Most people nowadays have heard of cholesterol,
and those with coronary heart disease will probably
be better acquainted than most with the terms
cholesterol and lipids and what they mean in respect
of their health. This section aims to
'fill in the gaps' to help you take control of your
cholesterol.

Coronary heart disease remains the biggest killer in the
UK, killing over 117,000 people each year. Experts
suggest that raised cholesterol is the most common risk
factor, being a major factor in nearly half (46%) of all
deaths from heart disease.

With 70% of the UK population aged over 45 years having
raised cholesterol, most of us would therefore benefit
from simple lifestyle adjustments to lower our cholesterol.

'At Risk' groups include those with existing
heart conditions and those with Diabetes.

Cholesterol and triglycerides are the two main lipids, or fats, in the blood. They are made by the body (mainly in the liver) and are also present in the food we eat. All of our body's cells contain cholesterol and although harmful to health in excessive levels, some cholesterol is vital for healthy cells. Cholesterol's three main beneficial functions are listed below:

- A component of all cells
- Used by the body to be a key part of a number of hormones and vitamin D.
- Necessary for the manufacture of bile acids, which help to break down and digest our food.

Cholesterol is actually present in foods such as meat, dairy products and eggs. Although the amount of cholesterol manufactured by the body varies depending on dietary cholesterol intake, the biggest influence on blood cholesterol is dietary saturated fat –intake. An excessive amount of saturated fat in the diet leads to increased blood cholesterol levels. The Guideline Daily Amount for Saturated Fat is 20g a day. Saturated fat is found in high quantities in foods such as fatty cuts of meat, pastries, hard cheese and butter.

If the body accumulates too much cholesterol, it forms deposits in the blood vessel walls, damaging and narrowing the arteries and impairing blood flow to the heart and other vital organs.

These deposits are known as “atheroma plaques”, which, when combined with hardening of the arteries, leads to the condition called atherosclerosis.

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The Good

Not all cholesterol in the blood is harmful to the arteries however. Total cholesterol can be split into HDL and LDL cholesterol. The HDL form of cholesterol (high-density lipoprotein) is actually beneficial because it is involved in picking up excess cholesterol in the bloodstream and taking it away from the arteries and back to the liver for removal from the body. It is therefore often referred to as 'Good' cholesterol. Up until the menopause, women tend to have higher HDL cholesterol levels than men, and this helps to protect them from premature coronary heart disease. So you could think of HDL cholesterol as the healthy cholesterol and we want HIGH levels of it.

The Bad

LDL cholesterol (low-density lipoprotein), on the other hand, is the predominant type of cholesterol making up 70% of our Total amount and encourages cholesterol towards our arteries where, if in excess levels it can build up causing narrowing. In order to prevent this process and reduce our risk of coronary heart disease we therefore need less LDL-cholesterol and so need to keep our LDL-cholesterol LOW.

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Experts recommend that we should all aim for a total cholesterol level below 5mmol/l (millimoles per litre) and LDL-cholesterol below 3mmol/l. However, those with established coronary heart disease, diabetes or a ten-year coronary heart disease risk of 20% or more should aim for a total cholesterol of below 4mmol/l and LDL-cholesterol of below 2mmol/l. Fasting triglyceride levels should be below 1.7mmol/l. Cholesterol levels should be checked every five years, however those at risk of heart disease should have their cholesterol levels checked every one or two years.

Heart UK estimates that currently the average cholesterol level in the UK is around 5.7mmol/l. Even modest reductions in cholesterol, combined with other healthy behaviours such as not smoking, weight loss, exercise and consuming a balanced diet, demonstrate a beneficial impact on the rates of heart and circulatory disease. For every 1% fall in cholesterol level, the risk of heart disease falls by 2%.

Through diet modifications

A few simple steps to help follow a balanced diet can help towards achieving a more appropriate blood cholesterol level which in turn may help to reduce your risk of developing heart disease.

