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Dr Rodney Foale, Consultant Cardiologist at The Harley Street Clinic, talks us through what cholesterol is and what we can do to prevent our cholesterol levels from rising too high. 

Dr Foale has been a full-time consultant cardiologist for more than 30 years and now with HCA UK, he consults at The Harley Street Clinic. His clinical interests lie in cardiovascular disease, general adult cardiology including, arrhythmia, hypertension and percutaneous interventional treatment of coronary artery disease.

What is cholesterol?

Cholesterol is a fatty chemical in the bloodstream and in the tissues of the human body. A certain amount of cholesterol is essential for supplying energy, building the structure of cell membranes, making certain hormones and helping your metabolism work efficiently. However, if the body has too much cholesterol, it can lead to health problems. 

What does it mean if someone has high cholesterol?

High cholesterol is when you have too much of a fatty substance called cholesterol in your blood stream. It is particularly harmful to the very fine, single-cell linings of arteries. 

When this injury occurs, this allows the cholesterol molecules to deposit within the lining of the arteries causing increasing blockages. A bit like stepping on a hose when you're trying to water your garden. 

When this occurs then the consequence is low blood flow to the affected area of the body, such as the heart, brain or legs. 

What are the signs and symptoms of high cholesterol?

There aren't usually any typical signs you have high cholesterol, which is why it's so important to get it checked out. It's a hidden risk factor, which means it happens without us knowing. 

However, sometimes, when a person is exercising and has high cholesterol, blocked arteries supplying organs will manifest as arterial blood shortage, which manifests in the heart or skeletal muscle as pain. Pain will depend on where the blockage is, for example, if it's in the heart, then people can experience chest pain during exercise or leg pain (claudication) if in the arteries of the legs. If it’s in main arteries, strokes or dementia may occur.

What are the most common causes of high cholesterol?

There's a genetic predisposition called familial hypercholesterolemia, which is a defect that makes the body unable to remove low-density lipoprotein (LDL) cholesterol (otherwise known as ‘bad’ cholesterol) from the blood. There are also variations in this mechanism between different ethnic groups and in different genders. 

There are also dietary causes and changes in our diet as a society, such as the introduction of fast-food outlets. The populations not accustomed to rich, fatty foods didn’t realise the impact that diet can have on their health, particularly the long-term dependency on processed foods and foods which are high in fat and cholesterol. 

What is the best diet to combat high cholesterol?

Very fatty foods and processed foods are adverse in terms of fat content. I would recommend people to reduce or avoid eating too many fatty foods, such as meat, sausages, dairy and processed foods.  

Certain fish, particularly shellfish, contain a fair amount of cholesterol as well.  

There's practically no cholesterol in vegetable products so vegetarians, no doubt, have got lower cholesterol levels, but then there's often a healthier attitude to exercise and weight reduction as well in this group of people.

How do you test for high cholesterol?

All you need to do is take a simple blood test. It's best to have a baseline level so that what you've eaten the night before doesn't affect the results, so I personally recommend the patient fasts for 14 hours before coming in for a test. 

When I began my medical career over 30 years ago, normal cholesterol was regarded as anything less than 7.5. Now the current guidelines are 5 or below for total cholesterol and less than 2.00mmol per litre of the adverse component, LDL (low density lipoprotein). 

What is the treatment for high cholesterol?

Lifestyle changes are very important. High cholesterol is directly related to body weight, so maintaining a healthy lifestyle is essential. Reducing processed foods and exercising regularly should keep those cholesterol levels in check. 

Then there's always the medication side as well, but that's not always appropriate for everybody. It’s important to look at each patient individually, but generally medication can be very effective at reducing cholesterol levels.  

There’s a group of new agents available called PCSK9 inhibitors, which are a new type of medicine for lowering cholesterol in the blood. It’s very exciting. In clinical studies, these medicines have lowered people’s cholesterol levels by more than half and early research shows they could prevent strokes and heart attacks too and are an alternative to pills, which have been the standard oral treatment.

At the moment they are rather limited in their availability to the general population, but we do have them in specialist lipid clinics such as at The Harley Street Clinic. We can enrol patients into research studies and prescribe them too. At the present time, they can only be prescribed by specialist cardiologists that are experts in this field, it’s really exciting that we are able to do this.  
Our cardiac consultants treat patients from all over the world in three London hospitals within the HCA UK group. View all of our cardiology treatments and services. 

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