Congratulations! You have taken the first step to learn how to balance your cholesterol!
Managing your cholesterol is all about balance. It’s about achieving a balance between a healthy diet and physical activity. It’s also about balancing your "good" cholesterol (HDL) and your "bad" cholesterol (LDL), which helps manage your Cholesterol Ratio.
You will learn a lot about your Cholesterol Ratio – and how to improve it - throughout this website.
This website is going to help you with motivation, active living and a proper diet. This is a one-stop resource for all of your cholesterol information.
But first, let’s start with the facts.
What is Cholesterol?
Your body needs cholesterol. What’s important is the kind of cholesterol you have and how much you have.
Cholesterol is a waxy substance that is produced naturally in your body and is important to your health. You use cholesterol in many ways; for example, it is used by your digestive system to digest fat, maintain healthy cell walls, and produce vitamin D.
The level of cholesterol in your blood (and the balance between "good" and "bad" cholesterol) is determined by your genes, how well your liver functions and your diet. The liver manufacturers 80% of the cholesterol in your blood, while only about 15% is as a result of a diet high in fats.
But, too much cholesterol in your body can be unhealthy. When there is too much cholesterol it settles on the inside of your blood vessels. This is called plaque. Over time, this plaque builds up in the blood vessels so that blood can’t flow properly. For many, this causes a condition called atherosclerosis, increasing your chance of having a heart attack or stroke.
Types of Cholesterol
Types of Cholesterol
There are two different types of cholesterol: low density lipoprotein (LDL) and high density lipoprotein (HDL).
A great way to remember the difference between LDL and HDL cholesterol is by thinking of the word LOUSY for LDL and the word HAPPY for HDL.
Low density lipoprotein (LDL)
LDL cholesterol is often called the “bad” cholesterol. Too much LDL in your blood can cause the gradual buildup of cholesterol, called plaque, on the walls of your blood vessels. This type of cholesterol usually comes from foods that have higher amounts of dietary cholesterol or fats. Lowering your LDL is an important goal of cholesterol treatment.
High density lipoprotein (HDL)
HDL cholesterol is often referred to as the “good” cholesterol because its job is to carry the LDL cholesterol away from the blood vessel walls to the liver, where it can be removed from the body. Higher HDL cholesterol levels are good and are thought to protect you from heart disease.
The Cholesterol Ratio
Lowering your LDL cholesterol is critical, but is only part of the story. That’s why the balance between “good” cholesterol and “bad” cholesterol is key. This important factor is called the Cholesterol Ratio and it is among the best predictors of long-term cardiovascular risk. The lower the Ratio, the lower the risk.
The Cholesterol Ratio measures all the total cholesterol in your body (both the HDL and LDL) and divides it by all the HDL in your body. Your doctor can help you do this simple calculation:
Total cholesterol ÷ HDL cholesterol = Cholesterol Ratio
Keeping your Cholesterol Ratio in a healthy range is vital. Regular activity and healthy eating can contribute to your overall plan to achieve a healthy Cholesterol Ratio. If lifestyle changes aren’t enough, you should see your doctor, as there are medications available that can help lower your LDL and Cholesterol Ratio.
Canadian Cholesterol Treatment Guidelines suggest that the higher your risk for heart disease or stroke, the lower your target levels should be for LDL cholesterol and your Cholesterol Ratio. Click here to see if you are at higher risk.
| Your Risk Category | Your 10-year risk of heart attack or death from heart disease | | Recommendations |
|---|---|---|---|
| High | Greater than 20% | AND | Treatment targets: Primary: LDL less than 2.0 Secondary: Cholesterol ratio less than 4.0 |
| Moderate | 10 to 19% | AND | Treat when your LDL is greater than or equal to 3.5 or when your Cholesterol Ratio is greater than or equal to 5.0 |
| Low | Less than 10% | AND | Treat when your LDL is greater than or equal to 5.0 or your Cholesterol Ratio is greater than or equal to 6.0 |
Triglycerides
Triglycerides are fats but, unlike cholesterol, they are a source of energy. Triglyceride levels increase after eating, especially after eating sweet foods like candy or drinking alcohol or soda. The danger with triglycerides is that they can convert to LDL cholesterol in your liver, so you need to be mindful of your triglyceride level as well. Doing more activity, staying away from excess alcohol and improving blood sugar control for diabetics can reduce high triglycerides.
Are You at Risk?
You should ask your doctor to have your LDL and Cholesterol Ratio tested if you:
- Are male and over 40 years of age
- Are female and over 50 years of age
- Are female and post-menopausal
And if you have the following risk factors you should be screened at any age:
- Diabetes mellitus
- Smoking – current or recent smoker (within the last year)
- Hypertension (high blood pressure)
- Abdominal obesity
- Strong family history of premature cardiovascular disease. This includes any first degree relative (for example your mother, sister, father or brother) who was diagnosed with heart disease at a young age – less that 55 years old for men and less than 65 for women
- Evidence of atherosclerosis (early heart disease or stroke)
- Hyperlipidemia (an excess of fats & cholesterol in the blood)
Some people may have other risk factors for heart disease that may warrant earlier testing of their LDL and Cholesterol Ratio levels. If in doubt, it is best to check with your doctor.
What Causes High Cholesterol?
The level of cholesterol in your blood, and the balance between the “good” and “bad” cholesterol, is determined by your genes, how well your liver works (since the liver manufactures 80% of the cholesterol in the blood) and your diet. For most people, eating foods lower in fat helps keep their Cholesterol Ratio at a healthy level.
