looking out for bad bad cholestrol

Managing bad cholesterol
Less than half of S'poreans who are at risk keep cholesterol levels in check
Tuesday • September 4, 2007, TODAY
Joanne Yap

It's a silent killer that rarely shows any outward signs and symptoms until it's too late. Bad cholesterol is often the main culprit in many cases of heart attack, but not many Singaporeans know what their cholesterol levels are. This ignorance is a costly oversight that could have dire consequences when a person reaches his or her senior years.

But it's not merely a lack of knowledge that's the problem, but also an indifference to managing one's condition.A local study by Dr Peter Yan (see box) — consultant cardiologist and physician at Gleneagles and Mt Elizabeth medical centres — found that 70 per cent of Singaporeans at risk of developing heart disease are still unable to keep their low-density lipoprotein (LDL), or bad cholesterol levels, in check.

It's a two-tiered problem caused by both the patients' reluctance to increase their dosage of prescribed medication, as well as poor management of lifestyle habits.Dr Yan advises going for regular annual health check-ups to monitor one's cholesterol levels and risk scores, so that when the need arises, early intervention can be put in place before the condition leads to a full-blown heart attack.Ideal LDL-cholesterol levels vary.

The Ministry of Health recommends that for those who fall within the high-risk group — people with cardiovascular disease and diabetes — the figure should be 100mg and below. Those in the intermediate and low-risk groups are advised to maintain their LDL levels at 130mg and 160mg respectively.

Dr Antono Sutandar, consultant cardiologist at Raffles Hospital, explained why LDL-cholesterol is harmful: "LDL is important for normal brain function and the production of hormones, but the amount of LDL required for bodily function is quite low. Most people's LDL levels are generally higher than what their bodies need."About two-thirds of the cholesterol in our body originates from the liver, but the amount it produces is determined by one's genes, which explains why some people have higher levels of cholesterol in the body than others.

Though there's not much one can do to regulate genetics, we can still work on the remaining one-third of the equation — one's diet. Avoid fatty, calorie-laden foods including bacon, sausages, egg yolks, cookies and pastries as these foods raise cholesterol levels. Instead, train your palette to adapt to a diet high in fresh fruits, vegetables, and soluble fibres such as oats, citrus fruits, berries and apples.

"Low-fat" is also a key phrase to keep in mind — add more portions of vegetable protein such as beans and tofu, white-meat poultry and fish to daily meals. But eating the right foods is not the only way to battle bad cholesterol.

Medication such as the use of statins — drugs used to lower cholesterol levels for those at risk of heart disease — are a good second-line defence in combating the problem. According to Dr Sutandar, medication works either by blocking the absorption of cholesterol from the intestines or by blocking the cholesterol-producing enzymes in the liver.The truth about statinsDr Peter Yan's study found that most doctors and patients are reluctant to increase their dosage of statin treatment, for fear of the side effects of the drug on one's liver.

But not everyone is susceptible. "It's an unfounded fear," said Dr Yan. "If side effects develop from the use of statins, these are detectable by a doctor and the patient will be monitored. For patients who do not experience any side effects, they can continue taking the medication for life."

It's also important to supplement medication with an active lifestyle, in order to burn off those extra calories. Early intervention — such as quitting smoking, losing weight and exercising regularly — is most beneficial for those in their 20s, 30s and 40s, as it halts the progress of bad cholesterol and helps cut the risk of heart disease when one reaches one's 50s. Certainly, prevention is better than cure and Dr Yan stressed: "Taking care of our cholesterol levels is equivalent to buying health insurance for the future."