High Cholesterol: The Silent Threat to Heart Health
High cholesterol, medically known as hyperlipidemia, is one of the major risk factors for heart disease and stroke—the leading causes of death in the Philippines. Despite its serious health implications, high cholesterol typically causes no symptoms until it leads to a cardiovascular event. Understanding and managing your cholesterol is essential for protecting your heart.
What is Cholesterol?
Cholesterol is a waxy, fat-like substance found in all cells of the body. Your body needs cholesterol to make hormones, vitamin D, and substances that help digest food. The body makes all the cholesterol it needs, but cholesterol is also found in foods from animal sources.
Cholesterol travels through the bloodstream attached to proteins called lipoproteins:
LDL (Low-Density Lipoprotein): Often called "bad" cholesterol, LDL carries cholesterol to the arteries. High LDL leads to plaque buildup in artery walls.
HDL (High-Density Lipoprotein): Often called "good" cholesterol, HDL carries cholesterol away from the arteries to the liver for removal. Higher HDL levels are protective.
Triglycerides: Another type of fat in the blood. High triglycerides combined with high LDL or low HDL increase cardiovascular risk.
Total Cholesterol: The sum of all cholesterol in your blood.
Understanding Your Numbers
Cholesterol levels are measured in milligrams per deciliter (mg/dL):
Total Cholesterol:
- Desirable: Less than 200 mg/dL
- Borderline high: 200-239 mg/dL
- High: 240 mg/dL and above
LDL Cholesterol:
- Optimal: Less than 100 mg/dL
- Near optimal: 100-129 mg/dL
- Borderline high: 130-159 mg/dL
- High: 160-189 mg/dL
- Very high: 190 mg/dL and above
HDL Cholesterol:
- Low (increased risk): Less than 40 mg/dL (men), less than 50 mg/dL (women)
- Desirable: 60 mg/dL and above
Triglycerides:
- Normal: Less than 150 mg/dL
- Borderline high: 150-199 mg/dL
- High: 200-499 mg/dL
- Very high: 500 mg/dL and above
How High Cholesterol Damages Your Body
When there's too much LDL cholesterol in the blood, it can deposit in the walls of arteries, forming plaques (atherosclerosis):
- Plaque Formation: LDL cholesterol, along with calcium and other substances, builds up in arterial walls
- Arterial Narrowing: Plaques grow and narrow the arteries
- Reduced Blood Flow: Less blood reaches vital organs
- Plaque Rupture: Plaques can rupture, triggering blood clots
- Acute Events: Clots can block blood flow completely, causing heart attack or stroke
High Cholesterol in the Philippines
Several factors contribute to the high prevalence of hyperlipidemia among Filipinos:
Dietary Patterns:
- High intake of fried foods (especially during celebrations)
- Love of fatty meats (lechon, crispy pata, chicharon)
- Coconut oil and coconut milk in many dishes (saturated fat)
- Rice and carbohydrate-heavy meals
- Increasing consumption of fast food and processed foods
Lifestyle Factors:
- Sedentary behavior (especially in urban areas)
- Rising obesity rates
- High rates of smoking
- Stress from economic pressures
Healthcare Factors:
- Many don't get regular cholesterol screening
- Uncontrolled diabetes and hypertension worsen lipid profiles
- Limited awareness of the importance of cholesterol management
Risk Factors for High Cholesterol
Factors You Cannot Control:
- Family history (familial hypercholesterolemia)
- Age (risk increases with age)
- Gender (men generally at higher risk; women's risk increases after menopause)
Factors You Can Control:
- Diet
- Weight
- Physical activity level
- Smoking
- Diabetes management
- Alcohol consumption
Treatment: Lowering Your Cholesterol
Lifestyle Modifications (First Line)
Heart-Healthy Diet:
- Reduce saturated fats (fatty meats, full-fat dairy, coconut oil)
- Eliminate trans fats (found in some processed and fried foods)
- Increase omega-3 fatty acids (fatty fish like salmon, mackerel)
- Add soluble fiber (oats, beans, fruits)