Treating High Cholesterol
Canadian specialists agree that the first step you need to take in lowering your cholesterol is to make changes to your diet and activity habits. This is not going to be easy, but with the support of the resources available on this website, you are going to be successful!
Lifestyle changes can be difficult. And choosing to eat healthier, low-fat foods can be especially challenging. www.knowyourratio.ca is here to help. After all, this goal is not really any different from any other goal in your life.
Ask yourself:
- Do I expect the good things in life to come easy with no effort?
- Is it my experience that things worth achieving are worth working for?
Virtually everyone agrees that life is challenging, but setting goals and working to achieve them is part of what makes life an exciting adventure. www.knowyourratio.ca is asking you to take on the challenge of improving your Cholesterol Ratio and LDL, as you would take on other worthwhile goals in your life. We probably don’t need to remind you that all major things you have accomplished in your life are a result of your determined hard work - work that leads to satisfaction, dignity and self-esteem.
The first step is to better understand more about the foods that you eat. With the hundreds of foods that you eat most often, the information can get very confusing – calories, fat, saturated fat, fibre and portion sizes – what does it all mean?
Check out the Eating Toward a Better Ratio page for the answers and many more details.
Getting and staying active is also an important part of lowering your Cholesterol Ratio and your LDL. Physical activity can give you more energy, increase your muscle mass, boost your metabolism, decrease stress and help you lose weight!
Don’t worry if all you can manage at first is a short walk. Believe it or not, everyday tasks like housework are all forms of physical activity! Soon you will be able to do much more, and be on your way to a healthier lifestyle. Take it slow and work your way up gradually – the key is to be active and consistent.
When you think of activity, you might think of the body builder in the gym or the lonely marathon runner spending hours on the road. If this is what you would like to be then “go for it.” But you need to know that this is only one form of physical activity. Bottom line, if you want to be an athlete you will need to do some hard activity, but if you want to be healthy all you have to do is move.
Everything and anything counts, build activity in small bits because it all adds up. A slow and gradual change to your behaviour is more likely to last.
Health is a race won by the tortoises not the hares.
Most of all – www.knowyourratio.ca is here to help! Check out the Moving Toward a Better Ratio page for more details.
Medications
Have you followed a diet low in cholesterol and saturated fat and increased your physical activity, but you can’t seem to get your Cholesterol Ratio where it should be? Unfortunately, some factors that affect your Cholesterol Ratio can’t be changed, such as age, gender and family history.
Only your doctor can decide which type of medication is right for you. Cholesterol-lowering medications work to lower your LDL and your Cholesterol Ratio. Along with a healthy and active lifestyle, talk to your doctor about the medications that will best help you reach your LDL and Cholesterol Ratio goals.
The following is a description of medications that your doctor may consider:
Statins
Statins are drugs that help block an enzyme in the liver, telling it to make less cholesterol. This reduced cholesterol production tells your liver to absorb more of the “bad” or LDL cholesterol from your bloodstream, washing the excess from your blood.
Lower LDL levels can lead to lower triglyceride levels and higher HDL or “good” cholesterol. Ask your doctor which statin is most appropriate for you.
Some common side effects of these medications include constipation, heartburn, gas, upset stomach, stomach cramps, diarrhea and headache. Many of these side effects get better if you take the medication with food. As your body gets used to the medication, the side effects may go away. One rare, but potentially serious side effect is muscle pain or damage, which usually starts as pain in the larger muscles of the legs or shoulders. If this happens you should see your physician immediately.
Fibrates
Fibrates, or fibric acids, work by lowering triglyceride levels, which can result in an increase in your levels of HDL or “good” cholesterol.
Some common side effects include skin rashes, upset stomach, vomiting, flatulence (gas), stomach pain, headache, dizziness and muscle pain.
Niacin
Prescription Niaspan, a form of vitamin B, is available by prescription only. It can affect LDL levels, while increasing HDL levels. Niaspan is currently the only niacin approved by Health Canada.
Some common side effects include flushing (redness or a burning or itching sensation), dry skin or a rash, upset stomach, diarrhea and headaches.
Resins
Resins are also known as bile acid sequestrants. Resins work by causing an increase in the amount of bile made by the liver, which leads to less LDL cholesterol circulating in the body.
The most common side effects are stomach or intestinal problems: constipation, abdominal pain or cramping, bloating, flatulence (gas), heartburn, nausea, vomiting and diarrhea.
Cholesterol absorber inhibitors
This type of drug stops your body from storing and absorbing cholesterol in your liver, and helps cholesterol clear from your blood more easily, lowering your total and LDL cholesterol levels.
Some common side effects include headache, diarrhea, dizziness, sore throat, runny nose, sneezing, joint and muscle pain.
You may not be able to “feel” the benefits of the medication you are taking, but that doesn’t mean it’s not working. It is very important to continue taking your medication as directed. If you stop taking your medication, the chance that your cholesterol will rise again is very high. Never stop taking your medication without first talking to your doctor.
Cholesterol's Role in Cardiovascular Disease
What does cardiovascular disease (heart disease) mean? When the veins and arteries in some parts of your body are blocked, your heart has to work extra hard to get blood circulating.
Blood vessels get blocked through a process called atherosclerosis, or “hardening of the arteries”. This happens when there is too much cholesterol in your blood and the only place for it to go is to settle in the lining of your arteries. The cholesterol that settles in the arteries is also called plaque.
When plaque ruptures, it can form a clot capable of blocking one of the coronary arteries. Ninety per cent of heart attacks are caused by blood clots in the coronary arteries.
This is why it is so important to manage your cholesterol. This website will help you with simple tips and help you stay motivated.
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