Download Cholesterol - Heart and Stroke Foundation of Canada

WHAT IS CHOLESTEROL?
Cholesterol is a soft waxy substance made by our bodies. It is one
of the fats (lipids) found in the blood and every cell of the body.
We often think that cholesterol is only linked to health problems.
In fact, cholesterol is vital if we are to have healthy cell membranes,
hormones and vitamin D levels.
Without cholesterol, our bodies could not function.
WHERE DOES CHOLESTEROL COME FROM?
The liver makes about 80 per cent of the cholesterol in your body.
The other 20 per cent comes from the foods you eat.
Almost 40 per cent of Canadian adults have high cholesterol levels.
WHY IS HIGH CHOLESTEROL
A HEALTH PROBLEM?
High cholesterol levels can make the arteries narrow. People with
narrow arteries (tubes that carry blood from the heart to other parts
of the body) are more likely to suffer a heart attack or stroke.
The cause of narrow arteries (also known as atherosclerosis) is a
build-up of a sticky coating called plaque on the inside of arteries.
Over time, plaque slowly blocks the tubes.
The main ingredient in plaque is cholesterol.
CHOLESTEROL LEVELS
AND OTHER RISK FACTORS
When deciding your target cholesterol ranges, your doctor will
review your cardiovascular risk factors (i.e. things that increase your
risk of heart disease and stroke).
RISK FACTORS
• Age & Gender:
° Men aged 55 and older
° Women who have gone through menopause
• Ethnicity:
° People of South Asian descent are at a greater
risk of heart disease
• People with a family history of heart attack or a stroke before
age 55 (male relative), or before age 65 (female relative)
• High blood pressure (hypertension)
• Diabetes
• Smoking
• Physical inactivity
• Being overweight
HOW CAN I KNOW IF I HAVE
HIGH CHOLESTEROL?
Most people have no signs of high cholesterol. The only way to know
your cholesterol levels is to have a simple blood test. Not sure if you
should be concerned about your cholesterol levels? Ask your doctor.
Canadian guidelines recommend having your cholesterol
tested if you:
• are a male over 40 years of age
• are a female over 50 years of age and or/post-menopausal
• have heart disease, diabetes or high blood pressure
• have a waist measurement greater than 90 cm for
South Asian men or 80 cm for South Asian women
• smoke or have smoked within the last year
• have erectile dysfunction
• have a family history of heart disease or stroke
The blood test can measure three kinds of fat found in blood.
Two of the fats are types of cholesterol, while the third kind of
fat is called triglycerides.
UNDERSTANDING YOUR TEST RESULTS
Lipoproteins are tiny packages that carry cholesterol in the blood.
A cholesterol blood test measures two kinds of lipoproteins:
• Low-density lipoproteins, known as LDL cholesterol, and
• High-density lipoproteins, known as HDL cholesterol
LDL cholesterol is “BAD” because it promotes the build-up
of plaque in the artery walls.
HDL cholesterol is “GOOD” because it helps carry LDL
cholesterol away from the artery walls.
Triglycerides are the third kind of fat measured by the test.
High levels of triglycerides occur mostly in adults who are
overweight, consume too much alcohol or have diabetes.
Total cholesterol (TC) is a test result that adds your LDL “bad”
and HDL “good” numbers together.
The final result on a cholesterol test is a ratio between HDL
“good” cholesterol and your overall cholesterol levels.
TRACKING MY CHOLESTEROL LEVELS
You may want to track your levels using this grid. This can help you
notice any changes over time.
1. Total
cholesterol
(TC)
LDL and HDL cholesterol are
added together. Strive for a
lower number.
2. HDL
cholesterol
Known as “good” cholesterol, it
is better to have a high reading.
3. LDL
cholesterol
Known as “bad” cholesterol, it is
better to have a low reading.
4. Triglycerides
High readings may need to be
tracked over time.
5. Ratio of
TC/HDL
This ratio shows how high your
HDL “good” cholesterol is,
compared to your overall
cholesterol levels. Having lower
numbers is better.
What is the best kind of test result?
You and your doctor need to review your test results along with your
risk factors, medical history and present health.
Your doctor is the best person to help you understand your test
results and advise you on what to do next.
• Follow a lower-fat diet. Less than 30 per cent of calories per day
should come from fat.
• Avoid trans fats, which are found in foods made with shortening
or partially hydrogenated vegetable oils. Trans fats raise
“bad” LDL cholesterol and lower “good” HDL cholesterol levels.
• Reduce your intake of foods that are high in saturated fat.
Such foods include fatty meats and dairy products such as butter,
cheese, cream and homogenized milk.
• Choose to eat healthy unsaturated fats found in oils, nuts and fish.
• Include more vegetables, fruits, whole grains, nuts, beans and
pulses in your daily diet.
Fibre is a vital part of a healthy diet but most Canadians consume
much less than the recommended amount.
Good sources of fibre are whole-grain products such as wild rice,
brown rice and oatmeal, as well as vegetables and fruit.
When shopping for packaged food, check the Nutrition Facts label
carefully. Products with 2 g of fibre or more are a healthy choice.
What are plant sterols?
Plant sterols occur naturally in small amounts in vegetable oils,
nuts, whole grains, vegetables and fruit. Research shows that
plant sterols can help lower LDL “bad” cholesterol.
Health Canada now allows food producers to add plant
sterols to certain foods.
You may see labels about plant sterols on mayonnaise,
margarine, salad dressing, yogurt and yogurt drinks, as well
as on some bottles of vegetable and fruit juices.
To get 2 g of natural plant sterols per day, you would need
to eat 210 carrots, 83 oranges or 20 tablespoons of
sesame seeds. Foods in Canada are now allowed to have up to
1 g of added plant sterols per serving.
