Cholesterol is a waxy, fatty substance in the blood that plays an important role in our cells and hormones. The liver produces all the cholesterol the body needs, but is encouraged to produce excess amounts by the fat (particularly saturated fat in meat/dairy products) that we eat.

Why is there such a negative perception of cholesterol?
A high blood cholesterol level is seen as dangerous to our health because excess amounts are deposited on the inside of arteries. If the blood cholesterol level continues to be high, more fatty material is deposited, narrowing the artery even more, resulting in restricted blood flow to the heart and other areas of the body. The restricted blood flow encourages formation of a blood clot, which may cause the final blockage. If the blood flow is blocked off completely, it can result in a heart attack or stroke.

High cholesterol is one of the major risk factors for heart disease, which include smoking, high blood pressure, diabetes, lack of physical exercise and obesity. The higher the cholesterol level, the higher the risk of heart disease.

‘Good’ and ‘Bad’ Cholesterol
High Density Lipoprotein (HDL) cholesterol, also known as the ‘good’ cholesterol, helps clear excess cholesterol from the blood back to the liver. The lower the HDL level, the higher the risk for heart disease.

Low Density Lipoprotein (LDL) cholesterol, or ‘bad’ cholesterol, is found in the fatty deposits in the arteries and can contribute to heart disease.

If you have high total cholesterol, it is important to know what type of cholesterol is high. It is better to have a normal or low LDL and high HDL cholesterol than a high LDL and a low HDL. Your doctor can perform this simple test.

When the blood cholesterol level is tested, the total cholesterol, as well as the different types of cholesterol is determined. It is necessary to fast for 10-12 hours before laboratory testing. The following are target values:

Total cholesterol <5.0 mmol/l

LDL cholesterol <3.0 mmol/l

HDL cholesterol >1.2 mmol/l

The target value for high-risk individuals should generally be lower.

80% of westernised South Africans have raised blood cholesterol, of which 20% have levels that place them at high risk of developing heart disease.

What are the causes of high cholesterol?
For the majority of people, their cholesterol level is determined by both hereditary and dietary factors. Some people have naturally high blood cholesterol levels, due to a hereditary condition known as familial hypercholesterolaemia (FH). In South Africa, this condition is very common in the Afrikaans, Indian and Jewish communities.

It is estimated that 1 in 75 individuals in these communities may be affected. These people often have a family history of premature heart disease i.e. heart attack or sudden death in men before the age of 55 years and before the age of 65 in women.

What are the risk factors for high cholesterol?

• Genetics: family medical history and race.
• Age: between the ages of 20 and 65 years, total cholesterol levels may steadily increase, where after they decrease slightly in men and tend to plateau in women
• Gender: women have higher HDL cholesterol levels than men and so have less risk of developing heart disease than men. With menopause the LDL increases and their risk equals that of men.
• Diet: a diet that is too high in saturated fat (mainly found in animal meat and fat see below), dietary cholesterol and energy, can increase blood cholesterol levels. It is common for South Africans to consume 40-50% of their total energy intake in the form of fat (it is recommended to keep fat intake below 30%), with usually more than 50% of these fats being saturated. Weight: overweight people tend to have higher LDL (bad) and lower HDL (good) cholesterol levels and thus have an increased risk.
• Lack of Exercise: the more active you are, the higher HDL levels (and the other way around). It also helps control weight and blood pressure.
• Smoking can contribute to increased cholesterol levels and diabetes.
• Stress has been associated with increased levels
• Excessive alcohol intake may contribute to increased levels

Who should have their cholesterol tested?
Most people with high cholesterol feel perfectly healthy - there are usually no warning signs of high levels. The only way to find out is to test for it.

All adults should know their cholesterol level and have it tested at least once every 5 years. Those with a family history need to be tested more regularly. If your cholesterol levels are normal, you only need to test it again in a few years, but if it is high or you have a family history of high cholesterol or heart disease, have it checked regularly. Children don't need to have their levels tested unless they have a family history.

How is cholesterol measured?
A blood sample is required and is usually taken from a vein in the arm. There is also a finger-prick method, where a machine will give your estimated total cholesterol within minutes, from a drop of blood (fasting is not necessary).

How can cholesterol levels be lowered?
The first step should always be dietary intervention. Drug treatment can be considered. The main focus point should be on lowering fat, especially saturated fat, intake. It is important to note that there are many different types of fat, not just the visible fats, i.e. the fats that you can see clearly such as oil, butter, margarine, chicken skin and fats on meat. Keep in mind the invisible fats such as those found in milk, cream, cheese, cakes, pastries, biscuits, snack foods, fast foods and sausage meats. These tend to be saturated fats and usually make up more than half the average person’s fat intake.

Dietary Intervention

• Eat a healthy balanced diet that includes a wide variety in types of food
• People who are overweight are advised to lose weight to reach their ideal   

      body weight

• Eat regular meals - either three main meals or smaller meals more often. When meals are distributed throughout the day, blood cholesterol levels and body weight can be controlled better
• Decrease fat intake, especially saturated fats
• Substitute saturated and trans fats with polyunsaturated and mono-unsaturated fats
• Increase fish and chicken and reduce red meat intake. Incorporate fatty fish (rich omega 3 fats – a type of polyunsaturated fat that can be beneficial to the heart) in the diet on a regular basis (at least one 100g serving a week). For example salmon, snoek, sardines, pilchards, anchovies, kippers, galjoen, mullet, mackerel, trout, tuna and herring
• Limit dietary cholesterol intake such as egg yolk, organ meats, fatty meats and some seafood (shrimps, prawns and calamari). Foods of plant origin contain no cholesterol
•    Increase fibre intake, especially soluble fibre (such as oat bran, legumes, cereals, fruit and vegetables) has a cholesterol lowering effect. It binds with cholesterol in the digestive tract, preventing absorption into the bloodstream.
• Eat at least five portions of different fruits and/or vegetables every day (especially good sources of vitamin C e.g. guava, orange and deep yellow/dark green types such as pumpkin and broccoli). Eat with the pips, skin and seeds if possible
• Eat 6 or more servings of whole-wheat unrefined products daily
• Legumes (soya, dry beans, peas and lentils) are high in fibre, low in fat, a good source of protein and have a high satiety effect
• If you use alcohol, do so in moderation. Limit your intake to 2 drinks/day for women and 3 drinks/day for men

This is one in a series of brochures. For the full series and more heart smart information call the Heart Mark diet line on 0860 1 43278 (0860 1 HEART) or visit www.heartfoundation.co.za.

BACK TO TOP