Cholesterol is a lipid which is a fatty substance. It is produced by the liver (endogenous cholesterol) but it is also contained in some of the foods that we eat (exogenous cholesterol). Cholesterol is essential for the building of cells, the transportation of fats around the body and the production of hormones and bile acids. However, if levels of cholesterol in the blood are too high, excess cholesterol is deposited on the walls of the arteries. This causes blockage and hardening of the arteries which is one of the most common causes of heart disease. People with heart disease are at a greater risk of heart attack or stroke.Cholesterol is carried in two different forms: low density lipoproteins (LDLs) and high density lipoproteins (HDLs). Low density lipoproteins transport cholesterol from the liver around the body to where it is needed and high density lipoproteins transport excess cholesterol back to the liver. The ratio of LDL to HDL is very important: there should be a low level of LDL cholesterol and a high level of HDL cholesterol in the body.Blood cholesterol can be measured by a blood test. Cholesterol is measured in units of millimols per litre (mmol/l) of blood. Levels should ideally be below 5.2 millimols per litre of blood.

Causes of High Cholesterol

  • diet the most common cause of high cholesterol is too much fat in the diet. Cholesterol is also contained in some of the foods that we eat such as egg yolks, prawns, shellfish, fish roe and offal such as liver, kidney and pâtégenetic - a condition known as familial hyperlipidaemia characterised by high cholesterol can be passed on from generation to generationexercise - being overweight and lack of exercise can also contribute to high cholesterol levelsmedicines - some medicines used to treat acne and high blood pressure can lead to high cholesterol levelsmedical conditions - people with certain medical conditions such as diabetes, an underactive thyroid or kidney problems may develop high cholesterol
  • drinking heavily - people who drink lots of alcohol may be at risk from high cholesterol

Avoiding High Cholesterol

  • stick to a low-fat diet. Avoid cakes, biscuits, chocolate, pastries, savoury snacks, fast food, processed foods, takeaways, oils (except fish oils), spreads, butter, meat products and full-fat dairy produceeliminate or cut right down on saturated fat in your diet. Saturated fat is usually solid at room temperature such as butter, lard or dripping. Replace these fats with small amounts of monounsaturated or polyunsaturated fats which are usually liquid or soft at room temperature such as olive oil, rapeseed oil, sunflower oil, nut oils or soya oils. To check the fat content of packaged foods before you buy, look at the fat content under 'nutritional information'. This will also tell you what sort of fat the product containsremove skin from poultry, trim off excess fat from meat and skim fat from casserolesour bodies produce enough cholesterol, therefore there is no need to eat foods which are high in cholesterol. Avoid high cholesterol foods such as egg yolks, prawns, shellfish, fish roe and offal such as liver, kidney and pâtéeat plenty of fibre. Fibre can be found in fresh fruit and vegetables, wholemeal bread, cereals, wholemeal pasta and pulseseat plenty of fish, especially oily fish such as pilchards, herring, mackerel, sardines, kippers, tuna, salmon and trout. Oily fish contains omega-3 oils which can reduce the risk of heart attack. However, the Department of Health advises us not to eat more than one portion of oily fish per week (130g) because toxic chemicals build up in fish as a result of polluted waters. The pollutants are stored in the fat content of fish so if you grill or bake your fish and remove any skin and visible fat, this will reduce the amount of pollutants that you consumedo not add fat to foods during cooking. Grill, steam, boil, poach or bake food instead of frying or roasting it. Try using a dry griddle or non-stick panstake some form of exercise each day such as a brisk walk, swimming or cyclingif you are overweight, try to lose weightdo not smoke. Smoking increases the risk of blood vessel disease which increases the risk of a heart attack or strokedo not drink more than three units of alcohol per day if you are a man or two units if you are a woman. One unit is equivalent to one glass of wine, one measure of a spirit or half a pint of ordinary strength beer, lager or cider. If you do drink, your alcohol intake should be spread evenly throughout the week. Do not drink your week's allowance on one night!
  • a recent study has shown that citrus peel, which contains polymethoxylated flavones (PMFs), can help to lower cholesterol. You could try adding citrus peel to your diet or look for some PMF supplements

TreatmentIf non-medicinal ways of lowering cholesterol have failed, there are a number of cholesterol-lowering medicines available from your doctor. They generally fall into one of five categories: fibrates, statins, bile acid binding drugs, nicotinic acid derivatives and resins and omega-3 marine triglycerides.They are used, together with a routine of healthy eating and exercise, to lower cholesterol levels and to reduce the risk of heart attack and stroke in people with coronary heart disease.

When To See A Doctor

Ask your doctor for a cholesterol test if a member of your family has had a heart attack at an early age or if you are a smoker or if you have high blood pressure.

Additional Information

For additional information about cholesterol and heart disease, contact the British Heart Foundation, 14 Fitzhardinge Street, London W1H 4DH. Telephone: 0171 935 0185. Or visit their website at <