Eating for a healthy heart

Fat facts

A diet high in saturated fat is associated with high blood
cholesterol levels and obesity, and can also contribute to the
development of type 2 diabetes. Kellogg's Optivita range of
cereals are low in Saturated Fat. Other tips include choosing
low-fat cheese and yoghurts. If you have to use oil, go for one
that's packed with monounsaturates such as olive oil or
grapeseed oil. Use skimmed, semi-skimmed milk or
soy milk on your breakfast cereal. Aim to eat fewer
fatty and fried foods like cream, butter, fatty cuts
of meat, some cakes, biscuits, pastries, take away
foods which can all be high in saturated fat – keep
these as occasional treats. Omega-3 fatty acids
reduce the levels of fats in the blood and help prevent
irregular heart rhythms and the formation of blood clots.
The richest source of omega-3 fatty acids is oily fish and
the Food Standards Agency recommend that eating
2 to 4 portions a week can provide the recommended
amount to help prevent heart disease in those at higher
risk. Swap canned tuna for grilled, fresh tuna, lunch on
sardines with toast or serve salmon for dinner. Tinned
sardines and pilchards are economical sources of fish.

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Salt

Some experts believe that a high salt intake is associated with high blood pressure (hypertension), and adults should aim to consume less than 6g of salt per day, the guideline daily amount (GDA). Avoid salty snacks and try substituting salt with lemon juice, herbs, spices, pepper or garlic as alternative food flavourings. Don't add salt at the table or to vegetables while cooking – your taste-buds will soon adjust! Kellogg's Optivita is a no added salt cereal containing only a trace of salt per serving.

Get your 5 a day

Fruit and vegetables contain heart healthy vitamins, minerals, antioxidants and fibre, and we should aim for at least 'five a day'. Currently in the UK we eat around half the recommended minimum. Slice a banana or scatter a handful of berries or grapes on your Kellogg's Optivita cereal and enjoy with a glass of orange juice. Pack your sandwich with salad, snack on fruit and pile you plate with vegetables at dinner. Fruit and Vegetables also tend to be low in fat and calories but packed full of fibre to help to fill you up.

Fibre

We all need to eat more fibre as 4 in 5 of us don't get enough. Kellogg's Optivita is packed with fibre to help boost your intakes at breakfast. Research shows that people who have diets high in fibre tend to have a healthier heart. Go for high fibre carbs such as wholemeal bread and high fibre cereals. They're also far more filling than the white varieties. Add lentils, beans and other pulses containing soluble fibre to soups, stews and casseroles. There are simple changes you can make to make a positive difference to heart health such as starting the day with a healthy oaty cereal like Kellogg's Optivita. Research shows that people who eat breakfast tend to have lower cholesterol levels and are less likely to be overweight than those who skip breakfast. Soluble fibre such as that found in oats, oat bran, beans and lentils and fruit and vegetables also have an active LDL-cholesterol lowering effect.

Alcohol

If you drink, stick to sensible limits – that's no more than 14 units per week for women and 21 for men (3-4 units a day for men and 2-3 units daily for women).

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Soy protein

Soya beans contain no cholesterol at all, and they are low in saturated fat. Research shows that the inclusion of at least 25g of soya protein per day, as part of a diet low in saturated fat, can help reduce blood cholesterol levels. Why not use soya milk on your Kellogg's Optivita cereal and add soy beans or tofu to stews and stir fries?

Stanols and sterols

Your GP may prescribe some medications to help you control your cholesterol levels – here are a few with a brief explanation:

Statins

Statins work by slowing down the production of cholesterol in the liver, where is where most of the body's cholesterol is made

• Atorvastatin
• Fluvastatin
• Pravastatin
• Rosuvastatin
• Simvastatin

Fibrates

Due to their blocking action on certain enzymes used in the liver for the production of cholesterol and triglycerides, fibrates are particularly useful when both are raised.

• Bezafibrate
• Ciprofibrate
• Fenfibrate
• Gemfibrozil

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Cholesterol Absorption Inhibitors

These drugs block the absorption of cholesterol into blood stream, from the small intestine. The cholesterol lowering effect is increased if combined with low dose statin.

