What is Cholesterol?
Cholesterol is an essential component of the body being a building block
for the production of cells and steroid hormones. It is only harmful when
it is present in the blood stream in excess. The high level we see in
Western civilisation that leads to heart disease is a product of our poor
diets and lack of exercise. Cholesterol levels in rural China are 3 mmol/I
and heart disease is less common. Cholesterol is insoluble in water and
needs to be carried in packets (particles) in the blood stream. There are
two kinds of cholesterol particles, LDL (bad cholesterol) is the harmful
form of cholesterol and HDL (good cholesterol) which confers some
protection from heart disease. When cholesterol is measured the total
level and the level of HDL are given. It is important when learning your
cholesterol level to know if you have mainly good or bad cholesterol.

What Level is Recommended?
The ideal level should be lower if you already have a problem with your
heart such as a heart attack, angina, bypass surgery or an angioplasty or
trouble with other blood vessels such as poor circulation or a stroke. In
this case you need to ensure the LDL cholesterol level is below 1.8mmol/
L. Triglyceride levels should be below 2 mmol/l. These parameters
apply to those at high risk of vascular disease, namely a strong family
history, diabetes, hypertension, renal disease, metabolic syndrome or of
Torres strait descent

How Can I Improve my Cholesterol Level?
The liver makes most of your cholesterol with dietary intake making up
about 10%. This means that improving your diet alone (unless extreme
measures are taken) is generally not enough. However, good diet with
low intake of saturated fat (animal fat) and cholesterol containing foods
(egg yolks) is an essential part of management to assist the effect of
medication. Short term reduction in cholesterol levels from diet are
usually not sustained.
Medication is often required to lower cholesterol levels to an acceptable
range. The commonest group of drugs are called HMG CoA reductase
inhibitors (Siinvastatin LIPEX, ZOCOR, Atorvastatin LIPITOR,
Fluvastatin VASTIN, Pravastatin PRAVACHOL, Cerivastatin Crestor).
They inhibit an enzyme in the liver to reduce cholesterol production.
Trials have shown that the use of these drugs can reduce the incidence
of heart attacks. The fabric acid derivative Gemfibrozil LOPIOD, JEZIL
or fenofibrate Lipidil are useful when the predominant problem is high
triglyceride levels.

What are the Side Effects of Treatment?
These tablets are remarkably safe. In a small number of patients tests of
the liver will reveal minor changes in the blood results necessitating
stopping the drug. Rarely, patients may experience muscle pains or a rise
in muscle enzymes on blood tests forcing the drug to be stopped.

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