CONTROL YOUR CHOLESTEROL BY TERRY MULGANNON & TEAM M&F Everything you need to know about preventing heart disease Of course, if you are like most people, you have already heard that high blood cholesterol is bad for you, and you have probably decided to deal with it someday — but sometime in the distant future. That would be a big mistake, says Mary McGowan, MD, author of Heart Fitness for Life (Oxford University Press). Cholesterol damage to your arteries doesn't begin when you are old. In fact, research has found that it starts earlier than anyone imagined. The build-up begins as early as age two, and it can be significant by the time you are ten. Young people today start getting into cholesterol trouble much earlier. They are starting careers, lead busy lifestyles and they eat fast food, which is full of fat. Sound familiar? If so, the time to start making changes is now. "Men in their 40s in particular don't just have heart attacks. They have set themselves up for heart attacks with bad diets throughout their lives," McGowan says. "And the sooner you get into the habit of eating the right foods, the better." How does cholesterol wreak havoc on your body, and how can you prevent that from happening without wrecking your lifestyle?

THE GOOD, THE BAD AND THE UGLY Your body makes cholesterol; you need it to produce membranes for cells, bile acids for digestion, and various hormones. But the excess collects on the walls of your arteries like ice in an old freezer. When the veins are sufficiently narrowed, there's no room for the blood to move through. If a heart artery becomes completely clogged, a heart attack can result; if the carotid artery is blocked, it causes a stroke. But that's not the whole story. Cholesterol comes in two major brands: "good" (high-density lipoprotein, or HDL) and "bad" (low-density lipoprotein, or LDL). LDL is known as the bad one because traces of it stay within your arteries. HDL, on the other hand, actually takes cholesterol away to the liver, leaving you with less in your blood. That's why doctors say that while you should keep your overall cholesterol levels low, you also need to maintain as low a ratio of total cholesterol to HDL as possible. LDL (low density lipoprotein): About 70% of cholesterol is transported as LDL. This is mostly fat and not much protein. LDL causes cholesterol to be deposited in the arteries. High levels of LDL are associated with an increased risk of heart disease. HDL (high density lipoprotein): About 20% of cholesterol is transported as HDL, which is mostly protein and not much fat. HDL actually helps prevent cholesterol building up in the arteries. Low levels of HDL are associated with an increased risk of heart disease. Women tend to have a higher HDL cholesterol level than men. Triglycerides:Triglycerides are a different type of fat, which mostly come from fats in food. Calories that are eaten and not used immediately are converted into triglycerides and transported to fat cells for storage. Although most triglycerides are stored in fat tissue, low levels are also found in the blood. They are carried in the blood as very low density lipoproteins (VLDL). A raised level of blood triglycerides together with high LDL can increase the risk of heart disease. WHAT CAUSES HIGH CHOLESTEROL? There are several factors that may contribute to high blood cholesterol: ›› a diet that's high in saturated fat and, less so, high in cholesterol. ›› lack of exercise may increase LDL (bad) cholesterol and decrease HDL (good) cholesterol. ›› family history — people are at a higher risk of high cholesterol if they have a direct male relative aged under 55 or female relative aged under 65 affected by coronary heart disease. ›› being overweight, which may increase LDL (bad) cholesterol and decrease HDL (good) cholesterol. ›› age and sex — cholesterol generally rises slightly with increasing age, and men are more likely to be affected than women. ›› drinking alcohol excessively. Rarely, high cholesterol can be caused by a condition that runs in the family called a lipid disorder (familial hypercholesterolaemia). Other health conditions such as poorly controlled diabetes, certain kidney and liver diseases and an underactive thyroid gland may also cause cholesterol levels to rise. Some medicines such as beta-blockers, steroids or thiazides (a type of diuretic) may also affect blood lipid levels. HOW DIET AFFECTS BLOOD CHOLESTEROL Only about 20% of cholesterol comes directly from the diet — the other 80% is produced by the liver. However, a diet high in saturated fats and cholesterol can cause the liver to produce more LDL (bad) cholesterol. The amount that diet influences cholesterol levels varies from person-to-person, and is probably an inherited characteristic. Some people who eat high-fat diets have high cholesterol levels; others may have normal or low cholesterol levels. HOW TO GO LOWER Lose your own fat: Fat is stored fuel, and when you're overweight, your liver tends to produce an excess of unwanted substances — including LDL cholesterol. Keep in mind that the younger you are, the easier it is to lose that spare tyre. Exercise regularly: This doesn't just help you lose weight so you have lower LDL levels; it also raises your HDL (good) cholesterol levels. About 30 minutes of brisk aerobic exercise four times a week is the bare minimum you need