Last week, my esteemed colleagues, Eulalee Thompson and Rosalee Brown, wrote very informative articles about cholesterol. This information, along with the eye-opener on the benefits of consuming coconut oil, from Eulalee's new book, Live Well, have motivated me to inform readers some more about cholesterol.

Eulalee reported that one in every 10 Jamaicans has a high-cholesterol problem. Rosalee told us how obesity, overweight and a diet high in saturated fats and trans fats were associated with high levels of cholesterol in the blood. Most of this waxy substance, cholesterol, is made in the body by our liver but some of it comes from our diet. High cholesterol levels in the blood (hyper-cholesterolaemia) is usually due to eating too much fat. Having plenty of alcohol can lead to high cholesterol levels too.

In a few cases, (about one in 500 persons in England) persons have an inherited abnormality in the way in which the body handles cholesterol, and abnormally large amounts of the stuff are produced.

Beware of 'bad' cholesterol

Abnormal levels of fats including cholesterol, if not controlled, will lead to long-term problems like coronary heart disease (CHD), heart attack and stroke. In fact, it is often stated that the best heart attack prevention plan involves exercising regularly, eating heart-healthy foods and controlling cholesterol. Not all cholesterols increase the risk of heart disease. It is the cholesterol carried by low-density lipoproteins or LDLs (the so-called 'bad' cholesterol), which need to be kept at a minimum for good health. Cholesterol carried by high-density lipoproteins or HDLs (the so-called 'good' cholesterol) lowers the risk of heart disease and is actually beneficial to the body.

Who should get tested?

Having a family history of CHD or high cholesterol, a personal history of heart disease, signs of high cholesterol, or having other heart disease risk factors, are good reasons to get tested with a simple blood test and to be treated, if necessary.

The good news

A good treatment for high cholesterol is to get our lifestyles right by eating a healthy diet, low in cholesterol and saturated fats, controlling our weight, and exercising regularly. In the smoker, high cholesterol presents a greater risk of CHD than in the non-smoker, so quitting has near-immediate benefits.

These treatments alone are not effective in everyone and, in such cases, depending on the presence of other risk factors, cholesterol-lowering medicines are prescribed and added to the lifestyle treatments - an ideal combination. To get the full benefit from the medications, clients are encouraged to stick to the low-fat diet and exercise regimen. In many cases, the lowering of high blood pressure and the use of low-dose aspirin are added strategies to lower the risk of heart attack and stroke.

Drug treatment of hyper-cholesterolaemia

Some of these drugs act on the liver to prevent it from producing cholesterol while other drugs prevent the intestines from absorbing cholesterol into the body. Lipid-regulating drugs are the mainstay of drug treatment in high-cholesterol situations and they increase survival rates. The statins and the fibrates are the two most common types used. Many of these drugs are taken at night, presumably because the body makes slightly more cholesterol between midnight and 5 a.m.

Statins

In this group, we have atorvastatin (Lipitor), cerivastatin (Baycol, Lipobay), fluvastatin (Lescol), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor). Grapefruit and its juice are a no-no for users of statins, since they increase the levels of statins in the blood and increase the risk of side effects.

A rare side effect of statins and fibrates is inflammation of the muscles (myositis) and serious muscle toxicity. A statin or fibrate user, who has unexpected muscle pain, tenderness or weakness should inform their doctor.

Fibrates

These include bezafibrate, ciprofibrate, fenofibrate and gemfibrozil (Lopid), but the latter is most commonly used here. They reduce triglycerides (another type of fat) and increase 'good' or HDL cholesterol levels.

Cholesterol absorption inhibitors

Ezetimibe (Zetia) is relatively new and has achieved much success. On its own, it will lower 'bad' or LDL cholesterol by 10 to 20 per cent but add a statin to that and the cholesterol level is lowered by up to 60 per cent. Drugs which bind bile acids (like colestipol and colestyramine) are other options as are nicotinic acid drugs, but they are rarely used.

More good news

Seniors who are registered under the Jamaica Drugs for the Elderly Programme (JADEP) can get a month's supply of simvastatin or pravastatin on prescription every month for $40. Those under 60 years old, who are registered with the National Health Fund for hyper-cholesterolaemia, will get huge subsidy each month when purchasing any cholesterol-lowering drug available here. All private health insurers also subsidise cholesterol-lowering products.

Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.