Cholesterol

Taking Action to Manage Your Cholesterol

Making recommended lifestyle changes can improve your cholesterol by 5% to 10%, but medications have been shown to lower LDL-cholesterol by 20% to 55%, depending on the type that is prescribed and the dosage. As a result, medication is often required in combination.

• Eat More Fibre. Fibre is a great cholesterol-fighting source. Between 5 to 10 g a day can reduce your LDL cholesterol by 3% to 5%.
• Every 1 mmol/L reduction in LDL is associated with a 20% to 25% decrease in cardiac death and heart attack.
• Treating high cholesterol can increase your average life expectancy by 1.67 years and allow 1.84 more years in which you’re free of CVD.

Diagnosis and Testing

A blood test is used to diagnose high cholesterol. Blood is drawn after an overnight fast to measure total cholesterol, triglycerides, LDL, and HDL levels.

The blood test generates a report known as a “lipid profile.” The fast should occur for a period of 10 to 12 hours before blood is drawn to ensure accurate results.⁵

Your doctor will calculate your level of risk (low, moderate or high) using a specific evaluation tool and factors such as these:

• Previous heart attack and/or stroke
• Artery blockages in your neck, arms, or legs
• Diabetes
• Age
• Two or more risk factors, such as smoking, high blood pressure, low HDL, or a family history of CVD

If none of the above-mentioned factors applies to you, and you are older than 20 years of age, your doctor will decide whether it’s necessary for you to be tested and how often. The frequency of cholesterol testing also depends on other risk factors you may have.

Treatment

To achieve healthy cholesterol levels, many patients require both cholesterol-lowering drugs and changes in lifestyle habits. Different drugs lower LDL and triglycerides, raise HDL, and reduce the amount of cholesterol absorbed in the digestive system. A patient may take more than one cholesterol-lowering drug at the same time. The three main types of treatment are as follows:

Cholesterol-Lowering Drugs 
All patients who already have coronary heart disease or diabetes should be treated with a statin. Statins are safe and effective drugs for lowering cholesterol. Some patients may require the addition of a second medication.

Triglyceride-Lowering Drugs
Drug therapy guidelines for high triglycerides are not as clear-cut as they are for cholesterol. However, fibrates are the drug of choice for lowering triglycerides in the very high range for people whose cholesterol levels are relatively normal. The most potent fibrates can lower triglycerides by 40%. Statins are effective against both cholesterol and triglycerides. Successful treatment requires consistent blood sugar control for people with diabetes and avoidance of alcohol, oral estrogen, and retinoids.

Treatment of Low HDL
The B vitamin niacin is capable of increasing HDL by 30% (and often by an even higher percentage with prolonged treatment). It is the most effective agent for increasing HDL levels.

Medication Therapy for High Cholesterol

Medications are commonly prescribed if:

• You are at high risk for CVD.
• You are at moderate risk and one or more of the following is applicable:
  • LDL greater than 3.5 mmol/L
  • Total cholesterol/HDL ratio greater than 5 mmol/L
  • Male older than age 50
  • Female older than age 60
  • Strong family history
  • Presence of diabetes or coronary artery disease (or arterial blockages)
• You are at low risk for CVD and have LDL cholesterol greater than 5 mmol/L.

Making recommended lifestyle changes can improve your cholesterol by 5% to 10%,⁶ but medications have been shown to lower LDL-cholesterol by 20% to 55%,⁷ depending on the type that is prescribed and the dosage. As a result, medication is often required in combination. The following chart provides the drugs commonly recommended for managing high cholesterol.

Best Practice Guidelines

Download the 2016 Canadian Cholesterol Guidelines.

Prevention and Management of High Blood Cholesterol

Lifestyle Changes

Important lifestyle changes for lowering cholesterol include:

• Eating a healthy diet high in fibre and low in saturated fat, trans fat, and cholesterol
• Losing weight
• Increasing exercise
• Quitting smoking
• Managing diabetes

When trying to make changes to your eating habits, here are some key places to start:

• Know Your Fats: Just as not all cholesterol is bad, not all fat is bad, either. Learn the difference between good and bad fats so you can make healthy food choices.
• Understand Your Cholesterol Limit: You can still consume cholesterol as part of your daily diet, but it’s important to know how much is recommended: 300 mg a day for healthy individuals and less than 200 mg a day for people with cardiovascular disease.
• Eat More Fibre: Fibre is a great cholesterol-fighting source. Between 5 to 10 g a day can reduce your LDL cholesterol by 3% to 5%.

Medication Tips

If you’ve been prescribed medication, it’s important to follow the prescription plan your doctor has set up for you. Remember to:

• Incorporate lifestyle changes along with your medication.
• Never stop taking your medication just because you are feeling better.
• Write down any symptoms you may experience so that you can remember to discuss them with your doctor.
• Keep track of your medication, especially if you are taking multiple pills. A medication record card can help.
• Be on time and consistent with your medication so that it remains effective.

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