Cholesterol Management

Managing high cholesterol effectively can reduce the risk of cardiovascular disease. Below, we provide evidence-based guidance on lifestyle changes, dietary adjustments, and available medications.

Lifestyle and Dietary Management

Dietary Adjustments

1. Foods to Increase:

   • Fruits, Vegetables, and Whole Grains: These are rich in fiber, helping reduce cholesterol absorption.
   • Healthy Fats: Include unsaturated fats from olive oil, nuts, seeds, and avocados.
   • Omega-3 Fatty Acids: Found in fatty fish (like salmon and mackerel), these improve heart health.
   • Sterol and Stanol-Enriched Foods: Compounds found in fortified spreads (such as Benecol and Flora ProActiv) help block cholesterol absorption. Regular use, alongside a balanced diet, may lower cholesterol by up to 10%.

2. Foods to Limit:

   • Saturated Fats: Reduce intake of red meat, butter, and high-fat dairy products.
   • Trans Fats: Common in processed foods, trans fats raise LDL cholesterol and should be avoided.
   • Sugary Foods and Refined Carbohydrates: Reduce intake of sugary snacks and refined carbs like white bread, which can elevate triglycerides.

For more dietary information, visit:

• NHS: Cholesterol and Diet
• British Heart Foundation: Eating Well

Other Lifestyle Measures

1. Exercise Regularly: Aim for at least 150 minutes of moderate exercise weekly, such as walking or cycling.
2. Maintain a Healthy Weight: Reducing weight, if needed, can help improve cholesterol levels.
3. Quit Smoking: Smoking lowers HDL (good) cholesterol. Quitting can have immediate health benefits.
4. Limit Alcohol: Stick within NHS guidelines to reduce cardiovascular risk.

For guidance on exercise, see: NHS: Exercise Guidelines

Medical Management Options

When lifestyle changes aren’t sufficient to control cholesterol, medications may be prescribed. Statins are the most common option, but other medications may be used if statins aren’t effective or suitable.

1. Statins

Statins work by blocking an enzyme in the liver needed for cholesterol production, effectively lowering LDL cholesterol levels.

• Common Statins: Atorvastatin, Simvastatin, Rosuvastatin.
• How to Take: Usually taken once daily, often in the evening.
• Side Effects: Common side effects include muscle aches, digestive issues (like nausea or constipation), and rare cases of liver inflammation.
• Risks and Safety: Statins are generally safe with a low risk of severe side effects. Regular blood tests are recommended to monitor liver function and cholesterol levels.

For more information, visit: NHS: Statins

2. Statin Alternatives

If statins aren’t suitable or tolerated, there are other medications for lowering cholesterol:

1. Ezetimibe: Lowers cholesterol by reducing its absorption in the intestines.

   • Use: Can be combined with a statin or used alone if statins aren’t tolerated.
   • Side Effects: Diarrhea, fatigue, and occasionally, liver inflammation.

2. PCSK9 Inhibitors (Alirocumab, Evolocumab): Injectable medications that increase the breakdown of LDL cholesterol.

   • Use: Suitable for people with high cholesterol levels, especially those with familial hypercholesterolemia, or who can’t tolerate statins.
   • Side Effects: May include flu-like symptoms, injection site reactions, and muscle pain.

3. Bempedoic Acid: Works similarly to statins by blocking cholesterol production in the liver.

   • Use: Typically for those who can’t tolerate statins.
   • Side Effects: Common side effects are muscle pain, increased uric acid levels, and rarely, liver enzyme elevation.

4. Inclisiran: A newer treatment that reduces LDL cholesterol by using RNA interference to target the PCSK9 gene.

   • Administration: Given as an injection twice a year after initial doses.
   • Use: Primarily for patients with very high cholesterol who haven’t responded to other medications.
   • Side Effects: Injection site reactions are the most common; it’s generally well tolerated.

For further details on statin alternatives, see: British Heart Foundation: Statin Alternatives

Blood Tests and Monitoring

Regular blood tests are important to monitor cholesterol levels and liver function, especially when taking medications. Here’s a general guideline:

• Initial Blood Test: Before starting any medication.
• 3 Months After Starting: To check effectiveness and adjust dosage if necessary.
• Every 6-12 Months: Regular monitoring to ensure cholesterol levels remain in the target range and assess liver function if on statins.

Target Cholesterol Levels:

• Total Cholesterol: Below 5 mmol/L
• LDL (Bad Cholesterol): Below 3 mmol/L, or lower if at high cardiovascular risk
• HDL (Good Cholesterol): Above 1 mmol/L

For more information on interpreting cholesterol test results, visit: Lab Tests Online UK: Lipid Profile

Summary

1. Start with Lifestyle Adjustments: Focus on diet, exercise, and weight management.
2. Consider Medication if Needed: Statins are the primary choice, but alternatives are available for those who need them.
3. Routine Monitoring: Regular blood tests are crucial to ensure safe and effective cholesterol management.

For additional resources on managing cholesterol, you can refer to:

• NHS: High Cholesterol Overview
• Heart UK: Cholesterol Advice

By following these steps, you can effectively manage cholesterol levels and reduce your cardiovascular risk. For personalized advice, consult your healthcare provider.