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High Cholesterol and Related Conditions

Cholesterol is a type of lipid, or fat, in the body, the levels of which are checked by blood tests. The results are given as the total blood cholesterol level, and in some cases, this level is broken down further into the different cholesterol types.

The World Health Organisation advises that the ideal level for total blood cholesterol is below 5.2mmol/l. If an individual is told that their cholesterol level is high, it is relative to this figure. This condition is termed hyperlipidaemia.

It is increasingly common to focus on the levels of the different types of cholesterol. Two types of cholesterol are often measured for screening purposes, and these are known as LDL and HDL. The reason for measuring the cholesterol fractions is that it is LDL specifically that has been linked to coronary heart disease (CHD), whereas HDL has been shown to have a protective effect.

A high total cholesterol level is usually due to a raised LDL level. The risk is further increased if HDL is relatively low when LDL is high, a condition termed as dyslipidaemia. HDL levels should ideally be above 0.9 mmol/1, and LDL below 3 mmol/l.

Triglycerides are another type of lipid, and levels are often checked at the same time as blood cholesterol. High levels of triglycerides in the blood are also associated with an increased risk of heart disease, particularly when accompanied by low HDL levels. The ideal range for triglycerides is 1.2 to 2.0 mmol/l.

CHD occurs when lipids, particularly LDL cholesterol, are deposited on the lining of the arteries around the heart, which can build up into a hard plaque of fatty tissue known as an atheroma. This in turn causes the arteries to become narrowed, often referred to as ‘hardening of the arteries’ or atherosclerosis.

With this condition, there is an increased risk of blood clots, or thrombus, forming and blocking the arteries.

Angina is a condition that can result from this, and describes the chest pain as the blood tries to flow through the narrowed arteries. The pain is often worse on exertion or during stress when the heart rate increases and blood flow is increased.

If a complete blockage occurs in the arteries around the heart, then this results in a heart attack.

Other parts of the body can be affected by atherosclerosis and this can lead to a reduced circulation in the lower part of the legs and pain on walking. In addition it can also increase the risk of stroke.

The protective effect of HDL cholesterol arises from it taking surplus cholesterol from the tissues back to the liver, where the body excretes it in the form of bile.

It is estimated that approximately half of the adult population in Britain have a cholesterol reading above the recommended level. Individuals who have a high fat intake, are overweight and have a high waist to hip ratio, or an “apple” shape, where the fat is typically situated centrally around the abdomen, are particularly at risk. This type of fat is more unstable and is more easily released into the blood stream, increasing the levels of circulating cholesterol.

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