High Cholesterol

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High cholesterol is a condition where there's an excess of cholesterol in the blood. 

Cholesterol is a waxy, fat-like substance that is essential for building cells, but too much of it can lead to plaque formation in the arteries, restricting blood flow and increasing the risk of heart disease and stroke.

High cholesterol can be caused by various factors, including:

• Poor diet, particularly high in saturated and trans fats
• Lack of physical activity
• Obesity
• Smoking
• Genetics
• Age
• Certain medical conditions like diabetes, kidney disease, or hypothyroidism

High cholesterol itself does not usually cause noticeable symptoms. It's often diagnosed through blood tests during a routine check-up. However, over time, high cholesterol levels can lead to atherosclerosis, leading to symptoms such as:

• Chest pain
• Shortness of breath
• Pain while walking (due to blocked arteries in the legs)
• Stroke or transient ischemic attacks

In Australia and around the world:

• Statins: Atorvastatin, Simvastatin, Rosuvastatin
• Cholesterol absorption inhibitors: Ezetimibe
• Fibrates: Fenofibrate
• Bile acid sequestrants: Cholestyramine

• Statins: Muscle pain, liver damage, increased blood sugar, neurological side effects
• Cholesterol absorption inhibitors: Stomach pain, fatigue, upper respiratory infections
• Fibrates: Nausea, diarrhea, gallstones
• Bile acid sequestrants: Constipation, bloating, nausea, increased triglycerides

Globally, it's estimated that nearly 40% of adults have high cholesterol. 

In Australia, around 33% of adults have cholesterol levels that are considered to be high, which corresponds to approximately 6 million people.

• Dietary Changes: Adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can significantly reduce cholesterol levels. Reducing saturated fats found in red meat and full-fat dairy products is especially effective.
  
• Exercise: Regular physical activity can raise HDL cholesterol and reduce LDL cholesterol. Activities like walking, jogging, cycling, and swimming are beneficial.
  
• Weight Management: Losing excess weight has been shown to lower overall cholesterol levels.
  
• Herbal Supplements: Some supplements, such as garlic, psyllium husk, and red yeast rice, may have cholesterol-lowering effects. However, these should be used with caution and under the supervision of a healthcare provider as they can interact with other medications.
  
• Stress Reduction: Techniques like mindfulness, meditation, and deep breathing can support overall heart health, though their direct impact on cholesterol may be less pronounced.
  
• Quitting Smoking: Stopping smoking can improve your overall cholesterol profile and heart health.
  
• Omega-3 Fatty Acids: Consuming omega-3 fatty acids, found in fatty fish like salmon, can lower triglycerides and promote heart health.
  

De-prescribing refers to the systematic process of reducing or eliminating unnecessary medications, with a focus on minimizing the use of medications that may not be beneficial or may even be harmful. In the case of high cholesterol, de-prescribing may be considered for certain individuals, especially in the context of lifestyle modifications and a holistic approach to health. Here's a summary of the evidence:

1. De-prescribing Statins in Older Adults: Some research has focused on de-prescribing statins in older populations where the risk-benefit balance may differ. A careful assessment of individual risk factors and preferences can guide this decision.
   
2. Individualized Approaches to De-prescribing: Tailoring de-prescribing to individual patients, considering factors like age, overall health, lifestyle, and patient preferences, has shown success in safely reducing medication burden.
   
3. Integrating Lifestyle Interventions with De-prescribing: Research has found that integrating lifestyle interventions such as dietary modifications, exercise, and weight management can support de-prescribing efforts.