
• A family history of high cholesterol or early heart disease
• Eating fatty food, not exercising, carrying extra weight, smoking, and drinking alcohol

South Asian background is on that list, which matters for readers in Pakistan: it is worth asking your doctor about a cholesterol test rather than waiting to be offered one.

Which foods help lower cholesterol?

The NHS advises eating more of:

• Oily fish such as mackerel and salmon
• Olive oil, rapeseed oil, and spreads made from them
• Brown rice, wholegrain bread and wholewheat pasta
• Nuts and seeds
• Fruit and vegetables

And cutting down on:

• Meat pies, sausages and fatty meat
• Butter, lard and ghee
• Cream and cheese
• Cakes and biscuits
• Anything made with coconut oil or palm oil

Ghee and palm oil appear on that list and are common in local cooking, so swapping some of the cooking fat for olive or rapeseed oil is one of the most practical changes available.

What else brings the numbers down?

The NHS recommends aiming for 150 minutes of moderate activity a week, or 75 minutes of vigorous activity — brisk walking, swimming and cycling are the suggested starting points. It also advises stopping smoking, which raises cholesterol as well as the risk of heart attack, stroke and cancer. For some people the doctor will add medicine alongside these changes; that decision belongs with your doctor after a test.

When to see a doctor

Ask your doctor about a cholesterol test if you are over 50, have a family history of high cholesterol or early heart disease, have diabetes or high blood pressure, are overweight, or smoke. Do not try to judge your cholesterol by how you feel.

Get emergency help immediately for these warning signs of a heart attack or stroke:

• Chest pain, pressure or tightness, especially spreading to the arm, neck or jaw
• Sudden shortness of breath, cold sweat, nausea or a feeling of doom
• Sudden weakness or numbness in the face, arm or leg, usually on one side
• Sudden trouble speaking, understanding speech, or seeing
• A sudden severe headache with no obvious cause, or sudden loss of balance

In these situations, call Rescue 1122 where available, or go to the nearest hospital emergency department. Do not drive yourself.