CHOLESTEROL 101

A high cholesterol level is a risk factor for heart disease – but what’s “good” cholesterol and what’s “bad,” and why does it all matter?
First, let’s look at the basics.

LDL VS. HDL CHOLESTEROL

Explaining how cholesterol works is a good first step to get your clients thinking about why their levels matter. Here are some key points you can use to explain cholesterol: Cholesterol is a type of fat found in the blood. There are two main types: low-density lipoprotein (LDL) cholesterol and high-density lipoprotein cholesterol (HDL).¹

LDL-cholesterol is often called the “bad” cholesterol. It travels in the blood to the cells, and a high level of LDL-cholesterol in the blood can lead to cholesterol adhering to and building up in the arteries.² Lower is better when it comes to LDL-cholesterol levels.^2,3

HDL-cholesterol, on the other hand, is often called the “good” cholesterol. HDL-cholesterol carries cholesterol to the liver, where it is removed from the body.² Since HDL-cholesterol helps remove cholesterol from the blood, higher levels are better.¹

THREE THINGS TO TELL YOUR CLIENTS ABOUT LDL CHOLESTEROL

1. High levels of LDL-cholesterol can lead to atherosclerosis, which is when “plaque,” consisting of cholesterol, fatty substances, cellular waste products, calcium and a clotting material called fibrin, builds up inside your arteries.^4-7
2. Lowering it is key to reducing the risk of cardiovascular disease.⁵
3. You can help manage high LDL-cholesterol levels through a healthy diet.⁴

TARGET CHOLESTEROL LEVELS IN CANADA

The Canadian Cardiovascular Society and other provincial organizations have guidelines around cholesterol levels, but it’s important that clients talk to their doctor about how those guidelines may apply to them.⁸

Target cholesterol levels are set based on a person’s 10-year risk of cardiovascular disease, measured through the modified Framingham Risk Score (FRS).⁹ The FRS is calculated based on a person’s risk factors, including smoking, high blood pressure, blood sugar problems (such as diabetes) and age.⁹

The 10-year risk of cardiovascular disease can be determined by completing this worksheet.⁹

For people with a high or intermediate 10-year risk of cardiovascular disease, the target for LDL-cholesterol is ≤2 mmol/L or a ≥50% decrease in LDL-cholesterol.⁸
For people with a low 10-year risk for cardiovascular disease, an LDL-cholesterol of <2.6 mmol/L is recommended.¹⁰

WHAT ARE THE BENEFITS OF LOWERING LDL-CHOLESTEROL?

LDL-cholesterol is the main cause of atherosclerosis,³ which is a risk factor for heart disease. Studies have consistently shown a 20-22% relative risk reduction for each mmol/L reduction in LDL-cholesterol.⁸ A recent meta-analysis from the American College of Cardiology suggests that “the most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.”¹¹ That includes a healthy diet, with an emphasis on vegetables, fruit and whole grains and lean protein.¹²

FATS AND LDL-CHOLESTEROL

Thinking about cholesterol likely gets your clients thinking about fat. It’s important to remind them that the type of fats they consume also matter.¹²

Myths continue to persist around the impact that fat has on cholesterol – specifically, that all fats lead to high cholesterol. In fact, the type of fat consumed is a more important risk factor to heart disease than the total amount of fat consumed.¹² Science shows that lowering the amount of saturated fat we eat by replacing it with unsaturated fat, without increasing energy levels, reduces both total and LDL-cholesterol levels.¹²

HOW CAN PEOPLE MANAGE CHOLESTEROL THROUGH DIET?

Canada’s Dietary Guidelines recommend more plant-based foods as a basis for healthier living. This can include higher intakes of the following foods, all of which can help lower LDL-cholesterol and/or the risk of cardiovascular disease:¹²

• Dietary fibre
• Vegetables and fruit
• Nuts
• Soy protein

It’s important to remind your clients that dietary changes aren’t a replacement for any prescription medication they may be using to manage their cholesterol levels. They should always discuss any changes to their medication with their doctor first.
Educating your clients about what LDL-cholesterol really is, and why it matters, will help them get one step further towards a healthier way of life.

References

1. Heart and Stroke Foundation. Blood cholesterol. 2019. https://www.heartandstroke.ca/heart/risk-and-prevention/condition-risk-factors/high-cholesterol Sourced Dec 5, 2019.
2. US Department of Agriculture. Dietary guidelines for Americans 2015-2020. Eighth edition. https://health.gov/dietaryguidelines/2015/guidelines/ Sourced Dec 5, 2019.
3. Grundy SM, et al. 2018 Guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2018. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625 Sourced Dec 5, 2019.
4. Sacks FM, et al. Dietary fats and cardiovascular disease - A presidential advisory from the American Heart Association. Circulation 2017;136:e1–e23. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510 Sourced Dec 5, 2019.
5. International Atherosclerosis Society. An International Atherosclerosis Society position paper: global recommendations for the management of dyslipidemia. J Clin Lipidol 2014;8(1):29-60. https://www.ncbi.nlm.nih.gov/pubmed/24528685 Sourced Dec 5, 2019.
6. National Heart, Lung, and Blood Institute (NHLBI). Atherosclerosis. 2018. https://www.nhlbi.nih.gov/health-topics/atherosclerosis Sourced Dec 5, 2019.
7. American Heart Association. Atherosclerosis. 2019. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis Sourced Dec 5, 2019.
8. Anderson TJ, et al. 2016 Canadian Cardiovascular Society (CCS) guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 2016;32:1263e1282. https://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf Sourced Dec 5, 2019.
9. Canadian Cardiovascular Society. Framingham risk score (FRS). 2017. https://ccs.ca/app/uploads/2020/12/FRS_eng_2017_fnl1.pdf Sourced Dec 20, 2021.
10. Healthlink BC. Cholesterol and triglycerides tests. 2017. https://www.healthlinkbc.ca/medical-tests/hw207814 Sourced Dec 5, 2019.
11. Circulation. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. 2019. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 Sourced Jan 23, 2019.
12. Health Canada. Canada’s dietary guidelines for health professionals and policy makers. 2019. https://food-guide.canada.ca/en/healthy-eating-resources/ Sourced Dec 5, 2019.