Cholesterol and Primary Prevention

I’ve suddenly developed a new interest in cholesterol.
Not particularly because of a new academic research paper or anything.
Just that I’ve discovered what mine is. And it’s a little high. 8.2 if you are interested.
We are all being told now that our cholesterol needs to below 5, but that’s not really the whole story.
HDL levels are very important too.
Remember, we aren’t actually too excited about the cholesterol itself: it’s the implications of a high cholesterol that are really important. For example having a heart attack or a stroke.
Predicting the risk of that happening depends on several factors- cholesterol is one, but the amount of that cholesterol that is of the HDL type is very important too.
It is the proportion of the Total Cholesterol that is HDL which is most strongly statistically associated with risk of stroke. (TC/HDL). A low ratio is good regardless of the total level of cholesterol. 3 or 4 is good.

Adding in TC/HDL to your blood pressure, age, whether you smoke of have diabetes and so on can be used to come up with an estimated risk to the individual of developing heart disease or stroke over a 10 year period. In this country we have been using an American equation to do this for years, but we now have our very own English equation. See www.qintervention.org to have a look. This is good because it also shows some “what if?” scenarios… such as  “what if I were to stop smoking?”
I plumbed all my figures in to this website, including my Cholesterol at 8.2, HDL at 1.5 (ratio 5.46), BMI of 30.5, Systolic BP of 116 and got a 10 year risk of 2%.
So even with a cholesterol a bit high and being just a little tubby, my risk is actually ever so slightly lower than average for my age.
Phew.
BUT, my risk of developing Type2 diabetes looks a little high. So perhaps I’d better lose a little weight anyway

Questions.
Should I go on a statin?
Will losing weight help my cholesterol?
What can I eat to improve my cholesterol?

Well, I don’t feel the need to rush onto simvastatin. In prevention of heart disease and strokes etc in healthy individuals the benefits are hardly measurable for men, and arguably not there at all for women. We do discuss their use once someone seems to have a risk in the order of 20-30% over 10 years.

Losing weight should lower my cholesterol, but it seems that what you eat can have a strong effect too.
Walnuts and almonds, soluble fibre, olive oil, plant stanols; and of course cutting down on animal fats.
(Apparently Pasties aren't good. Damn!)
Drinking just a little alcohol might boost my HDL cholesterol.

So all in all I come out quite encouraged. I know I’m going to die anyway one day, but the risk doesn’t seem imminent. I shall try to eat appropriately and lose a little weight. Perhaps just a beer or two on a Friday night as well.

The Government has started a bit of an agenda with GPs to start looking at this area of primary prevention of heart disease and stroke. We are being asked to use our computer records to estimate which of our patients who appear healthy might actually be statistically at increased risk. Once we have found them though, what to do with them? We do appreciate that every individual patient will have a different response to being told they might be at high risk. Probably then we’ll end up writing to you if you might be at high risk and leave it to you to decide whether to come in and discuss it further or not.