If you have recently had a heart attack or stroke, one of the reasons for this is that your blood cholesterol levels are high. You may already be taking medication for cholesterol. Or you may be trying to control your cholesterol by controlling your diet and exercising. You may not even know you have cholesterol. Whatever the reason, now that you have heart disease, it is very important to maintain your cholesterol levels at a healthy level. The first thing we need to do is talk to your doctor about this and develop a treatment plan that is right for you.
Let's understand the good and bad sides of cholesterol
Simply put, cholesterol is a type of fat that is essential for the formation of cells in our body. But there are two types of it. Let's identify these as good cholesterol and bad cholesterol.
- LDL (Low-Density Lipoprotein) Cholesterol: This is the "bad" type of cholesterol . When these levels increase, they begin to build up on the walls of our blood vessels (arteries). It's like dirt building up inside a water pipe. Over time, this build-up (we call it `plaque`) builds up and narrows and sometimes blocks the blood vessels. If an artery supplying blood to the heart becomes blocked, it can cause a heart attack, and if an artery supplying blood to the brain becomes blocked, it can cause a stroke.
- HDL (High-Density Lipoprotein) Cholesterol: This is the "good" type of cholesterol . Its role is to help carry away bad cholesterol that has built up in the blood vessels and be removed from the body by the liver. This means that the higher the HDL level, the better for us.
Therefore, our goal should be to reduce bad (LDL) cholesterol and keep good (HDL) cholesterol levels at a healthy level.
What are your cholesterol goals?
Although we usually talk about cholesterol levels for a healthy adult, the goals for someone with heart disease are different. Your doctor may give you more stringent goals . The most important thing is to reduce your risk of having another heart attack or stroke as much as possible.
Look at the table below. Then you can get a better idea about this.
| Cholesterol type | Normal healthy level (mg/dL) | Target for someone with heart disease (mg/dL) |
|---|---|---|
| Total Cholesterol | Between 125 - 200 | The doctor decides. Mainly concerned with LDL levels. |
| "Bad" LDL cholesterol | Less than 100 | Should be less than 70. In some cases, a target of less than 55 may be given. |
| "Good" HDL cholesterol | Over 40 for men, over 50 for women | Maintain as high a level as possible. |
The important thing is that these are just general recommendations. Your doctor will determine your specific target levels based on your age, other medical conditions, and overall health.
Statins - the main drug for controlling cholesterol
Statins are the most widely used class of drugs in the world to control cholesterol. If you have had a heart attack, your doctor will likely prescribe this type of medication.
What happens with 'statins'?
Statin drugs work in two main ways:
1. Reduces the production of LDL (bad) cholesterol by the liver: Most of the cholesterol our body needs is produced by the liver. Statins control this production.
2. Reduces the rate of cholesterol deposition in blood vessels: This reduces the risk of blood vessel blockage.
Some of the most commonly used statins in Sri Lanka are `Atorvastatin`, `Rosuvastatin`, and `Simvastatin`. Your doctor will choose the most appropriate statin type and dosage for you based on how much you want to lower your LDL cholesterol level, any other medical conditions you have (e.g. diabetes, kidney disease), and any other medications you are taking.
Medicine alone is not enough! Lifestyle changes are essential
Although statins are very effective drugs, cholesterol control is not something that can be limited to a pill alone. We can achieve the best results when these treatments are combined with a healthy lifestyle.
- Heart-healthy diet:
- Reduce your intake of oil, fried foods, and processed foods as much as possible. Stay away from things like sausages, meatballs, cakes, biscuits, and instant noodles.
- Limit foods high in saturated fat and trans fat. Use curries with a lot of coconut milk, palm oil, and margarine in moderation.
- Include more vegetables, fruits, legumes, and foods high in fiber in your diet. Grains like oats, buckwheat, and barley are very beneficial.
- Exercising regularly:
- Start with simple exercise like brisk walking for at least 30 minutes a day. Swimming and cycling are also great exercises.
- Exercise is a great help in increasing good cholesterol (HDL) levels and controlling weight.
- Quitting smoking completely:
- Smoking damages blood vessels, accelerates cholesterol deposition, and lowers good cholesterol (HDL) levels. If you smoke, it is imperative to stop immediately.
- Controlling body weight:
- Excess weight, especially fat accumulation around the abdomen, increases bad cholesterol levels.
Take-Home Message
- If you have heart disease, controlling your cholesterol is even more important than the average person.
- Your doctor will give you specific, strict cholesterol goals. Reaching those goals is very important for your future health.
- Statins are the mainstay of cholesterol control medications. Never stop taking them or change the dosage without medical advice.
- As well as taking medication, it is also essential to maintain a healthy diet and regular exercise .
- If you have any concerns about your cholesterol levels, treatment options, or medication side effects, discuss all of these openly with your doctor.
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