Cholesterol and the Heart

Dr. Hassan Chamsi Pasha Dr. Fawaz Akhras

There is overwhelming evidence that a high blood cholesterol level increases the risk of developing atherosclerosis (Hardening of blood vessels due to accumulation of fatty deposits on the inner lining of arteries), and with it the risk of coronary artery disease or stroke.

What is cholesterol?

Cholesterol is a fatty substance found only in animal and human cells. Cholesterol is essential for the proper functioning of your body. It is used to produce new cells and certain hormones. About 75% of the cholesterol in your body is made in the liver.

What is the relation between cholesterol and coronary heart disease?

Doctors have noted that victims of coronary heart disease tend to have abnormally high levels of cholesterol in their blood. Scientists believe that atherosclerosis begins when high blood levels of cholesterol penetrates the smooth lining of the arteries forming small deposits. The process, is usually gradual if the arteries are otherwise healthy. However, the process will become much faster if a person has high blood pressure, and if he smokes.

What are the causes of high lipids in the blood?

High lipids in blood is mostly secondary to eating too much fat in our diet. However, it may be inherited or may be a consequence of another disorder, such as hypothyroidism, diabetes mellitus, nephrotic syndrome, alcohol dependence or cushing syndrome.

Is there a bad cholesterol and good cholesterol?

Everyone's body contains several proteins that attach themselves to cholesterol. One is called L.D.L. (Low density lipoprotein), which is particularly harmful. It is believed to collect cholesterol and deposit it in the cells. The good cholesterol is called H.D.L. (High density lipoprotein), which is thought to pick up excess cholesterol and help the body to eliminate it. Those who have high HDL in their blood seem to a have lower incidence of coronary heart disease than others.

What is high Cholesterol?

At present it is recommended to have a blood cholesterol below 200 mg% (5.2 mmol/l), a blood level of cholesterol between 200-240 mg% (5.2-6.2 mmol/l)is called borderline-high. If your blood cholesterol is above 240 mg% (6.2 mmol/l) this is considered high. It is worth remembering that the higher the level of bad cholesterol, the higher the risk of having a heart attack.

How can blood cholesterol be checked?

You can get it checked with a blood test. Often the screening can be done with a drop or two of blood from the finger, called "finger stick". If your blood cholesterol is high your doctor would like to know the level of your "HDL, the good cholesterol" and the "LDL, the bad cholesterol". Don't take the attitude of "I don't want to know my cholesterol level" and don't wait too long.

What am I going to do next?

If your cholesterol is under 200 mg% (5.2 mmol/l) you need to continue with a prudent diet, quit smoking, loose weight if needed, do regular exercise, relax and have your cholesterol checked again in one year.

If your cholesterol is between 200-240 mg% (5.2-6.2 mmol/l) you need to see the dietician in order to start on a low fat low cholesterol diet.

If your cholesterol is above 240 mg% (6.2 mmol/l)you need to be on a more strict diet particularly if you have coronary artery disease or at risk of having coronary artery disease.

If the blood cholesterol is too high your doctor may also commence you on a cholesterol lowering drug.

What is the other type of lipids in the blood?

The other type is called "triglycerides". They are the most common form of fat in the diet and in human body. Very high levels of triglycerides put the patient at risk of pancreatitis.

What is a low fat diet?

Your diet should be low in saturated fats and rich in poly and monounsaturated fatty acids. It should also be low in cholesterol.

What are the Saturated fats in the diet?

Fats are classified as saturated or unsaturated fat according to their chemical structure. Saturated fats are found in animal meat of milk, butter, cheese, cream, egg yolks, ice cream and other dairy products. Surprisingly, two vegetable oils (palm oil and coconut oil) are loaded with saturated fatty acid. Another source of saturated fat is the hydrogenation or the hardening process that converts some of the good unsaturated fat in vegetable oils into bad saturated fat such as in margarine and shortening.

What are the unsaturated fats?

Unsaturated fats are the good type of fat. They are classified as polyunsaturated or monounsaturated fat that come from vegetables and sea food.

The polyunsaturated fats are found in corn, sunflower, or Soya bean oils. The monounsaturated fat are found in olive oil, peanut oil and rape seed oil.

It has been recently known that in cultures where olive oil is the main fat source instead of saturated fat, the people are healthier and usually are less likely to have heart attacks.

Olive oil is now the first choice of oils to use in food preparation, salads and cooking.

What are omega 3 fatty acids?

They are also good fats. They are found in fish, seafood and in some plants.

Why should I loose weight?

Obesity places a person at greater risk of acquiring serious disorders, such as hypertension, diabetes mellitus, coronary artery disease, stroke and osteoarthritis. The cause is usually an excess of intake of calories.

What are the main guidelines for a healthy diet?

1. Avoid saturated fats such as animal fat and dairy products.

2. Use corn oil, sunflower oil, or olive oil in cooking and salads.

3. Cut down consumption of red meat. Instead eat fish and poultry.

4. Eat whole grain products, including whole meal bread, beans and peas.

5. Eat plenty of vegetables and fruits.

6. Cut down on sugar in all foods and avoid sweets and cakes.

Some tips for a low fat diet:

1. Grill, bake rather than fry.

2. Remove the skin from chicken.

3. Eat more fish (twice/week).

4. If you do eat red meat , trim away any fat before cooking.

5. If you do fry, use polyunsaturated or monounsaturated oil rather than margarine or butter and in non stick pan so that you use only a very small amount of oil.

6. Fry mince without adding any fat and then drain off all fat.

7. Use polyunsaturated margarine instead of butter.

8. Avoid hard cheese such as cheddar and cream cheese, and buy low fat cheese (10% fat ).

9. Change from full fat milk to low fat milk.

10.Boil eggs rather than frying them (do not exceed 2 or 3 eggs per week).

11.Eat baked or boiled potatoes in preference to chips.

12.Avoid manufactured foods such as, biscuits, cakes, sweets, crisps as they are rich in "hidden" fat.

From the Book : “ Patient Guidelines to Heart Disease : Questions and Answers “

By Dr. Hassan Chamsi Pasha & Dr. Fawaz Akhras

Dar Almanara – Jeddah in 1999

Tel : 6603652