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Lifestyle modification essential to managing cholesterol


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Cholesterol is an essential substance in the human system. Of two types, it is important to have the knowledge to balance both. In this interview with GERALDINE AKUTU, Dr. Akinsanya Olusegun-Joseph, a Consultant Cardiologist at the Lagos University Teaching Hospital (LUTH) enlightens on cholesterol, how to balance and manage it.

What is Cholesterol?

Cholestrol is a wax-like, fatty substance that the body needs for normal function.


It is a sterol (a modified steroid) biosynthesized by all animal cells.  

It is manufactured by the body but can also be ingested through animal derived food.

It is essential for existence because it is an important structural component of all animal cell membranes, vital in maintaining membrane structural integrity.

Cholesterol is transported in the body via lipoproteins, since they are mainly water insoluble.

Lipoproteins and Triglycerides

Lipoproteins are simply complexes of lipid and protein involved in the transport of lipids in the blood to the tissues.

They are classified according to their density: high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL).

Triglycerides is a combination of glycerol ester and three fatty acid molecules (tri glyceride).

Triglycerides are the fats in the food we eat that are carried in the blood. Examples include butter, margarines and oils in our food.


What are the good and bad cholesterol?

Low density lipoprotein (LDL) transports cholesterol from the liver to the tissues.

It is highly linked with formation of atherosclerotic plaques, following oxidation (a chemical modification) which will eventually result in formation of fatty streaks in the arteries that can progressively increase and cause heart attacks, strokes, peripheral artery diseases, thus the name bad cholesterol.

Oxidized LDL is also a substrate for chronic inflammation, systemic autoimmune disease, liver disease (Non-alcoholic fatty liver disease) as well as chronic kidney disease.

In contrast, high density lipoprotein (HDL) is called good cholesterol because it helps to transport fat molecules from the tissues, arterial walls back mainly to the liver to be excreted (reverse cholesterol transport).

A portion of the cholesterol carried by HDL is transported to the adrenal gland, ovaries, and testes from which steroid hormones are formed.

Also, there is overwhelming evidence that HDL prevents, halt progression as well as reverses atherosclerosis.

Furthermore, HDL particles have anti-oxidant and anti-inflammatory properties.


They can also help to prevent blood clot formation, as well as improve immunity.

The higher the level of total cholesterol (>200mg/dl), LDL (>100mg/dl) in the blood the more at risk of developing heart attack, while the reverse is true for HDL (HDL <40mg/dl increases the risk of heart attack). The cut off for total cholesterol and LDL depends on the cardiovascular risk score or classification of patients. High Triglyceride (>200mg/dl) has also been implicated in heart attack, stroke and renal disease.

What are the factors associated with cholesterol levels?

Hypertension, diabetes, obesity, smoking and sedentary lifestyle are associated with high LDL and low HDL.

Some people also have familial hypercholesterolemia or triglyceridemia (genetic defect resulting in very high cholesterol and / or Triglyceride in family members).


On the other hand exercise, intake of fruits, nuts, cereals are all beneficial in that they contribute to the decrease of LDL and increase of HDL.

Treatment options for lowering LDL

Treatment option can be both non-pharmacological and pharmacological.

Non-pharmacological- this is basically lifestyle modification and includes regular exercise, at least 30 minutes per day, at least five days a week; or making sure one takes at least 10,000 steps every day.

Others include smoking cessation, weight reduction measures.

Reducing intake of processed food and snacks, which are often very high in salt and saturated fat.

Also reducing intake of red meat, replacing with fish, white meat like chicken and Turkey, but remove the skin.


Increase intake of fruits, nuts, cereals, and vegetables as mentioned earlier.

Pharmacological- these are drugs that the doctor will prescribe.

There are several types, but it is advised that those who need such drugs should get the prescription from their doctors.

Self-medication is discouraged totally.

Also, treatment of associated cardiovascular illnesses like hypertension and diabetes will help the patient overall.

How often should people check cholesterol levels?

Cholesterol levels should be checked, at least, once a year for those who are 40 years and above.

For those who have other cardiovascular risk factors and high cholesterol levels, it should be re-checked four to six months after commencement of cholesterol lowering drug.

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