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AUTHOR: Benjamin Heisler

What is Cholesterol and why is it important?

Cholesterol is a lipid (fatty) molecule that is found in the blood and cells of animals. It is an important molecule for making up the membranes, or lining, of our body's cells and it is used by the body to make bile salts and steroid hormones such as testosterone and estrogen.

Cholesterol levels can become too high and this can lead to heart disease, stroke and gangrene of the legs over time. This occurs because high cholesterol is one of the leading risks factors for atherosclerosis (sometimes called hardening of the arteries).

What causes high Cholesterol?

Some forms of high cholesterol run in families and are inherited. These conditions are called inherited hyperlipidemias and there are several types of them.

Most people with high cholesterol actually have consumed too much of the stuff over time. It is found in meat products and is especially high in fatty meats and processed meats.

There are also two main types of cholesterol - LDL and HDL. High levels of LDL cholesterol is a major risk factor for atherosclerosis. Higher levels of HDL cholesterol actually reduces a person's risk for atherosclerosis.

What are the symptoms of elevated Cholesterol?

There are very few symptoms of elevated (high) cholesterol. Some people can develop xanthalomas which are small, yellowy lumps that are seen on the eyelids and over tendons. Other people can develop a pale arc or circle around the iris of the eye.

The vast majority of people with elevated cholesterol have no symptoms.

Diagnosis and tests for elevated Cholesterol

Testing for high cholesterol is done with a simple blood test called a serum lipid profile. Iin order to do this test, you usually have to be fasting before midnight and have the test done in the morning. Your doctor will usually give you an order sheet for the test which will typically have the instructions for the test on it.

This test looks for LDL, HDL, total cholesterol, triglycerides (which are fats) and will be reported with a value called the cholesterol ratio. The cholesterol ratio is calculated by dividing the total cholesterol by the HDL cholesterol.

As a rule, low LDL, low total cholesterol, low triglycerides and a low cholesterol ratio are good as is a high HDL level.

Lifestyle modification for elevated Cholesterol

Cholesterol is found in fatty meats and processed foods. Limiting intake of these is of utmost importance. Cholesterol is also found in eggs, which in moderation can be good for you.

As a general rule, we should be eating more fruits, vegetables and nuts, which do not have cholesterol in them and we should be eating food that is high in fibre such as grains (bran, oats, barley). As well, we should be watching our waistlines as high LDL levels and lower HDL levels are found in people who are inactive and overweight.

Non-surgical and medical management for elevated Cholesterol

There are a number of medications that are being used to treat high cholesterol. Statins such as Lipitor (atorvastatin), Zocor (simvastatin) and Crestor (rosuvastatin), just to name a few, are probably the most commonly prescribed drugs for this. They will reduce LDL, elevate HDL and have been shown to reduce the risk of heart attack and stroke in certain circumstances. Fibrates such as Lipidil, vitamins such as Niacin and agents that block the bowel from absorbing cholesterol from food are also sometimes prescribed. There are a number of herbal and alternative remedies out there as well and if you use these you should let your doctor know as some do not react well with precriptions.

Guidelines for Intervention for elevated Cholesterol

Numerous physician groups have come out with guidelines for treating high cholesterol levels. The American Heart Association and the Canadian Cardiology Association have similar "target levels" for treating LDL and cholesterol ratios depending upon what a person's risk level is for a heart attack or stroke over the next few years. For example, for someone who has trouble walking due to peripheral arterial disease, the targets for therapy would be an LDL level less than 2 mmol/L and a cholesterol level of less than 4.

Surgical treatment for elevated Cholesterol


Endovascular Treatment for Cholesterol


When should I see my doctor?

Certainly, if you have a family history or hyperlipidemia or a family history of early heart disease, stroke of peripheral arterial disease (PAD), you should consider consulting your doctor who will likely order a lipid profile test. Similarly, a screening test might be orderred by your doctor once you have turned 40 if you are a male and 50 if you are a female. If you have ever had a heart attack, angina, stroke, aneurysm or trouble walking due to PAD, your doctor will also likely order a lipid profile.

References and Resources

Canadian Heart and Stroke

Canada's Foodguide

Mayo Clinic

Public Health Agency of Canada

Vascular Conditions

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CSVS Guidelines for Abdominal Aortic Aneurysm screening

“The 2018 CSVS guidelines suggest all men 65-80 and all women who have smoked or have heart disease and are between the ages of 65-80 should have an abdominal ultrasound (US) to rule out an abdominal aortic aneurysm (AAA).

Those older than 80 can be considered for screening, but it is important to talk to your doctor. Speak to your primary care physician or vascular surgeon to ensure you have been screened.


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