Is high cholesterol really worth worrying about?

Have you recently been for a routine check-up and found out your cholesterol is too high? Perhaps your doctor has also talked about putting you on statins—drugs that control your cholesterol levels.

With recent stories in the media questioning how much cholesterol really contributes to heart disease, you’d be excused for being confused about how important cholesterol levels are in reducing your risk of heart disease.

But with 12 per cent of deaths in Australia caused by coronary heart disease, according to the Heart Foundation, it’s worth discussing a bit further.

​What causes heart disease?​

Heart disease develops slowly, starting years before any symptoms.

The arteries of the heart begin to narrow due to a buildup of plaque, a fatty material that clings to the artery walls. Over time, this can reduce blood flow to the heart, potentially causing cardiac arrest.

High cholesterol, along with high blood pressure, smoking and diabetes are all risk factors which can speed up this process.

Different types of cholesterol

There are two main types of cholesterol and it’s the low density lipoprotein (LDL) one, called ‘bad cholesterol’, that your doctor is interested in. It’s so-called because it’s thought to cause buildup and blockage in the arteries.

Where does cholesterol fit in with heart disease?

Since 1913, cholesterol has been suspected as a bogeyman. It all started when a Russian pathologist fed rabbits a diet of egg yolks and showed their blood cholesterol increased.

After the release of results in 1984 of a study on 3800 middle-aged men—which showed lower levels of ‘bad’ or low-density lipoprotein (LDL) cholesterol resulted in lower levels of heart attacks—the link was pretty much accepted.

But in recent years, the role of cholesterol in heart disease is being questioned by numerous researchers.

Whilst the link between high-LDL and heart attacks isn’t 100 per cent proven, the evidence points to this being most likely, says Richard Lehman, from the widely-respected independent medical research institute, Cochrane.

Other factors are just as important

The effect of cholesterol is important but other factors should not be overlooked. More than half of all heart attacks or strokes occur in apparently healthy people, with normal or low levels of LDL cholesterol.

Not smoking, eating a healthy diet, exercising and reducing your stress levels are all just as important as your cholesterol levels.

New test for heart disease

Until recently, the only tool doctors had to predict your heart disease risk was to assess factors such as your age, sex, whether you smoke or have diabetes, and your blood pressure and cholesterol levels. While  risk assessment is useful as a starting point, research shows it is not entirely accurate as a predictor.

A relatively new test appears to provide a more robust predictor: the Coronary Artery Calcium (CAC) Score  particularly when combined with assessment of the other accepted risk factors.

It’s much better at identifying the narrowing of arteries than other heart checks available, according to Dr Christian Hamilton-Craig, Chair of the Cardiac Society of Australia and New Zealand Working Group on CAC Scoring.

A randomised clinical trial of coronary calcium for risk evaluation and prevention in people with a strong family history of coronary artery disease is currently underway.

The test may also help assess how important it is for you to take medication. However, it isn’t yet endorsed by the Australian Government, which means it’s not covered by Medicare.

If you are concerned about your cholesterol levels and heart disease risk you could discuss this option with your doctor.

Ways to lower your cholesterol naturally

There are clear links between your diet and your level of LDL cholesterol, so you may be able to lower your cholesterol naturally.

Some fats are essential to keep your body healthy, but saturated fats are linked to higher blood cholesterol. So replace these fats—which many of us consume too much of—with unsaturated fats where possible.

Foods to reduce include:

• Fatty meat and meat products, such as sausages;
• Butter, full-fat dairy, cheese (especially hard cheese);
• Chocolate, biscuits, cakes and pastries.

Good fats include:

• Olive oil and grapeseed oil
• Avocados
• Some nuts such as almonds, brazil nuts and peanuts.

Increasing the amount of soluble fibre in your diet is also helpful—so eat more oats, fruits and vegetables, and whole grains.

Don’t despair, you can still eat cake! The Heart Foundation’s healthy cake and biscuit recipes make sure you can still treat yourself.

All evidence suggests there is a link between high LDL cholesterol and heart disease, so discuss all options with your doctor. The key? Look at practical steps you can take to reduce your cholesterol, whether you are on medication or not.