How to treat high cholesterol

Cholesterol is a type of fat produced in the body and found in some foods. We need cholesterol to build and repair cells and create hormones. HDL or ‘good’ cholesterol helps reduce a build-up of cholesterol in your arteries, whereas ‘bad’ LDL cholesterol does the opposite.¹

“Too much of your bad or LDL cholesterol builds up in your blood and can form these fatty deposits, which are called plaque, in your arteries,” says Bupa Dietitian Kiran Dhaliwal.

“These plaques can narrow the arteries and reduce blood flow, which is called atherosclerosis. This can then increase your risk of heart disease, heart attacks and stroke. Being able to manage high cholesterol, means you can significantly reduce your risk of these serious cardiovascular events.”

High cholesterol can be diagnosed with a blood test called a lipid profile or panel. You may need to fast before the test to ensure it is accurate.

It is recommended that Aboriginal and Torres Strait Islander peoples have a cholesterol check every 5 years over the age of 35. All other adults should be tested every 5 years over the age of 45.

High cholesterol can be treated in different ways and your GP will make recommendations based on your unique health status.

“Some GPs might recommend medication whereas others might suggest trying some changes in lifestyle,” says Kiran. “Or you may need a combination of both. Some people prefer to try lifestyle changes first to avoid medication but it’s not always possible.”

1. Limit alcohol: “Excessive alcohol can increase your overall cholesterol. It’s recommended not to have more than 10 standard drinks per week,” says Kiran. “But, with alcohol and cholesterol, I always say the less you’re drinking, the better.”
2. Stop smoking: “Smoking has a big impact. Stopping smoking doesn’t only reduce your bad cholesterol but increases your good cholesterol.”
3. Lose any excess weight: “If you are overweight, losing about 5-10% of body weight can significantly improve cholesterol markers, particularly your LDLs,” says Kiran.
4. Stay physically active: “We're aiming for around 150 minutes per week of moderate intensity activity, or 30 minutes a day to help to lower your LDL cholesterol and increase your good cholesterol.”
5. Eat heart healthy foods: “Reduce your saturated fat intake by replacing fatty meats, butter and processed foods with healthier fats, such as olive oil, nuts, seeds, avocados and oily fish. These foods can lower your LDL by up to about 8-10% and increase your HDL. Try and include foods that contain plant sterols which can also reduce your LDL. You can find them in different spreads, cereal and milk that have been enriched with plant sterols.”

Statins²

The most commonly prescribed treatment for high cholesterol is a medication called statins.

Statins work by reducing the amount of cholesterol your liver produces, thus reducing the amount that builds up in your blood.

“2 commonly prescribed statins are atorvastatin and rosuvastatin. They block an enzyme in the liver that can help with reducing cholesterol production, hence lowering your LDL cholesterol and your risk of heart attacks and strokes,” says Kiran. “Stains are proven to lower your LDL by between 30 to 50% or more depending on the dosage.”

Like all medications, statins can cause some side effects which your doctor will discuss with you.

“Side effects of statins can include muscle aches or cramps, headaches and digestive issues. More serious side effects are rare but can include changes in liver function, increased blood sugars, muscle breakdown, or inflammation of the liver.”

Ezetimibe

Taken alone or with a statin, ezetimibe works by decreasing how much cholesterol is absorbed in the small intestine. “Ezetimibe can lower your LDL by 15-20% and it's useful for those who can't tolerate a high dose statin,” says Kiran. “Common side effects would be an upset stomach, diarrhoea, fatigue and muscle soreness.”

PCSK9 inhibitors

One of the latest medical treatments for high cholesterol is PCSK9 inhibitors. “A newer, injectable medication for people at high risk, this medication helps the liver remove more LDL cholesterol from the blood and can lower LDL cholesterol by 50-60%. It's very effective and useful for those with very high cholesterol or genetic conditions. Common side effects would be a reaction at the injection site, or flu-like symptoms. A rare side effect would be an allergic reaction.”

Talk to your GP about the most appropriate and effective approach to lowering high cholesterol for you and your health needs.