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What is high cholesterol?

Cholesterol is a fatty substance in our blood, which is produced naturally by the liver. 1 Everyone has cholesterol as the human body needs it to function properly. 1 Some of the cholesterol in our bodies comes from the foods we eat.1 Cholesterol is carried around the body bound to proteins – these particles are called lipoproteins (“lipo” = fat). 1 There are two main types of cholesterol:

  • High density lipoprotein-cholesterol (HDL-C) – this is known as “good” cholesterol as it delivers cholesterol you don’t need back to the liver where it is broken down. 1
  • Low density lipoprotein-cholesterol (LDL-C) – also known as “bad” cholesterol as it carries cholesterol from the liver to the rest of the body. If you have too much of this cholesterol it can stick to the walls of the blood vessels to form fatty plaques or “atheroma”, which over time can lead to narrowing or blockage of the blood vessels. 1

What causes high cholesterol?

Anyone can get high cholesterol and you don’t have to be fat to have high cholesterol. 1,2 Some risk factors for high cholesterol are nonmodifiable i.e. you cannot change them, but a lot are modifiable i.e. because of poor lifestyle habits that you can change. 1

Nonmodifiable risk factors

  • Increasing age 1
  • Diabetes 2
  • Ethnic background 1
  • Family history 3

Modifiable risk factors

  • Diet high in saturated fats 1
  • Smoking 1
  • Sedentary lifestyle 1
  • Excess body fat around your middle 1
  • Drinking too much alcohol

What are the complications of high cholesterol?

Having high levels of LDL-cholesterol for a long time causes a build-up of fatty plaques in the blood vessels. 2 This causes hardening and narrowing of the blood vessels so blood flow through the blood vessels is decreased. 2 Sometimes clots develop and shut off blood flow completely. 2 If this happens to a blood vessel supplying the heart, it will cause a heart attack, and in the brain, it will cause a stroke. 2 Fatty plaques in the major blood vessels supplying the legs can cause circulation problems called peripheral vascular disease. 2

visual artery showing the difference between a norm

How do you manage high cholesterol?

Making good lifestyle choices can help lower your cholesterol levels. 1 These include:

  • Eating a healthy diet – g. a diet low in saturated fats and sugar and high in fibre, fruits, vegetables, healthy fats and lean protein 1
  • Exercising regularly – strengthens your heart and helps to lower bad cholesterol and increase good cholesterol levels 1
  • Stopping smoking – can help lower your cholesterol and improve your health 1
  • Losing weight – a weight loss of even 2,5 kg can improve your cholesterol levels 3

If your cholesterol is very high and if lifestyle changes are not enough, you may need to go on medication to lower your cholesterol. 1 These medications may include:

  • Statins – reduce the amount of cholesterol produced in the liver 3
  • Fibrates – bind to bile acids, which contain cholesterol, in the intestine and prevent them from being absorbed 4
  • Ezetimibe – blocks the absorption of cholesterol from food and bile juices in your intestines into your blood 4

References: 1. British Heart Foundation. High cholesterol. [online] [cited 2018 Nov 19]. Available from: URL: 2. Merck Manual Consumer Version. Quick Facts: High Cholesterol. [online] [cited 2018 Nov 19]. Available from: URL: 3. Heart & Stroke Foundation South Africa. Cholesterol. [online] 2017 Nov [cited 2018 Nov 19]. Available from: URL: 4. National Health Service (NHS). Treatment High Cholesterol. [online] 2018 Jul 30 [cited 2018 Nov 20]. Available from: URL:

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