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Cholesterol is a waxy, fat-like substance that is found in blood and most cells of the body, especially in the nervous system.

  • The brain is the most cholesterol rich organ.

  • Your body needs cholesterol to make *hormones, *vitamin D and *substances that help you digest food.

  • Cholesterol cannot dissolve in the bloodstream but needs to be carried through the body.

  • It travels through your body in small packages called lipoproteins.

  • 2 kinds of lipoproteins carry cholesterol throughout your body: 

  • low density lipoproteins(LDL) and

  • high density lipoproteins (HDL).


*LDL – bad cholesterol – high levels of LDL leads to a build-up of cholesterol in the arteries=atherosclerosis=coronary artery disease.

*HDL – good cholesterol – carries cholesterol from other parts of the body back to the liver.  Your liver removes cholesterol from your body.


Normal Cholesterol:  3,6 – 7,8 mmol/l

*** Framingham score: This is used to calculate your risk of getting a heart attack and it takes in consideration your age, gender, co-morbidities and risk factors, etc.  According to your score medical aids will decide if they will reimburse cholesterol therapy or not.

Total Cholesterol blood test consists of:

  • LDL

  • HDL

  • Triglycerides



  • Hereditary factors are the most common cause.

  • A diet high in saturated fat and cholesterol.

  • Other disorders, such as diabetes mellitus, kidney disease, and hypothyroidism.

  • Certain drugs, such as oestrogen, corticosteroids, retinoids, protease inhibitors, thiazide diuretics, and beta-blockers.

  • Obesity.

  • Chronic, excessive alcohol use.

  • Smoking and not exercising.

  • Steroid uses, alcoholism, hypothyroidism, oral contraceptives, chronic renal failure, hypopituitarism and nephritic syndrome are other contributors to hyperlipidemia.



 **Cholesterol is seen as “the silent killer” because there are no symptoms – only complications.


  • Coronary Heart Disease or atherosclerosis at other sites, symptoms may include chest pain (angina), heart attack, or stroke.

  • Hyperlipidemia itself does not produce symptoms. When levels are exceedingly high, cholesterol may be deposited (xanthomas) in tendons or just beneath the skin under the eyes. Very high triglyceride levels may result in the formation of nodules on the elbows or knees, or the appearance of multiple, pimple-sized, yellowish skin eruptions.

  • The skin deposits fats or xanthomas.

  • Swelling of organs such as the liver, spleen, or pancreas (pancreatitis).

  • Blockage of blood vessels in brain and heart.



  • Having type 2 diabetes can raise your risk, as it reduces high density lipoprotein (HDL or ’good’) cholesterol and increases low density lipoproteins (LDL or “bad”) cholesterol. [7]

  • Being overweight or obese has been linked to high levels of triglyceride, LDL cholesterol and low levels of HDL cholesterol. [7]

  • Having a diet that consist mostly of saturated fats such as cheese, red meat, butter, ice-cream and trans fats such as baked cookies, crackers, microwaved popcorn and fast foods may increase your cholesterol levels. [8]

  • Regular exercise helps boost HDL cholesterol and lack of exercise can thus decrease the HDL levels and increase the LDL levels. Lack of exercise may also cause weight gain which can increase your cholesterol. [7;8]

  • Smoking has a direct toxicity to your blood vessels. It can damage the blood vessels making it more likely for fat to deposit in them. [7]

  • Family history: having a first-degree family member may increase your risk due to genetics. Having a family history of Familial Hypercholesterolemia may also increase your risk. [7;8]

  • As we age, our body chemistry changes and thus we are unable to clear cholesterol from our body’s as well as when we were younger, which thus increases the risk. [7;8]



High cholesterol may increase the risk of cardiovascular disease. Firstly, you should try to change your lifestyle to improve your cholesterol, however, lifestyle change is sometimes not enough, and medications need to be added. [2]

  • Speak to your doctor about seeing a dietician who would help with a healthy balanced diet. The dietician will help you create a diet that will have more monounsaturated fats, reduced saturated fats, eliminated trans fats, foods which are rich in omega-3 fatty acid and increased soluble fibre. [1]

    • Monosaturated fat such as olives, olive oil, canola oil, almonds, pecans, avocados, hazelnuts, etc.[2]

    • Saturated fats such as those found in red meats, full fat dairy products, etc. [2]

    • Trans fats such as margarines, store-bought cookies, crackers, cakes, pastries, etc. [2]

    • Foods rich in omega-3 fatty acids such as salmon, mackerel, walnuts, fish, flaxseeds, etc. [2]

    • Soluble fibre such as oatmeal, beans, apples, pears, brussels sprouts, etc. [2]


  • Exercise is important to improve cholesterol and can increase HDL (good) cholesterol. One needs at least 30 minutes of exercise for at least five times a week. Losing excessive weight can help you improve cholesterol levels. [1]

  • Stop smoking as it can lower HDL (good) cholesterol and increase your risk of heart disease. Three months of quitting can improve your lung function and blood circulation. [3]

  • Reduce the amount of alcohol, as excessive alcohol may reduce HDL (good) cholesterol. [2]

  • Ask your doctor about supplements that contain fish oil such as omega-3 and soluble fibre such as psyllium. They have been seen to improve cholesterol and promote health. [1]  

Fig. 3 [6]


  1. Mayo Clinic Staff [Internet]. Top 5 lifestyle changes to improve your cholesterol. America: Mayo Foundation for Medical Education Research; [updated 2018 Aug 11; cited 2019 Aug 12]. Available from:

  2. editorial staff [Internet]. Life changes to improve your cholesterol. America: American Academy of Family Physicians; [updated 2017 Oct 09; cited 2019 Aug 12]. Available from:

  3. America Heart Association [Internet]. Prevention and treatment of high cholesterol. America: American heart Association; [updated 2017 Apr 30; cited 2019 Aug 12]. Available from:

  4. Retiree news [Internet]. 9 Things dietitians wish you knew about high cholesterol. Hawaii: retiree News; [updated 2017 Mar 07; cited 2019 Aug 12]. Available from:

  5. Newsroom [Internet]. 2018 Cholesterol guidelines for heart health announced. America: Johns Hopkins Medicine; [Updated 2018 Oct 11; cited 2019 Aug 12]. Available from:

  6. WebMD [Internet]. Foods to help lower LDL (‘bad’) cholesterol. America: WebMD; [updated 2018 Jun 14; cited 2019 Aug 12]. Available from:

  7. CDC [Internet]. Knowing your risk factors. America: Centers for Disease Control and Prevention; [updated 2019 Feb 06; cited 2019 Aug 22]. Available from:

  8. Mayo Clinic Staff [Internet]. High Cholesterol. America: Mayo Clinic; [updated 2019 Jul 13; cited 2019 Aug 22]. Available from:

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