By Dr. Thum Chan Ho, Cardiologist Institut Jantung Negara
By now, many of us may be aware of the need to watch our cholesterol. And we may think that long as we feel healthy, there’s no need to worry about having high cholesterol levels.
Not so fast, says Institut Jantung Negara (IJN) Cardiologist Dr Thum Chan Ho.
“It is a misconception to think that being at average weight will prevent raised cholesterol levels,” he says. “High cholesterol, like hypertension, is asymptomatic at the early stages. By the time there are symptoms or signs, there is usually already significant narrowing of blood vessels — which would require medical intervention.”
As it stands, the only way to know if you have high cholesterol is through a medical screening. This process involves a simple blood test to measure your cholesterol levels. While the general advice is to get your cholesterol checked once in five years, Dr Thum adds that there is no hard or fast rule for when you should do a cholesterol screening.
“Some would advocate starting cholesterol screening at 20-years-old, every five years, and perhaps more frequently after 45 years of age. However, for those who are at high risk of cardiovascular disease, screenings should be done more earlier and frequently.”
High cholesterol can lead to a range of health complications and has been identified as a major risk factor for cardiovascular disease. Given the increasing burden of heart disease in the country, addressing such risk factors is crucial in helping patients maintain their heart health.
To this end, says Dr Thum, IJN’s recently established Cardiovascular Risk Reduction Clinic is one way forward in preventing cardiovascular diseases. “The Cardiovascular Risk Reduction Clinic takes an inclusive and multidisciplinary approach to primary and secondary prevention of cardiovascular disease. We treat our patients in a holistic manner targeting the cardiovascular disease itself along with its risk factors – such as high cholesterol,” he says.
Cholesterol, both good and bad
Despite its bad reputation, cholesterol is in fact essential for health — as long as its within healthy levels.
“Cholesterol is needed by our cells in the body to maintain its cell membrane. It is also an important component in hormones and bile acid production,” explains Dr Thum.
The main source of cholesterol in the body is the liver, which produces all the cholesterol needed for these important health functions. Dietary cholesterol, found in meat, seafood, poultry and dairy products, makes up the remainder of cholesterol in the body. Additionally, foods that are high in saturated fat can cause the liver to produce more cholesterol than it normally would.
There are two types of cholesterol: low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. While HDL cholesterol is broken down by the liver and flushed out by the body, it’s LDL cholesterol that is commonly referred to as “bad” cholesterol.
When there’s too much LDL in the body, it can sometimes build up (called plaque) in the blood vessels — which can spell trouble for the heart.
“Just like any blood vessel in the body, the coronary vessels are susceptible to cholesterol deposition and plaque formation. As it gradually increases in size, the plaque becomes more unstable and is prone to rupture causing acute blockage of the vessel, leading to a heart attack,” says Dr Thum.
Reducing cholesterol holistically
While the predominant causes of raised cholesterol levels are unhealthy diets and genetics, Dr Thum explains that the condition tends to arise from a combination of multiple factors. “Other factors like sedentary lifestyle, uncontrolled diabetes, hypothyroidism and smoking may also affect cholesterol levels and risk of developing cardiovascular disease,” he says.
He adds that while avoiding a high cholesterol diet – such as fatty meats and cheese – and eating plenty of fibres can be useful in reducing cholesterol levels, other lifestyle choices such as quitting smoking and getting enough exercise are also crucial in maintaining healthy cholesterol levels.
While some patients may be able to regulate their cholesterol levels through dietary and lifestyle changes alone, others may need a bit more help. One of the most commonly prescribed medications for high cholesterol are statins, which help prevent cholesterol from forming in the first place. Other treatments include cholesterol absorption inhibitors, as well as a new class of injectables such as PCSK9 inhibitors, to control cholesterol levels.
“We usually weigh the pros and cons prior to starting any sort of therapy,” says Dr Thum. “Most side effects of medications such as statins are mild or manageable, but should patients find them unbearable, they should inform their doctors as there will usually be an alternative treatment available. Most importantly, we should not simply just stop the medication, as a high cholesterol level will eventually lead to future heart disease ”
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