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Managing cholesterol: the good, the bad and the ugly!


You may think that managing cholesterol often implies health problems, but it is also important to know the good side of cholesterol.  It is a vital building block of cell membranes, hormones and vitamin D.  Without cholesterol, our bodies couldn’t function. Cholesterol is a soft waxy substance, and is one of the lipids (fats) normally found in the blood and in every cell of the body.

Cholesterol is carried through the body by the blood, in tiny cholesterol-protein packets called lipoproteins. The major lipoproteins are:

    • High-density lipoprotein, or HDL cholesterol
  • Low-density lipoprotein, or LDL cholesterol

In our body, the liver makes about 80% of the cholesterol, while the other 20% comes from the foods we eat.

The good …

HDL cholesterol is known as the “good” cholesterol (remember, “H” is for happy!). It helps move LDL cholesterol out of the cells that line the arteries to the bloodstream and back to the liver for excretion from the body.

The bad …

LDL cholesterol is known as the “bad” cholesterol (remember, “L” is for lousy!). While our bodies need normal amounts of LDL cholesterol for cell growth and repair, high LDL cholesterol levels are responsible for the build-up of plaques in the arteries.

The ugly …

Blood glucose levels higher than normal range cause damage to the lining of the blood vessels. In the presence of high levels of LDL cholesterol and/or high blood pressure, plaques start to form inside the blood vessels. When the plaques get too big, they either slow or completely stop the blood flow to the target tissues. If the heart muscle is deprived of blood supply, it results in a heart attack; if the brain tissue is deprived of blood supply, it results in a stroke.

Triglycerides are another type of fat – in fact, they’re the most common form of fat in the body – and are usually measured when cholesterol levels are tested. Although they appear to be associated with an increased risk of heart disease, the exact relationship is not yet known. However, high levels of triglycerides in the blood may increase its tendency to clot. The greater the tendency to clot, the greater the risk of a heart attack or stroke.

How to manage high cholesterol?

Since 20% of cholesterol comes from the foods we eat, healthy eating not only improves cholesterol levels in people with diabetes, it also provides added benefits such as better blood glucose and blood pressure control.

Other changes that can help to keep cholesterol in check are: exercising 150 minutes per week in bouts of 10 minutes or more; achieving and maintaining a healthy body weight and quitting smoking.

When diet and exercise are not enough to reduce cholesterol levels to a healthy range, cholesterol-lowering medications are used to complement healthy eating and exercise.  

Medication types

Statins block an enzyme in the liver that is required to make cholesterol. As a result, the liver makes less cholesterol and starts to remove LDL cholesterol from the bloodstream.

The newer statins (atorvastatin and rosuvastatin) can be taken any time during the day; however, the older statins (fluvastatin, lovastatin, pravastatin and simvastatin) should be taken in the evening, when the liver makes the most cholesterol.

Grapefruit juice is known to slow the elimination of statins from the body, and higher than desirable levels of medication may result. People who take statins should refrain from drinking grapefruit juice or eating grapefruit.

Ezetimibe, a cholesterol absorption inhibitor, works by preventing the body from absorbing and storing cholesterol in the liver; it also improves the way that cholesterol is cleared from the blood.

Resins (cholestyramine) work by binding to bile acid, preventing it from being used during digestion. In response, the liver makes more bile acid; the more it makes, the more LDL cholesterol it removes from the blood circulation.

Fibrates (bezafibrate, fenofibrate and gemfibrozil) break down triglycerides, so they are used to treat very high triglyceride levels.

Niacin works by slowing the liver’s production of the chemicals that help make LDL cholesterol.

If you or the person you support with diabetes take medication to lower cholesterol, it is important that they be taken as prescribed. Lab tests done at regular intervals are the best way to find out whether your medication is working well, without any adverse effects. Partnering with your diabetes healthcare care team and your doctor will ensure that you get the best care possible.  You can use our Cholesterol Tracker to keep a record of your cholesterol levels, which you will find in the Diabetes Self-Management Tools area of this website.

I look forward to receiving your comments in the Medication section of our Community Forums.

About Freda Leung

Freda Leung is a consultant pharmacist who specializes in diabetes and geriatric medication management. She is a Certified Diabetes Educator (CDE), a Certified Geriatric Pharmacist (CGP), a Certified Respiratory Educator (CRE) as well as a graduate from “Teacher of Adults Certificate Program” from Centennial College. Freda is also a faculty member of the Institute for Healthcare Communication; a facilitator to “Choices and Changes - Clinician Influence and Patient Action” and “Brief Action Planning”, programs developed for health care professionals to support self-management in people living with chronic health conditions. Currently she is a clinical pharmacist at The Scarborough Hospital GAIN geriatric clinic. Her other professional activities include: consultation to long term care homes on diabetes management; teaching continuing education programs at The Ontario Pharmacists’ Association and speaking on topics related to diabetes, geriatric medications and health behaviour changes.
Healthy food in heart and water diet concept

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