GuideCholesterol

Cholesterol helps to carry digested fat through our blood system to the cells where it id needed. But since fat and water do not mix (and blood is mostly water) our body needs to parcel up the cholesterol and other fats with soluble substances called lipoproteins. There are to types of lipoproteins: Low Density Lipoproteins (LDL: the bad cholesterol) and High Density Lipoproteins (HDL: the good cholesterol). The liver sends out the LDL’s with their load of cholesterol to distribute around our body. On their journey some of these LDL’s cal leave their cholesterol stuck along the walls of the blood vessels, making them narrower. If this happens in the blood vessels of the heart it can cause coronary artery disease. It is the job of the HDL’s to try and remove the “stuck” cholesterol and carry it back to the liver to be recycled or disposed of.

A large body of evidence has demonstrated that cholesterol lowering reduces the risks of CHD events in patients with high cholesterol levels or a history of CHD.

The size of the reduction in CHD risk appears to be proportional to the size of the cholesterol reduction achived, such that reductions of about 1-1.5 mmol/ (40-60 mg/dl) produced by 3-hydroxy-3-methylglutariylcoenzime A reductase inhibitors (statins) reduce the risk of major CHD events by between a fifth and a third.

In all adults aged 20 years or older, a fasting lipoprotein profile (total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride) should be obtained once every 5 years. If the test opportunity is non fasting, only the values for total cholesterol and HDL cholesterol should be usable. In such a case , if total cholesterol is ³ 200 mg/dl or HDL is < 40 mg/dl, a follow-up lipoprotein profile is needed for appropriate management based on LDL.

LDL cholesterol goals and cut-points for therapeutic lifestyle changes (TLC) and drug therapy in different risk categories

The fase 1 is suggested to everybody. Fase 2 and 3 are suggested to people with cardiovascular disease.

Cholesterol is a waxy, yellow-white substance produced mostly in the liver. One of its main jobs is to help to produce the substances we need to digest the fats that we eat (the bile acids). It is also needed by every cell in our body, it helps to insulate our nerves, make vitamin D, and to build some hormones such as sex ones.

Cholesterol is found only in animal products. Plant foods (such as grains, fruits, vegetables, nuts) do not contain cholesterol. The cholesterol in foods we eat is dietary cholesterol. While the cholesterol in our blood come from two sources: the foods we eat and the body’s manufacturing process. The cholesterol we eat has much less effect on raising blood cholesterol levels than does saturated fat. With only a few exceptions, saturated fats and cholesterol occur in the same foods. The exceptions are egg yolks, organ meats, and shrimp (which are high in cholesterol but have only moderate amounts of saturated fat), and tropical oils (coconut, palm, palm kernel, and cocoa butter), which are high in saturated fat but have no cholesterol. Saturated fats (rich are: red meats and whole milk dairy products, including butter and cheese), are generally solid at room temperature. Polyunsaturated fats are generally liquid at room temperature. All vegetable oils except the tropical oils are generally high in polyunsaturated fats. Margarine is a vegetable oil that has been made solid by a process called hydrogenation, which makes it act like a saturated fat. It is suggested to choose a whipped tub margarine that lists a vegetable oil as its first gradient.

For subjects with borderline high cholesterol (200-239 mg/dL) and no other risk factors. The diet is based on a maximum of 300 mg of cholesterol a day and no more than 35% of total calories from fat

Foods	Recommended	To be used in moderation	To be avoided
Cereals	Wholegrain bread and cereals, crisbread, porridge, pasta, matzo rice		Croissant, brioche
Milk products	Skimmed milk, very low-fat yoghurt, very low-fat cheese (e.g. cottage cheeses, quark, fat-free fromage frais	Semi-skimmed milk, low-fat cheese (e.g. camembert, brie, feta, ricotta, low-fat yoghurt, Edam, Gouda)	Whole milk, full-fat yoghurt, full-fat cheese, imitation milk, condensed milk, cream
Eggs	Egg white	Eggs yolks one weekly	Whole eggs, egg yolk
Vegetables, salads and fruits	All fresh or frozen vegetables, particularly legumes, dried beans, lentils, chick peas, sweetcorn, boiled or jacket potatoes, all fresh or dried fruit, tinned fruit (unsweetened)	Roast or chipped potatoes cooked in permitted oils	Roast or chipped potatoes, vegetables or rice fried in unsuitable oils or fats, oven chips, potato crisps, salted tinned vegetables
Fish	All white and oily fish (grilled, poached, smoked). Avoid skin!	Fish fried in suitable oils	Eel, roe, fish fried in unknown or unsuitable oils or fats
Shellfish		Mussels, scampi, lobster, oyster, scallops	Prawns, shrimps, calamari
Meat	Turkey, veal, game, rabbit, spring lamb, chicken (avoid skin!)	Very lean beef, ham, lamb, veal or chicken sausage, liver twice a month	Goose, duck, usual sausage, all visibly fatty meats, meat pies, salamis, patès, bacon, poultry skin
Dressings	Pepper, mustard, herbs, spices	Low-fat salad dressing	Cream, mayonnaise, added sat
Soups	Vegetable soups, consommés		Thickened soups, cream soups
Fats		Unsaturated oils e. g. olive, sunflower, corn, safflower, walnut, soft (unhydrogenated) margarines based on those oils, expecially low-fat preads	Butter, lard, suet, dripping, palm oil, hard margarines, hydrogenated fats
Desserts/sugars	Fruit salad	Sugar, jelly, marmalade, jelly, gelatine, pure sugar candy, sorbet, angel food cake, vanilla wafers, ginger snaps, meringues, puddings made with low-fat ingredients	Ice cream, puddings, dumplings, sauces made with cream or butter
Baked foods		Pastry, biscuits med with unsaturated margarine or oils	Commercial pastries, biscuits, pies, snacks
Confectionery		Marzipan, halva, nougat, boiled sweets, Turkish delight	Chocolate, fudge, toffees, coconut bars, butterscotch
Nuts		Walnuts, almonds, chestnuts, hazelnuts, peanuts, pistachios, brazils	Cashews, coconut, salted nuts
Beverages	Tea, mineral water, calorie-free soft drinks, filter or instant coffee	Alcohol, low-fat chocolate drinks	Irish coffee, chocolate drinks, full-fat malted drinks, boiled coffee
Flavors/spices	Herbs, spices, horseradish, Tabasco sauce, pickles, mustard, soy sauce	Salt ketchup, barbecue sauce, Worcesterschire sauce, relishes	Condiments or flavor aids made from fats and oils

For subjects with borderline high cholesterol plus two or more cardiac risk factors. This diet is based on a maximum of 200-250 milligrams of cholesterol a day, with no more than 25% of total calories from fats. If you are in the blue zone, use the yellow diet as a guide, but modify it as follows:

For subjects with cholesterol > 240 mg/dL or higher. This diet is based on a maximum of 100 milligrams of cholesterol a day, with no more of 20% of calories from fat.

In addition to limiting dietary fats, avoid alcohol and simple sugars. These include:

Risk category	LDL goal mg/dL	LDL level at which to initiate TLC (mg/dL)	LDL level at which to consider Drug therapy (mg/dL)
CDH or diabetes (10 years risk > 20%	< 100	³ 100	³ 130 (100-129 drug optional)
2+ risk factors (10 year risk ≤ 20%)	< 130	³ 130	10-year risk 10-20%: ³130 10-year risk< 10%: ³ 160
0-1 risk factors = 10-year risk < 10%	< 160	³ 160	³ 190 (160-189: LDL-lowering drug optional)