• Ezetimibe
• Ezetimibe/Simvastatin Combination

Bile Acid Sequestrants

These drugs are known as resins. They prevent re-absorption of bile salts in the intestine, which means that cholesterol is used up in replacing them.

• Colestipole
• Colestyramine

Nicotinic Acid

Niconinic acid inhibits fatty acid release from fat cells in the body, leading to a reduction in LDL-cholesterol and a rise in HDL-Cholesterol

• Acipimox
• Niaspan

Omega-3 Fish Oils

Fish oils reduce triglyceride levels. Eating three portions of oily fish can provide the recommended amount but fish oil capsules can provide an alternative source.

• Omacor

Consume more

• Fruit and vegetables
• Oats and oat bran
• Nuts, beans and pulses
• High fibre
• Omega 3
• Soya protein

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Consume less

• Foods containing saturated fat e.g. full fat dairy, hard and cream cheese, cream, fatty meat, pies, cakes and pastries, some ready meals.
• Hydrogenated saturated fat which are mainly found in some processed foods e.g. meat pies, pastries and some margarines
• Salty snacks nuts in oil and salt
• Generally high fat foods
• Alcohol

Ideal levels for most people

• Total cholesterol below 5.00mmol/l
• LDL-cholesterol below 3.00mmol/l
• HDL-cholesterol above 1.00mmol/l

Ideal level for those at higher risk of heart disease

• Total cholesterol below 4.0mmol/l
• LDL-cholesterol below 2.0mmol/l
• HDL-cholesterol above 1.0mmol/l

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• Diabetes is an independent risk factor for coronary heart disease, and a cluster of abnormalities, collectively known as the “metabolic syndrome”, often precedes the onset of type 2 diabetes. Metabolic syndrome is characterised by central abdominal obesity i.e. having a higher than healthy waist line, raised blood triglycerides and blood pressure, low HDL-cholesterol and unhealthy fasting glucose levels.

• Obesity, particularly around our waistline, is an independent
risk factor for the development of heart disease and is known to
exacerbate other risk factors, including high blood pressure and
elevated blood glucose. People who reduce central obesity
demonstrate an improvement in their heart disease risk
profile. For more information, see the Ashwell Shape Chart.

• Increase physical activity. Cardiovascular benefits of
regular physical activity include reduced blood
pressure, weight control and an increase in 'good'
HDL-cholesterol. Brisk walking, cycling,
swimming and dancing all help to maintain
heart health, and 30 minutes' moderate
activity each day is recommended. The
good news is that it can even be divided
into 10-minute chunks. Gardening,
vacuuming and bed-making can
provide a good 'cardiovascular
workout' too! If you have
coronary heart disease or feel
you are at risk, consult your
doctor before starting an
exercise programme.

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For more easy ways to exercise, please visit the Easy Ways to Help Crack It area
of Optivita Village™.

• Alcohol in moderation may help reduce the risk of coronary heart disease. Keep to sensible limits when drinking alcohol – 14 units a week for women and 21 units a week for men, spread throughout the week. A unit is half a pint of ordinary strength lager, beer or cider, or a small glass (pub measure only) of wine, sherry or spirits. A typical glass of wine
works out at about 2 units, and a bottle of lager or a bottle of alcopop
are each 1.7 units. But don't be fooled, lots of drinks have higher
alcohol levels than these standard examples.

• High blood pressure increases the risk of heart attack,
stroke and heart failure, and the optimal blood
pressure target is below 140mmHg systolic
(top reading) and 85mmHg diastolic. Ask your
doctor for your reading.

• Smokers should stop – about 20% of
heart disease deaths and about 25%
of all deaths are attributable to
smoking. Passive smoking also
increases the risk of coronary
heart disease. Ask your doctor,
pharmacist or practice nurse for
advice on smoking cessation
support and treatments
available.

• Stress can exacerbate
symptoms in people
with heart disease and when
prolonged it may also lead
to self neglect. It's important
to include some relaxation
time in our everyday lives
and avoid stress. Exercise
is a great way to help
manage stress levels.

