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High cholesterol a catalyst for heart disease and stroke

<div><p><span style="font-family: helvetica;">Cholesterol is a cheesy substance that coats the inner lining of blood vessels. It is carried in blood as microscopic particles bound to proteins commonly known as LDL. The body needs cholesterol to build healthy cells for example nerve cells have high fat content, but high levels of cholesterol can increase the risk of heart disease. With long standing elevated cholesterol, that fatty particle streak into the lining of blood vessels and fatty deposits that make the vessel stiff and unhealthy. Eventually, these deposits grow eating up the inner diameter of the vessel making it difficult for enough blood to flow through the arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke. </span></p><p><span style="font-family: helvetica;"> High cholesterol is often the result of unhealthy lifestyle choices, which makes it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol. High cholesterol has no symptoms. A blood test is the only way to detect if one has it. Cholesterol is carried through the blood, attached to proteins called lipoproteins. Occasionally people with high cholesterol, particularly of the familial type, have abnormal fatty deposits on the eye lids and tendons known as xanthomas. </span></p><p><strong style="font-family: helvetica;">Types of cholesterol/ &#39;Good&#39; and &#39;Bad&#39; cholesterol</strong></p><p><span style="font-family: helvetica;">There are different types of cholesterol, based on the lipoprotein that it binds. They include: Low-density lipoprotein (LDL) and high density lipoprotein (HDL), LDL or &quot;bad&quot; cholesterol, transports cholesterol particles throughout the body. LDL cholesterol builds up in the walls of the arteries, making them hard and narrow.</span></p><p><span style="font-family: helvetica;"><strong>High-density lipoprotein (HDL).</strong> HDL, or &quot;good&quot; cholesterol, picks up excess cholesterol and takes it back to the liver where is it metabolised.</span></p><p><span style="font-family: helvetica;">A lipid profile also typically measures triglycerides, a type of fat in the blood. Having a high triglyceride level can also increase your risk of heart disease. </span></p><p><span style="font-family: helvetica;">Factors that can be controlled such as sedentary lifestyle, obesity and unhealthy diet contribute to high cholesterol and low HDL cholesterol. On the other hand, people with genetic causes of high LDL have high LDL early in life that leads to early and accelerated atherosclerosis. </span></p><p><strong style="font-family: helvetica;">Factors that can increase the risk of bad cholesterol include:</strong></p><ul><li><span style="font-family: helvetica;">Poor diet: Consuming saturated fats that are found in animal products and trans fats which are found in some commercially baked cookies, crackers and microwave popcorns raise cholesterol level. Consumption of foods that are high in cholesterol such as red meat and full-fat dairy products may also increase cholesterol.</span></li><li><span style="font-family: helvetica;">Sedentary lifestyle: Exercise helps in boosting the body&#39;s HDL or &quot;good,&quot; cholesterol while increasing the size of the particles that make up your LDL or &quot;bad,&quot; cholesterol, which makes it less harmful.</span></li><li><span style="font-family: helvetica;">Obesity: Having a BMI of 30 or more than puts one at a risk of high cholesterol. </span></li><li><span style="font-family: helvetica;">Age: The body chemistry changes as one ages thus the risk of high cholesterol climbs. As one age, the liver becomes less able to remove LDL cholesterol.</span></li><li><span style="font-family: helvetica;">Diabetes: High blood sugar contributes to higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lowers HDL cholesterol. It also damages the lining of the arteries.</span></li><li><span style="font-family: helvetica;">Smoking: Cigarette smoking damages the walls of the blood vessels, making them more prone to accumulate fatty deposits. Smoking might also lower the level of HDL cholesterol. Indeed stopping tobacco is associated with increase in HDL.</span></li></ul><p><strong style="font-family: helvetica;">Foods with cholesterol to avoid;</strong></p><p><span style="font-family: helvetica;">The following are the foods to avoid with fats:</span></p><ul><li><span style="font-family: helvetica;">Trans fats - They not only increase levels of bad cholesterol but also lower levels of good cholesterol. They are the most harmful fats. Examples of trans-fats include: packaged cookies, cakes, donuts, pastries, potato chips, commercially fried foods, bakery goods that contain shortening, buttered popcorn and any products that contain partially hydrogenated or hydrogenated vegetable oils.</span></li><li><span style="font-family: helvetica;">Saturated fats- They mostly occur in meat and dairy products. They instruct the liver to produce more bad cholesterol. Examples of saturated fats include: fatty beef, lamb, pork, poultry with skin, lard and shortening, dairy products made from whole or reduced-fat milk, saturated vegetable oils such as coconut oil, palm oil and palm kernel oil.