What is Cholesterol?

Over time, plaques and blockages can form in our blood vessels. This is a process known as “atherosclerosis.” Many factors can make atherosclerosis worse, such as smoking, high blood pressure, and diabetes. Cholesterol is another factor.

The following video shows the process of atherosclerosis and how the plaques build up inside the blood vessels, until they finally block off blood flow resulting in a heart attack or stroke. 

WHAT IS “CARDIOVASCULAR RISK”?

A persons "cardiovascular risk" is a persons risk of having a heart attack or stroke in the next 10 years. There are many factors that determine a persons cardiovascular risk, such as age, sex, smoking history, blood pressure, family history, AND cholesterol levels.

A Framingham risk score is a tool we can use to determine your cardiovascular risk. We use this tool to calculate and categorize patients as low, medium or high risk of having a heart attack or stroke in the next 10 years.

LOW RISK = less than 10% risk

MEDIUM RISK = between 10% to 20% risk

HIGH RISK = more than 20% risk

Depending on the patients risk category, different prevention and treatment options may recommended.

CHOLESTEROL PILLS (“STATINS”):

When recommending ways to reduce a person’s cardiovascular risk, it is important to address ALL relevant risk factors. For example, if a person smokes, he/she should try to quit smoking. If a person has high blood pressure, he/she should try to improve it. Whether or not to be on a cholesterol pill is just one of many factors. However, this section is only going to focus on the topic of cholesterol. Furthermore, there are different types of cholesterol pills, but this section is only going to focus on the main type, called “statins“.

KEY POINTS:

• Even though statins reduce a person’s “bad cholesterol” (LDL) levels, that may not be the actual reason they reduce a person’s cardiovascular risk.

• Studies are showing that statins seem to have an “anti-inflammatory” effect that protects our blood vessels, regardless of how high or low a person’s cholesterol level is. Even a person with traditionally “low” cholesterol may still be protected by taking a statin.

• We should think of statins as “heart protecter pills”, rather than “cholesterol pills”.

• With this in mind, a statin is recommended based on a person’s overall cardiovascular risk, rather than just the cholesterol level. (As shown above, a person’s cholesterol level is one factor that determines a person’s cardiovascular risk, but it is not the whole story).

Regardless of a person’s cholesterol level, the following is recommended for heart and stroke prevention:

• LOW risk –> a statin is not recommended

• MEDIUM risk –> medium dose statin

• HIGH risk –> high dose statin

SECONDARY PREVENTION:

Reducing a person’s risk of having a heart attack or stroke. This is known as “Primary Prevention.” Primary prevention we want to reduce the person’s chance of having a heart attack or stroke in the first place.

But what if a person has already had a heart attack or stroke? In this case, the person is automatically deemed “High Risk.” For these patients, we are talking about “Secondary Prevention”. We want to prevent patients from having another.

Studies are very clear that for Secondary Prevention, all of these patients are “High Risk” and should be on a high dose statin.

Dyslipidemia Diet - If you have high cholesterol, the dyslipidemia diet guideline should be followed to help improve cholesterol levels. Please refer to the guideline below.