Eight myths about cholesterol busted by a cardiologist

 There’s a good reason why high cholesterol is known as a “silent killer”. In most cases it has no symptoms but potentially fatal repercussions if left unchecked. And while some people are at risk due to questionable dietary and lifestyle choices, for others it may simply be a case of drawing the short straw in the genetic lottery.

Dr Oliver Guttmann is a consultant cardiologist at The Wellington Hospital (part of HCA Healthcare UK). When he tells people they have high cholesterol, he gets a range of reactions. “Sometimes patients know they live unhealthy lives,” he explains. “But often there will be a very fit, slim, healthy-looking person sitting in front of me, and when I tell them they’ve got massively elevated LDLs [‘bad’ cholesterol], they’re really shocked.”

Believing that being slim means you are not at risk is just one of many cholesterol-related misconceptions. Either through lack of information or misinformation, certain myths around the topic have taken root. However, given that cardiovascular disease is the leading cause of death and disability in the UK, killing about 170,000 people each year, it is vital to be armed with the facts.

Myth one: If your total cholesterol is fine, then you’re fine

Total cholesterol is the overall amount of cholesterol in your blood, both good and bad. High levels of “good” HDL cholesterol are protective, while high levels of “bad” LDL cholesterol increase your risk of heart attack and stroke.

When you have a cholesterol test, you should be given a range of results that include your total cholesterol (TC), HDL cholesterol, non-HDL cholesterol (the sum of all the “bad” cholesterol), LDL cholesterol, and triglycerides (another type of “bad” cholesterol).

“Total cholesterol is helpful,” says Dr Guttmann, “but what’s really important is the breakdown of the different types of cholesterol – especially LDLs, which are the main contributor to plaque in your coronary arteries.

“With all of these different types, we look first at how much of each you have but also at the ratio between them. For example, your total cholesterol might be normal but if your LDLs are really high and your HDLs are low, that’s a cause for concern.

“Another thing to consider is triglycerides.” The ratio between triglycerides and HDLs is also an indicator for heart health and underlying metabolic dysfunction.

Myth two: I’m slim so I won’t have high cholesterol

“Just because you’re slim or you go to the gym regularly, it doesn’t mean your cholesterol levels are good,” says Dr Guttmann. “Cholesterol is also influenced by how the liver works, the type of food you eat and your family history. It’s a combination of nature and nurture.”

As Dr Guttmann points out, you may stay slim by controlling your calorie intake, but if the food you’re eating is full of saturated fats, this will raise your LDL level. “Some people exercise every day,” he says, “but they eat unhealthy things like takeaways, fried foods, cheese, pastries, butter and processed meats. To begin with, when people have high cholesterol, there are no symptoms: they can look great but have very high ‘bad’ cholesterol for many years. That’s why it’s useful to have it checked regularly.”

Myth three: I had my cholesterol checked a few years ago, so I’m fine

Factors like menopause, changes in diet and lifestyle, and simply getting older can all affect your cholesterol levels, so it’s important not to be complacent.

“We learn more about cholesterol every day and that changes the way [doctors] react to it,” says Dr Guttmann. “In the past, we would start people on statins if their risk score was above 20 per cent. Now the guideline is 10 per cent, because we know how important it is to be more aggressive with treatment.”

For women, in particular, hormonal changes in middle age can affect cholesterol levels. LDL levels, for example, rise by 23 per cent post-menopause. “If you look at the statistics, women have heart attacks later in life than men,” says Dr Guttmann. “They’re protected, before that, by their hormones. But when your hormones start to change during menopause, a lot of things change, and one of them is your lipid profile and your risk of heart attack and stroke.”

Myth four: I’m healthy and in my 30s so I won’t have high cholesterol

Familial cholesterolemia, also known as familial hypercholesterolemia, is an inherited genetic disorder that causes extremely high levels of LDL cholesterol from birth. About one in 250 to one in 500 people has this condition, yet fewer than one in 10 of the people with familial hypercholesterolaemia in the UK is currently identified.

It is therefore crucial for anyone with a family history of heart disease to get their cholesterol checked early in life. “It doesn’t mean they’ll immediately be put on statins,” reassures Dr Guttmann. “But if an individual’s father had a heart attack when he was 45, and that individual is now 25 and their cholesterol is high, they need to exercise, monitor their diet, and generally make sure they look after themselves.”

Unfortunately, people with familial hypercholesterolaemia do sometimes have heart attacks early in life, as Dr Guttmann confirms. “Just this weekend I treated a 36-year-old woman who had suffered a heart attack,” he says. “Her mother had a heart bypass when she was 36. In cases like this, although there’s often an element of diet and lifestyle involved, family history is the key factor.”