</span></li></ul><p><span style="font-family: helvetica;">Other foods that contain cholesterol and may be best avoided include: red meat, sausage, bacon and organ meats such as kidney and liver.</span></p><p><strong style="font-family: helvetica;">Complications of high levels of cholesterol</strong></p><p><span style="font-family: helvetica;">High cholesterol can cause a dangerous accumulation of cholesterol and other deposits on the walls of the arteries (atherosclerosis). These deposits (plaques) can reduce blood flow through the arteries which can cause complications such as:</span></p><ul><li><span style="font-family: helvetica;">Chest pain- If the arteries that supply the heart with blood (coronary arteries) are affected, one may develop chest pain (angina) and other symptoms of coronary artery disease. </span></li><li><span style="font-family: helvetica;">Heart attack- If plaques tear or rupture, a blood clot forms at the plaque-rupture site blocking the flow of blood or breaking free and plugging an artery downstream. If blood flows to any part of the heart stops a heart attack occurs, commonly manifested as severe crashing chest pain.</span></li><li><span style="font-family: helvetica;">Stroke- a stroke occurs when a blood clot blocks blood flow to any part of the brain.</span></li></ul><p><strong style="font-family: helvetica;">Cholesterol healthy eating to avoid heart disease</strong></p><p><span style="font-family: helvetica;">A completely fat-free diet can also be harmful because it would deplete the levels of good carbohydrates, impair normal nerve and brain function and possibly increase inflammation.</span></p><p><span style="font-family: helvetica;">The following are foods to include:</span></p><ul><li><span style="font-family: helvetica;">Fiber- Fiber is important for a healthy heart. It&#39;s present in two main forms: soluble and insoluble. Insoluble fiber is important for digestive health while soluble fiber binds to cholesterol in the bloodstream and helps remove it through stool. The soluble fiber has the added benefit of helping control blood sugar levels as well. Below are some cholesterol-friendly fiber options to consider. They include: fatty fish such as salmon, trout, albacore tuna, sardines, nuts, seeds, legumes, the skins of fruit, nontropical natural vegetable oils such as olive oil, avocado oil, canola oil, and sunflower oil, oats, oat bran, chia, ground flaxseeds, beans, barley, psyllium, oranges, blueberries and brussels sprouts.</span></li><li><span style="font-family: helvetica;">Leaner cuts of meat and smaller portions, as well as low-fat or fat-free milk and yoghurts.</span></li></ul><p><strong style="font-family: helvetica;">Treatment for cholesterol induced heart disease</strong></p><p><span style="font-family: helvetica;">The first line of defense against high cholesterol is lifestyle changes such as exercising and eating a healthy diet. If the cholesterol levels remain high after the lifestyle changes then the doctor might recommend medication. The choice of medication or combination of medications depends on various factors which include: personal risk factors, age, health and possible drug side effects. The common choices include: </span></p><ul><li><span style="font-family: helvetica;">Statins - They block the most important enzyme inthe liver necessary for the synthesise of cholesterol. This causes the liver to remove cholesterol from the blood. Statins can also help the body reabsorb cholesterol from built-up deposits on the artery walls, potentially reversing coronary artery disease.</span></li><li><span style="font-family: helvetica;">Bile-acid-binding resins - The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine, colesevelam and colestipol lower cholesterol indirectly by binding to bile acids. This prompts the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood. </span></li><li><span style="font-family: helvetica;">Cholesterol absorption inhibitors - The small intestine absorbs the cholesterol from the diet and releases it into your bloodstream. The drug ezetimibe helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.</span></li><li><span style="font-family: helvetica;">Injectable medications - Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can help the liver absorb more LDL cholesterol which lowers the amount of cholesterol circulating in the blood. Alirocumab and evolocumab might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.</span></li></ul><p><span style="font-family: helvetica;">In conclusion, cholesterol remains the second most important modifiable risk factor (after tobacco cessation) to prevent heart attack and stroke. Indeed studies in North America and Europe have backed this finding and the increasing impetus to increase awareness on the need for humans to keep the cholesterol as low as possible using proven lifestyle choices.</span></p><p><em style="font-family: helvetica;">By Dr Mzee Ngunga, Consultant Interventional Cardiologist at Aga Khan University Hospital, Nairobi</em></p></div>

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