- Eat plenty of vegetables and fruits
- Choose lean proteins
- Limit cholesterol-rich foods (organ meats, egg yolks—in moderation)
The Filipino Heart-Healthy Plate:
- Half vegetables and fruits
- Quarter lean protein (fish, chicken without skin, tofu)
- Quarter whole grains (brown rice, whole wheat)
- Cooking methods: steaming, grilling, baking instead of frying
- Limit rice portions
- Use healthier cooking oils (olive oil, canola oil) in moderation
Physical Activity:
- At least 150 minutes of moderate aerobic exercise per week
- Include strength training
- Choose activities you enjoy: walking, swimming, dancing
- Increase daily movement (take stairs, walk more)
Weight Management:
- Losing even 5-10% of body weight improves cholesterol
- Focus on sustainable changes, not quick fixes
Other Lifestyle Changes:
- Quit smoking (raises HDL and improves overall cardiovascular health)
- Limit alcohol (excessive drinking raises triglycerides)
- Manage stress
Medications
When lifestyle changes aren't enough, medications can help:
Statins (Most Commonly Prescribed):
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Lower LDL by 30-50%
- Also reduce inflammation and stabilize plaques
- Generally safe; monitor for muscle pain and liver effects
Ezetimibe (Zetia):
- Blocks cholesterol absorption in the intestine
- Often combined with statins
- Good option for those who can't tolerate high-dose statins
PCSK9 Inhibitors:
- Injectable medications (evolocumab, alirocumab)
- Very effective (can lower LDL by 60%+)
- Used for high-risk patients or those not reaching goals with other treatments
- Expensive, but increasingly available
Fibrates:
- Primarily lower triglycerides
- Modestly increase HDL
- Include fenofibrate and gemfibrozil
Omega-3 Fatty Acids:
- High-dose prescription omega-3s (e.g., icosapent ethyl)
- Lower triglycerides
- Some forms shown to reduce cardiovascular events
Bile Acid Sequestrants:
- Bind bile acids, forcing liver to use cholesterol to make more
- Lower LDL moderately
- Include cholestyramine, colesevelam
Special Considerations
Familial Hypercholesterolemia:
- Genetic condition causing very high LDL from birth
- Requires aggressive treatment, often with multiple medications
- Screen family members if diagnosed
Diabetes and Cholesterol:
- Diabetes often causes high triglycerides and low HDL
- LDL particles become smaller and more dangerous
- Aggressive cholesterol management essential
After a Heart Attack or Stroke:
- Very strict LDL targets (usually below 70 mg/dL)
- Most patients need statin therapy
- Consider additional medications if needed
Living with High Cholesterol
Monitoring:
- Get cholesterol checked regularly (yearly or as advised)
- Track your numbers over time
- Know your cardiovascular risk level
Taking Medications:
- Take as prescribed, even if you feel fine
- Statins are usually taken at night
- Don't stop without consulting your doctor
- Report any side effects
Daily Habits:
- Read food labels for saturated fat and trans fat content
- Plan meals ahead
- Cook at home more often
- Find physical activities you enjoy
- Manage stress
When Eating Out:
- Choose grilled, steamed, or baked dishes
- Ask for dressings and sauces on the side
- Share large portions or take half home
- Skip the fried appetizers
Prevention
Even if your cholesterol is currently normal:
- Maintain a heart-healthy diet
- Stay physically active
- Maintain healthy weight
- Don't smoke
- Get regular check-ups
- Know your family history
The Bottom Line
High cholesterol is a serious condition, but it's highly manageable. Through lifestyle changes and, when needed, medications, you can significantly reduce your risk of heart attack and stroke. Don't wait for symptoms—high cholesterol rarely announces itself until damage is done.
Get your cholesterol checked. Know your numbers. Take action.
"Ang puso mo, alagaan mo." (Take care of your heart.)