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Cholesterol testing, along with risk assessment and advice, is now available from pharmacists and all GP surgeries using a finger-prick sample of blood. It is recommended that adults from 40 years onwards should have a blood test at their GP surgery for Total Cholesterol and LDL and HDL cholesterol.

Risk Factors

Those with the following risk factors should see their doctor for a fasting lipid profile (total cholesterol, HDL and LDL-cholesterol and triglycerides, following a 12-hour fast):

- A personal history of cardiovascular disease
- A family history of cardiovascular disease
- High blood pressure (hypertension)
- Diabetes mellitus
- Clinical signs of high cholesterol
- Large waist circumference in relation to your height
- Chronic kidney disease
- Those who smoke
- South Asian origin

Waist Circumference

Measuring waist circumference, to get an indication of central obesity, is thought to be a better indicator of overall health risk than measuring just body weight. Maintaining a healthy body shape is essential as high waist circumference has been shown to increase the risk of coronary heart disease. Central obesity is linked to the development of several risk factors such as abnormal cholesterol levels, insulin resistance, type 2 diabetes, metabolic syndrome, high blood pressure and likelihood of thrombosis which may lead to heart disease.

A handy rule of thumb is that your waist circumference should be less than half your height. This is why the Ashwell® Shape Chart can be used by all men and women to see the health risk associated with their body shape.

Are you an apple or a pear?

Use this chart to work out the health risk attached to your own body shape. It is suitable for both men and women.

The size of your waist circumference is a good indication of your overall health risk. Why is this?

Excess fat which is found deep down in the region of the stomach gives someone a large waist circumference and an 'apple' shape. This is often associated with risk factors for serious conditions such as heart disease, raised blood pressure, diabetes and some types of cancer.

Excess fat which is found under the skin, around the bottom, hips and thighs gives
someone a smaller waist circumference and a 'pear' shape. This is generally accepted
to be less harmful to health.

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You should keep your waist circumference to less than half your height

This chart has been based on scientific evidence from the Universities of Cambridge and London in the United Kingdom.

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What to do and what it means:

Matching your height to your smallest waist circumference, where does your shape fall in the Chart?

If your shape is in the brown 'chilli' region, you should take care. You will not need to decrease your waistline.

If your shape is in the green 'pear' region, you have a healthy OK shape.

If your shape falls in the yellow 'pearapple' region (particularly the upper end), you should take care. Make certain that you don't increase your waistline any more.

If your shape falls in the red 'apple' region, your health is probably at risk. Why not talk with your GP and take action?

Reference Curves derived from scientific data as described in: Ashwell M and Hsieh SD (2005). International Journal of Food Sciences and Nutrition; 56: 303–307; Ashwell, M.A., LeJeune, S.R.E. and McPherson, K. (1996) British Medical Journal; 312: 377; Cox, B.D. and Whichelow, M.J. (1996) British Medical Journal; 313: 1487.

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For those with inherited lipid disorders such as familial hypercholesterolaemia (FH or inherited high cholesterol), pre-existing coronary heart disease or diabetes, lipid-lowering agents may be needed in addition to diet and lifestyle measures. The following classes of agents are prescribed for treating raised cholesterol and triglycerides:

Statins, which slow down the production of cholesterol in the liver and are very effective in reducing LDL-cholesterol in particular.

Fibrates, which reduce triglycerides and cholesterol.

Resins, which are relatively safe for children because they are not absorbed by the body.

Selective cholesterol absorption inhibitors, which block the absorption of both dietary and biliary cholesterol in the small intestine.

Nicotinic acid, which increases HDL-cholesterol.

Omega-3 fish oils, which reduce triglyceride levels.

Although some progress has been made towards reducing the number of heart attacks happening in the UK, they remain the UK's biggest killer – in fact we are eight and a half times more likely to die from a heart attack than breast cancer and six and a half times more likely to die from a heart attack than colon cancer.

It's never too soon to begin reducing your of heart disease and lowering your cholesterol level need not be difficult. Being aware of cholesterol level and making simple dietary and lifestyle changes are important first steps to taking control of your heart health.