Plant sterols can reduce LDL “bad” cholesterol levels by
10 per cent, but they have no impact on HDL “good”
cholesterol or triglycerides.
The best way to create a total cholesterol profile that is
healthy is to follow a healthy diet and be active.
Physical activity will help you improve your cholesterol levels and
general heart health. Aim for 150 minutes a week. This can be
accumulated in sessions of 10 minutes or more.
Cycling, swimming and playing outdoor games like cricket and
kabaddi are great ways to keep active. Or take a brisk walk around
the neighborhood after dinner.
Being overweight or obese raises your level of triglycerides and
lowers your HDL “good” cholesterol level. It also raises your risk of
diabetes, heart disease and stroke. By being at a healthy weight,
you can reduce those risk factors.
Smokers have lower levels of HDL “good” cholesterol than
non-smokers. However, a few weeks after becoming smoke-free,
levels of HDL “good” cholesterol start to rise.
HOW TO BE IN CHARGE OF DIETARY FAT
Dietary intake accounts for 20 per cent of cholesterol levels.
This applies especially to saturated fats and trans fats.
Taking a low-fat approach to food means that only 20 to 35 per cent
of your daily calories should come from fat.
For a woman, this means 45 to 75 g of fat a day
For a man, this means 60 to 105 g of fat a day
Use this guideline for men and women to compare how much fat is
in a food or recipe with how much fat you should eat each day.
KNOW YOUR FATS
All fats are not created equal. Some are bad for your health while
others, in moderate amounts, are good. The goal is to reduce bad
fats, especially trans and saturated fats. If you replace some of them
with unsaturated fats and foods high in fibre and nutrient content,
you will be helping to lower cholesterol levels.
Good choice
or
poor choice?
Monounsaturated
fat
(Monounsaturates)
Olive, canola and peanut oils,
non-hydrogenated margarines,
nuts, seeds and avocados
Good choice,
in moderation
Polyunsaturated
fat
(Polyunsaturates)
Safflower, sunflower and corn oils,
non-hydrogenated margarines,
nuts and seeds*
Good choice,
in moderation
Omega-3 fat
Fish such as mackerel, herring,
trout, salmon and sardines,
canola and soybean oils, flaxseeds,
omega-3 enriched eggs, walnuts,
pecans and pine nuts
Good choice,
in moderation
Saturated fat
(Saturates)
Ghee, fatty meats, full-fat milk
products, butter and lard,
coconut, palm and palm kernel
oils, fast foods, snack foods, many
packaged foods and all foods
made with hydrogenated
vegetable oil
Poor choice
Trans fat
All foods made with shortening or
partially hydrogenated
vegetable oil, snack foods, fast
foods and many packaged foods
Poor choice
* While nuts and seeds provide a healthy type of fat, they are also high in calories. Eat them in
moderation. To learn more about portion sizes, visit heartandstroke.ca/healthyliving
MAKE THE NUTRITION FACTS LABEL
YOUR FRIEND
Eating more foods that do not come in a package may be a good
step toward healthy eating.
When you buy packaged foods, the Nutrition Facts label can help
you make better choices. If you have high cholesterol levels, you will
need to limit saturated and trans fats.
All packaged food sold in Canada must have a label that states the
amount of trans fat in the product.
Along with the Nutrition Facts label, read the ingredient list.
The words “partially hydrogenated” or “vegetable oil shortening”
means that a product contains trans fats.
The Health Check logo ensures that a packaged
food product meets the healthy eating
standards of the Heart and Stroke Foundation.
To learn more, visit healthcheck.org
Sometimes diet and exercise are not enough to lower your
cholesterol levels. Some people have inherited a tendency towards
high cholesterol levels. If this applies to you, your doctor may
prescribe medication.
Several types of drugs are available to lower your cholesterol.
Your doctor will help you decide which one is best for you.
These medications do not cure high cholesterol or replace
a healthy lifestyle.
These drugs block an enzyme that your liver uses to make
cholesterol. As a result, your liver makes less cholesterol and picks
up LDL “bad” cholesterol from your bloodstream. They are the most
widely used kind of medicine for lowering cholesterol.
There is currently only one cholesterol absorption inhibitor that
doctors may prescribe in Canada. This drug lowers the levels of
total and LDL-cholesterol in your blood. These drugs reduce the
absorption of cholesterol from the intestines. The resulting
decreased delivery of cholesterol to the liver prompts more
clearance of LDL (bad cholesterol) from the blood stream.
Your body breaks down cholesterol to make bile acids — that help
you digest fats in your food as well as fat-soluble vitamins. Bile acid
sequestrants bind to bile acids in the intestine to form an insoluble
complex that is excreted in the feces. This process reduces bile acid
levels in the liver and promotes more synthesis of bile acids from
cholesterol, thereby decreasing liver cholesterol levels.
These drugs work by lowering your triglycerides. Lowering your
triglyceride levels can increase the levels of HDL (good cholesterol).
Sometimes, this kind of drug is used along with other drugs that
lower cholesterol.
Niacin helps to raise HDL “good” cholesterol. It is a form of
vitamin B that should only be taken to lower cholesterol when
prescribed by your doctor.
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This publication How to Manage Your Cholesterol is for informational purposes only and is not intended to be
considered or relied upon as medical advice or a substitute for medical advice, a medical diagnosis or treatment from a
physician or qualified healthcare professional. You are responsible for obtaining appropriate medical advice from a
physician or other qualified healthcare professional prior to acting upon any information available through this
publication.
The Heart and Stroke Foundation thanks RBC Foundation for providing the funds to make development of this resource
possible. Acceptance of financial support by the Heart and Stroke Foundation does not constitute an endorsement.