Are statins the answer to heart disease? PART 1

This is a 2 part post…….

I have  just about emerged alive from a month-long marking marathon, hence my absence from the blogosphere.  I am glad to be back writing again so have plumped for what’s in the news this week – another statin scare.  I was on the radio last month (when there was a previous panic about statins) talking about some misleading figures that suggested side effects were more common than previously calculated. In fact these figures were withdrawn and the statement retracted  but the damage had already been done. People that were on statins became very wary about taking them and the worry then was they would stop taking them.

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So I thought it might help to explain what all this most recent  fuss is about – should you believe what you read about these statins? Should you be worried? Should you do anything?  Or perhaps you have no idea what everyone is going on about, you have no idea what statins do and don’t understand what this cholesterol stuff is anyway so you are just going to bury your head in the sand and ignore it all. Either way, I am hoping I can shed some light on the situation.

Today’s post is part 1 – all about cholesterol. If we get what cholesterol does in the body, we can better understand why we need to eating more healthily to be more healthy, understand what exactly we should and should not be eating. And if you want to know about statins, I will explain all tomorrow…………why people take them, what they do and what the current advice is.  I must add here however, that if you are on statins, you keep taking them.

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So let’s set the scene; people take statins to help lower their cholesterol levels in the body.  We shouldn’t consume too much saturated fat or cholesterol in our diet as it increases the risk of developing cardiovascular disease. This means we could be more likely to develop coronary artery disease (where the vessels or the heart get blocked by fatty deposits) angina (chest pain caused by the coronary artery disease), have a heart attack (where the blood supply to the heart is blocked) or stroke (blood supply to the brain is blocked). So basically, statins can help lower the risk of disease by lowering your cholesterol levels.  I’ll come back to these tomorrow so let’s get to grips with cholesterol.

What is cholesterol and where does it come from?

Cholesterol is a fatty substance, that if you held in your hand, would be very much like the very fine waxy scrapings of a candle. Too much of it affects how blood flows through the body and is certainly harmful towards our health.

Cholesterol comes from food and this is known as dietary cholesterol.  Foods quite high in dietary cholesterol include kidneys, eggs and prawns.  You might be surprised however, to hear that dietary cholesterol is not the culprit when it comes to cardiovascular disease. Saturated fat is.  The cholesterol found in food has much less of an effect on the level of cholesterol in your blood than the amount of saturated fat that you eat.

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Eating foods that are high in saturated fat can raise  levels of ‘bad’ cholesterol in the blood.

Foods high in saturated fat include:

  • meat pies, sausage rolls etc.
  • sausages, fatty bacon
  • fatty cuts of red meat and chicken skin!
  • butter, lard and ghee
  • cream, ice cream and other desserts
  • hard cheeses
  • cakes, pastries and biscuits
  • foods containing coconut or palm oil (used in South Asian and African cooking)

What happens to this saturated fat when we eat it?

Saturated fat, along with all the other types of fat from our diet gets broken down, absorbed and ultimately enters the bloodstream. On this journey, these fats get taken to the liver for processing and ultimately travel to various destinations around the body.  It is the saturated fat that increases the amount of cholesterol circulating in the blood, which can potentially reach harmful and dangerous levels.

Cholesterol flows through the bloodstream, but this is not a simple process. Because lipids are oil-based and blood is water-based, they don’t mix. As a result, we have to transport cholesterol attached to a carrier. A bit like a taxi, these carriers pick  the cholesterol up and drop it off somewhere else in the body.

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So there are two types of taxi:

  1. one taxi travels from the liver to the body cells and tissues, whilst the other taxi travels in the reverse direction:
  2. one taxi travels from the body cells back to the liver.

So lets start with the first one – this taxi is called LDL, or Low Density Lipoprotein -funnily enough this is made of lipid (fat), hence the lipo bit combined with protein. It’s job is to pick up cholesterol from the liver and take it to the cells in the body that need it. The problem with this is that this taxi tends to deposit cholesterol in the blood vessels of the body.  Now this is not good – a build up of cholesterol in the blood vessel walls can block them, preventing blood and oxygen form reaching important cells (i.e. in the heart or brain). This is why we call LDL ‘bad’ cholesterol.

The other taxi is called HDL, or High Density Lipoprotein. This guy scavenges cholesterol, picking it up from the cells and tissues and taking it back to the liver.  The liver’s job is to get rid of this cholesterol – this is the only route by which we can eliminate harmful cholesterol from the body so HDL is very important to us.  This is why we call it ‘good’ cholesterol.

So cholesterol is not all bad news then?

Cholesterol does get a bad press.  It’s the villain and we need to get shot of it.  Well yes and no.Yes, LDL (bad) cholesterol is one of the main contributors to the high levels of heart disease we have in our society today but cholesterol is not all bad news – we need some in our body for important functions!

We use cholesterol to make cells, hormones like testosterone and oestrogen and to make Vitamin D in the body.  We also need cholesterol to make substances called bile acids that help us digest fats in the gut.  What we don’t need is too much cholesterol and we certainly don’t want too much of the bad stuff.

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Because we have a need for cholesterol we have an ability to make it ourselves in the liver. Now that’s fine if we don’t go overboard and top up these levels unnecessarily (through eating fatty foods, specifically foods rich in saturated fat). The problem we have these days is that many of us rely heavily on processed, convenience foods which are ‘naturally’ rich in saturated fat.  It’s the processed food that is the villain in this story.  Basically, eating too much crap is what is raising our blood cholesterol levels beyond manageable levels and more specifically increasing the bad (LDL) cholesterol. This is also the reason why statins can be helpful in more quickly lowering cholesterol to safer levels.

Now there is another issue here – it is true that some of us will be genetically programmed to have a high cholesterol level, no matter how healthy our diet is. This is a condition called familial hypercholesterolaemia – try saying that without your false teeth in. It’s much easier to say FH isn’t it?!

It is also important to note that smoking, being overweight, being inactive, having diabetes  or high blood pressure or simply getting older are all associated with high cholesterol levels.

Next I will be explaining what we can do to improve our cholesterol levels; how we can lower the levels of LDL and increase the HDL through diet and lifestyle changes, but also examining the role of statin medication…………..please click here to read it.

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