CORONARY HEART DISEASE AND CHOLESTEROL
Taking a statin to reduce the risk of coronary heart disease and stroke - patient decision aid
This decision aid is intended to help you to make up your mind whether or not to take a statin to help reduce your risk of having a heart attack or developing angina (together called coronary heart disease or CHD), or of having a stroke. Your decision depends on several things that this information will help to explain. Different people will feel that some of these things are more important to them than others, so it is important that you make a decision that is right for you.
To download the patient decision aid, please click on this link.
Cholesterol is a fatty substance which is made in the liver. It’s found in some foods too.
Cholesterol plays a vital role in how your body works. There is cholesterol in every cell in your body, and it's especially important in your brain, nerves and skin.
Cholesterol has three main jobs:
- It’s part of the outer layer, or membrane, of all your body’s cells
- It’s used to make vitamin D and steroid hormones which keep your bones, teeth and muscles healthy
- It’s used to make bile, which helps to digest the fats you eat
Some of our cholesterol comes from the food we eat, but most (about 80%) is made in the liver in a complex 37-step process. Cholesterol and another type of blood fat called triglycerides cannot circulate loosel in the blood, so the liver packages them into "parcels" called lipoproteins. The lipoproteins are then released into the blood and carried around the body to wherever they're needed.
Once in the blood stream, some cholesterol will be returned to the liver and broken down. It’s used to make bile acids which are released into the intestines to help with digestion– bile acids break down the fats in food. A small amount of bile acids will be removed from the body as a waste product in your poo. But most will be absorbed back into the blood, returned to the liver and used again for digestion.
Some treatments for high cholesterol work by stopping bile from being absorbed back into the blood. The liver has to take more cholesterol out of the blood to make more bile, lowering your cholesterol levels.
What are the different types of cholesterol?
Cholesterol is a type of blood fat, and blood fats are known as lipids. Cholesterol and other lipids are carried in the blood attached to proteins, forming tiny spheres, or "parcels" known as lipoproteins. So, lipoproteins are lipids plus proteins.
There are two main types of lipoproteins
When people talk about the different types of cholesterol, they’re usually talking about these lipoproteins:
- LDL cholesterol (low density lipoprotein)
This is often called bad cholesterol, because too much in the blood can lead to health problems. These lipoproteins contain lots of cholesterol. Their job is to deliver cholesterol to the cells where it’s needed. But if there’s too much LDL cholesterol in your blood it can build up in the arteries, clogging them up.
- HDL cholesterol (high density lipoprotein)
This is often called good cholesterol because it helps prevent disease. They contain lots of protein, and very little cholesterol. HDL cholesterol's job is to carry cholesterol away from the cells, back to the liver, where it can be broken down and removed from the body.
There are other types of lipoproteins too
- VLDL (very low density lipoproteins)
These are larger. They carry triglycerides plus some cholesterol from the liver around your body. They contain lots of fat and very little protein. If there is too much VLDL in your blood, fat can be laid down in your artery walls, clogging them up.
- IDL (Intermediate density lipoproteins)
These lipoproteins also carry cholesterol and triglycerides. They are in fact VLDL lipoproteins – after some of the triglycerides have been taken out of them. They sit between VLDL and LDL cholesterol in terms of how much fat they carry.
These are the largest lipoprotein. They carry triglycerides from the gut to the liver after a meal. They are broken down in the liver and the fats are repackaged into the other lipoproteins.
We all need some cholesterol in our bodies, but having too much can clog up your arteries and lead to health problems in the future including heart attacks and strokes.