High Cholesterol (Dyslipidemia)

What Is Cholesterol?

Cholesterol is a fatty substance made by your liver and found in some foods. It’s essential for building cells and hormones, but too much of the wrong kind can build up in your arteries, increasing your risk of heart attack and stroke. There are several types but, to keep things simple, the two main types that you will often hear about are

LDL (Low-Density Lipoprotein): “Bad” cholesterol. High levels can clog arteries.
HDL (High-Density Lipoprotein): “Good” cholesterol. Helps clear LDL from the blood.

Managing your cholesterol through diet, exercise, and sometimes medication is important for heart health.

Why Does High Cholesterol Matter?

Excess LDL cholesterol can lead to atherosclerosis (plaque buildup), increasing the risk of:

Heart attack
Stroke
Peripheral artery disease
Kidney disease
Cardiovascular death

High cholesterol has no symptoms. The only way to know your levels is through a blood test.

What Causes High Cholesterol?

High intake of saturated and trans fats
Physical inactivity
Obesity or excess weight
Smoking
Excess alcohol
Certain medical conditions (e.g. diabetes, kidney disease, thyroid disorders)
Genetics (e.g. familial hypercholesterolemia or high Lp(a))

How Is It Diagnosed?

A lipid panel blood test measures:

Total cholesterol
LDL (bad) cholesterol
HDL (good) cholesterol
Triglycerides

Your doctor will also consider your overall cardiovascular risk using tools like the Framingham Risk Score or ASCVD Risk Estimator. The decision to treat your cholesterol depends on a combination of your overall cholesterol levels, as well as your cardiovascular risk. People at higher risk of cardiovascular complications (e.g. heart attacks, strokes) are more likely to benefit from lower cholesterol levels.

🧪 Should I Be on Cholesterol-Lowering Medication?

Your doctor may recommend medication if:

Your LDL is very high (e.g. ≥ 5 mmol/L)
You’ve had a heart attack, stroke, or vascular procedure
You have diabetes, kidney disease, or very high blood pressure
You have a moderate or high 10-year cardiovascular risk
You have a strong family history of early heart disease

Even if your cholesterol isn’t extremely high, your overall risk level is what matters most.

🍎 What Diets Help Lower Cholesterol?

✅ Portfolio Diet (Made in Canada)

Includes plant sterols, viscous fiber (oats, barley, psyllium), soy protein, and nuts
Shown to lower LDL cholesterol by up to 30%

✅ DASH Diet

Focuses on vegetables, fruits, low-fat dairy, whole grains, and reduced sodium
Supports both cholesterol and blood pressure control

✅ Mediterranean Diet

High in healthy fats (olive oil, nuts, fish), fiber, and antioxidants
Lowers cardiovascular risk and inflammation

Quick tips:

Avoid trans fats and minimize saturated fats
Choose foods high in soluble fiber
Cook with olive oil instead of butter
Eat more legumes, whole grains, and vegetables

💊 Medications to Lower Cholesterol

When lifestyle changes aren’t enough, medications help lower your risk of heart attack and stroke.

Medication Class	How It Works	Common Medications	How Often
Statins	Reduce cholesterol production in the liver	Atorvastatin, Rosuvastatin	Daily
Ezetimibe	Blocks cholesterol absorption from food	Ezetrol	Daily
PCSK9 Inhibitors	Help the liver clear LDL from the blood	Evolocumab, Alirocumab	Injection every 2–4 weeks
Inclisiran	Lowers cholesterol production via RNA interference	(Limited use in Canada)	Injection every 6 months
Fibrates	Lower triglycerides	Fenofibrate	Daily
Bempedoic acid	Similar to statins but works only in the liver	(Limited use in Canada)	Daily

⭐ Statins: What You Should Know

Statins are the most studied and most effective medications for reducing cardiovascular risk.

✅ Benefits of Statins:

Lower LDL by 30–60%, lower inflammation, and improve stability of cholesterol plaques
Reduce risk of heart attack, stroke, and cardiovascular death
Proven effective for primary prevention (before a heart event) and secondary prevention (after a heart event)

🛡️ Who Benefits Most from Statins:

People with known cardiovascular disease
Adults with diabetes over age 40
Those with LDL ≥ 5.0 mmol/L
Those at moderate or high cardiovascular risk

⚠️ Possible Side Effects:

Muscle aches (mild and reversible in most cases)
Elevated liver enzymes (rare)
Slight increase in diabetes risk (for some individuals)

💡 The benefits of statins far outweigh the risks for most patients.

❓ Frequently Asked Questions

What is Lipoprotein(a)?

Lp(a) is a genetic cholesterol particle that increases risk. It’s not routinely measured, but your doctor may check it if you have a family history of early heart disease or unexplained high cholesterol.

Can I stop medication once my cholesterol improves?

No. Cholesterol medications control your levels but do not cure the underlying issue. Stopping them usually causes levels to rise again.

Do I need to take medication forever?

Often yes, but with healthy changes and long-term management, your doctor may consider adjusting the dose. Never stop or change treatment without medical advice.

✅ Final Takeaway

High cholesterol is common and silent—but it’s also very manageable. With the right combination of:

Heart-healthy eating
Exercise and lifestyle change
Medications when appropriate

…you can significantly reduce your risk of heart disease and live a longer, healthier life.