I read an article recently about a new 'wonder drug' for treating high cholesterol in those people that don't tolerate statins. A common response I hear from patients is that statins cause them problems with their muscles, gut, headaches and sleep. Despite having raised cholesterol levels, they refuse to take the medications.
So what exactly is cholesterol and how is it best treated? We know cholesterol is a building block that is naturally found in cells within the body. It plays an important role in the formation of vitamin D and certain hormones and it helps digest dietary fat. Special proteins called 'lipoproteins' carry cholesterol around the body. These can either be high density lipoproteins (HDL) (aka 'good cholesterol') or low density lipoproteins (LDL) (aka 'bad cholesterol'). The levels of these lipoproteins in the blood are extremely important when it comes to heart health. For example, high levels of LDL cholesterol and low HDL levels can cause the blood vessels in our bodies to become narrowed and blocked. This increases people's risk of heart attacks, stroke, angina and peripheral artery disease (i.e. narrowing of blood vessels in the legs). Collectively, they are known as cardiovascular disease (CVD). Smoking, high blood pressure, diabetes, family history and being overweight also increase CVD risk.
We know elevated cholesterol levels are treated through diet, lifestyle and medication and GPs are encouraged to prescribe statins to everyone who has a 10% chance of having a heart attack. Regarding diet, despite recent evidence, national guidelines continue to recommend reducing saturated fat intake and replacing it with unsaturated fats to treat high cholesterol. Saturated fat is found in full-fat dairy products, meat and meat products, pastries, pies, ghee, lard, butter, cream, coconut milk, palm and coconut oils.
As a dietitian, I always advise people to replace these foods with polyunsaturated and monounsaturated oils such as sunflower, safflower, olive or rapeseed oils and spreads; avocados; nuts; and oily fish such as mackerel, herring, fresh tuna and salmon. Including foods that are high in soluble fibre such as oats and pulses can also lower LDL cholesterol. In addition, plant sterols and stanols are naturally occurring plant extracts that reduce absorption of cholesterol from the gut. Research shows that including 2g a day and following a healthy diet can reduce LDL cholesterol levels by 10 - 15%. These are found in fortified foods such as mini drinks, spreads, milks and yoghurts.
Very often I see new patients in clinic who don't realise the importance of following a healthy diet and feel it doesn't matter what they eat because they're on statins or similar cholesterol reducing medications. Highlighting the importance of diet, exercise and maintaining a healthy weight are as important as medication. Whether this new 'wonder drug' is introduced to our NHS or not, all healthcare professionals should be advising on the need for lifestyle and dietary changes in addition to medication.
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