to stay healthy; four hours a week plus some weight training is better. Take a drink — but take care: Some of the media hype about alcohol and the heart is true — two to six drinks a week can help raise your levels of HDL cholesterol, perhaps by suppressing enzymes in the blood that break HDL down. But be careful, McGowan warns, consuming as little as two drinks a day can dramatically raise some men's blood pressure. It can also raise levels of triglycerides, another substance in the blood that's an important marker for heart disease. Finally, alcohol contains lots of empty calories, contributing to the above-mentioned weight gain. Butt out: lf you smoke, the most important thing you can do for your arteries is quit immediately. Smoking damages artery walls and oxidises LDL cholesterol, making it even easier for dangerous plaque to build up. It also keeps your HDL levels low. "Within six months of quitting, you can increase your HDL levels by about 10 per cent," McGowan says. Eat right: A wide variety of foods and supplements can help lower your total cholesterol levels. Some researchers believe that eating a clove of garlic a day — or its capsule equivalent — will eventually lower your cholesterol total by 9 per cent. Healthy eating can reduce cholesterol. Your diet should be low in saturated fats in particular, and low in fat overall. Biscuits, cakes, pastries, red meat, hard cheese, butter and foods containing coconut or palm oil all tend to be high in saturated fats. Large amounts of cholesterol are found in a few foods, including eggs and offal such as liver and kidneys. Although dietary cholesterol does not usually contribute much to blood cholesterol, it is still advisable to limit these foods to three servings a week if you have high cholesterol. It's also important to eat plenty of fibre, especially soluble fibre, which is thought to lower cholesterol. This is found in fruits and vegetables, beans and oats. Aim to eat at least five portions of fruit and vegetables a day. "The higher your cholesterol, the greater the (potential) reduction – it can be as much as 10 or 15 per cent," McGowan says. Other replacement strategies include substituting monounsaturated fats for the saturated fats already in your diet – use walnuts, peanuts and almonds instead of meats and cheeses, or swap lard and vegetable oils for olive or canola oils. Supplement yourself: A few natural substances have been shown to help lower cholesterol. For instance, the B vitamin niacin helps raise HDL while diminishing the production of chemicals that eventually turn into LDL. (However, McGowan warns that liver damage is possible if it's taken in high doses, so she recommends talking to your doctor before getting carried away with it.) Say yes to drugs: Many people, especially young ones, are reluctant to see a doctor for cholesterol-lowering drugs, but if your levels are dangerously high, they can make a big difference in your health. (This is especially true if you have familial hypercholesterolemia – known as FH – a genetic predisposition towards extremely high cholesterol levels.) But remember, even with medication, you still need to exercise and watch your diet. THE BOTTOM LINE No, you don't have to purge every gram of fat from your diet and live on sprouts and tofu. You can probably lower your cholesterol levels significantly with relatively easy lifestyle improvements. Find sports or exercises you enjoy and do them consistently; find healthy foods you really like (there are plenty of great ones out there); and make friends with the fruit and vegetable aisle in your supermarket. How about this for a cholesterol-lowering prescription? A vigorous workout, swim or bike ride, followed by some veggie pizza with fresh garlic, and a glass of red wine or a beer. When you stop to think about it, that's not exactly a big sacrifice. MEASURING UP Cholesterol is measured in units called millimoles per litre of blood, usually shortened to ‘mmol/litre' or ‘mmol/l'. America uses the units milligrams per decilitre of blood: mg/dl instead. It is desirable to have a total cholesterol level under 5 mmol/l, and an LDL level under 3 mmol/l. In order to estimate the risk of a person getting CHD (Coronary Heart Disease), doctors look at the ratio between total cholesterol and HDL (‘good' cholesterol), called the TC:HDL ratio. A lower ratio is desirable, indicating that the level of HDL is high. Measuring cholesterol involves a simple blood test. A blood sample may be taken either by using a needle and a syringe, or by using a finger prick. This may be done at a GP's surgery, at a hospital appointment, or as part of a health assessment. WHO SHOULD HAVE A CHOLESTEROL TEST? Anyone who has any cardiovascular disease, such as coronary heart disease, peripheral vascular disease (disease in the blood vessels that supply the limbs) or stroke, should have their cholesterol measured by a doctor. Anyone, even children, with a family history of familial hyperchole-sterolaemia should have their cholesterol measured. Anyone aged 35 or over should consider having their cholesterol measured if they have one or more of the following risk factors: family history of early heart disease, diabetes, high blood pressure, smoking. M&F Further information can be obtained from: The British Heart Foundation, telephone: 08450-708070 or visit: www.bhf.org.uk