Controlling your cholesterol

People with diabetes are at higher risk of developing macrovascular (large blood vessel) problems than people who do not have diabetes. As a result the risk of developing heart attacks and strokes are also higher in people with diabetes than the general population.

To minimise the risk of developing macrovascular disease there are 3 main areas that need to be well controlled, these are:

  1. Your blood glucose levels, as high BGLs can damage the vessels which increase the risk of plaque formation and hence increase the risk of blockages
  2. Your blood pressure, as high blood pressure puts more strain on the heart and blood vessels
  3. Your cholesterol levels

When your doctor organises to check your cholesterol or “lipid profile” the following checks are done: total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol.

HDL cholesterol, or High-Density Lipoprotein, is often called the “good” cholesterol as higher levels of this type of fat in the blood stream seems to protect against cardiovascular disease.

LDL cholesterol, or Low-Density Lipoprotein, is also nicknamed the “bad” cholesterol, as high levels of LDL can clog arteries and increase the risk of heart attacks and strokes.

Triglycerides are another important measure of your heart health.  They are a type of fat found in your blood as a result of the body converting unused calories, particularly those from carbohydrates and fats, into a separate type of fat that can more easily be stored.  High triglyceride levels can be an indicator of poorly controlled diabetes and can lead to hardening of arteries (or atherosclerosis, which increases the risk of stroke and heart disease), and can cause acute pancreatitis (inflammation of the pancreas).

To improve cholesterol levels it is important to eat “heart-healthy” foods.  This means

  1. Reducing your intake of saturated fats (which can be found primarily in red meat, processed meat, fried foods and take-away, cakes, biscuits and full-fat dairy products)
  2. Eating foods rich in omega-3 fatty acids (by eating fish and other seafood, especially cold-water fatty fish such as salmon, and by including nuts and seeds in your diet) and
  3. Increasing your intake of soluble fibre (by eating foods such as beans, oat bran and Brussels sprouts).

To improve your cholesterol it is also important to increase your physical activity.  Moderate physical activity (such as walking, riding a bike, and swimming) can help raise the HDL cholesterol.  It is recommend to work up to at least 150 minutes per week (this is equivalent to 30 minutes 5 days per week).

Other things to consider to improve your cholesterol levels are to quit smoking, lose weight if you are overweight, and to reduce your alcohol intake to just 2 standard drinks per day with at least 2 alcohol free days per week.

Medications for cholesterol

However, despite your best efforts, sometimes lifestyle changes alone are not enough to get your cholesterol levels to target. If this is the case your doctor may prescribe a cholesterol lowering medication.  It is important to take your medication as prescribed and to continue your healthy lifestyle changes, as these can help to keep the dosage lower.

The main group of cholesterol lowering medications is known as Statins and include medications such as Crestor, Lipitor, Pravachol and Zocor.  They work by blocking a substance that your body requires to make cholesterol and they help your body to reabsorb cholesterol that has built up in your arteries.  If you are at very high risk of developing macrovascular disease, or if you have had a heart attack in the past, your doctor may prescribe a statin even if your cholesterol levels are to target.

Statins are usually well tolerated, but may have side-effects.  The most common side-effects include: headaches, nausea, and muscle or joint pains.  If you develop side-effects when taking any type of medication it is always important to talk to your doctor.  You should not take statins if you are pregnant or breast feeding.

Another group of cholesterol medications is known as the Fibrates and include medications such as gemfibrozil or Lopid and fenofibrate or Lipidil. Fibrates lower triglyceride levels in 2 ways: by reducing the production of triglycerides in the liver and by increasing the rate at which they are removed from the blood stream.  Recent research has shown that fenofibrates are effective in slowing the progression of diabetic retinopathy (eye disease) and therefore are sometimes prescribed to people with normal triglyceride levels.

Know your numbers

Knowing your cholesterol numbers will help you to know if you are on track.  For most people with diabetes it is recommended to aim for the following numbers:

Total Cholesterol < 4.0 mmol/L

Triglycerides < 2.0 mmol/L

HDL > 1.0 mmol/L

LDL < 2.0 mmol/L

However, please talk to your doctor or healthcare professional to find out what numbers you personally should aim for.

For more information on cholesterol check out the NDSS website here or visit the Heart Foundation website at www.heartfoundation.org.au.

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