HIGH BLOOD CHOLESTEROL: WHAT YOU NEED TO KNOW

Why Is Cholesterol Important?

Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.

How Does Cholesterol Cause Heart Disease?

When there is too much cholesterol (a fat-like substance) in your blood, it builds up in the walls of your arteries. Over time, this buildup causes "hardening of the arteries" so that arteries become narrowed and blood flow to the heart is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. Cholesterol lowering is important for everyone--younger, middle age, and older adults; women and men; and people with or without heart disease.

What Do Your Cholesterol Numbers Mean?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a "lipoprotein profile" to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:

• Total cholesterol
• LDL (bad) cholesterol--the main source of cholesterol buildup and blockage in the arteries
• HDL (good) cholesterol--helps keep cholesterol from building up in the arteries
• Triglycerides--another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL* or more or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. See how your cholesterol numbers compare to the tables below.

Total Cholesterol Level	Category
Less than 200 mg/dL	Desirable
200-239 mg/dL	Borderline High
240 mg/dL and above	High

* Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

LDL Cholesterol Level	LDL-Cholesterol Category
Less than 100 mg/dL	Optimal
100-129 mg/dL	Near optimal/above optimal
130-159 mg/dL	Borderline high
160-189 mg/dL	High
190 mg/dL and above	Very high

HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels?

A variety of things can affect cholesterol levels. These are things you can do something about:

·         Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.

·         Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.

·    Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.

Things you cannot do anything about also can affect cholesterol levels. These include:

·         Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.

·         Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

What Is Your Risk of Developing Heart Disease or Having a Heart Attack?

In general, the higher your LDL level and the more risk factors you have (other than LDL), the greater your chances of developing heart disease or having a heart attack. Some people are at high risk for a heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes (which is a strong risk factor) or a combination of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease.

Step 1: Check the table below to see how many of the listed risk factors you have; these are the risk factors that affect your LDL goal.

Major Risk Factors That Affect Your LDL Goal

• Cigarette smoking
• High blood pressure (140/90 mmHg or higher or on blood pressure medication)
• Low HDL cholesterol (less than 40 mg/dL)*
• Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
• Age (men 45 years or older; women 55 years or older)

* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.

Even though obesity and physical inactivity are not counted in this list, they are conditions that need to be corrected.

Step 2: How many major risk factors do you have? If you have 2 or more risk factors in the table above, use the attached risk scoring tables (which include your cholesterol levels) to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage. My risk score is ________%.

Step 3: Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.

If You Have	You Are in Category
Heart disease, diabetes, or risk score more than 20%*	I. High Risk
2 or more risk factors and risk score 10-20%	II. Next Highest Risk
2 or more risk factors and risk score less than 10%	III. Moderate Risk
0 or 1 risk factor	IV. Low-to-Moderate Risk

* Means that more than 20 of 100 people in this category will have a heart attack within 10 years.

My risk category is ______________________.

Treating High Cholesterol

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the boxes below for your risk category. There are two main ways to lower your cholesterol:

·         Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.

·         Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

If you are in...

·         Category I, Highest Risk, your LDL goal is less than 100 mg/dL. you will need to begin the TLC diet to reduce your high risk even if your LDL is below 100 mg/dL. If your LDL is 100 or above, you will need to start drug treatment at the same time as the TLC diet. If your LDL is below 100 mg/dL, you may also need to start drug treatment together with the TLC diet if your doctor finds our risk is very high, for example if you had a recent heart attack or have both heart disease and diabetes.

·         Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.

·         Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans.

·         Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC)

TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:

·         The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.

·         Weight Management. Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).

• Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

Foods low in saturated fat include fat-free or 1percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products. Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.

Drug Treatment

Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including statins, bile acid sequestrants, nicotinic acid, fibric acids, and cholesterol absorption inhibitors. Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Cholesterol absorption inhibitorrs lower LDL and can be used alone or in combination with statin drugs.

Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Heart, Lung, and Blood Institute

NIH Publication No. 05-3290
Originally printed May 2001
Revised June 2005

WHAT IS A STROKE, AND WHAT CAN YOU DO TO PREVENT IT?

By: Rohit Bhattacharjee, Rita Krishnamurthi, Valery Feigin

National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand

Stroke is one of the biggest causes of disability and death in the world. In Nigeria, it is estimated that strokes are responsible for between 5 to 17% of all medical deaths per year. In addition to this, strokes have enormous economic, psychological and social burden for patients, families and caregivers. However, despite the huge impact of stroke, very few people outside the health sector are aware of what a stroke is, how to identify a stroke, what the risk factors of stroke are and how they can reduce their chances of having a stroke. This article will aim to answer some of those questions, and give people the information needed to prevent them from suffering a stroke.

What is a stroke?

A stroke is a medical emergency where blood circulation in the brain is disrupted, due to either a blockage in the blood vessel (ischaemic stroke) or if the blood vessel ruptures or bursts (haemorrhagic stroke). This results in a part of the brain not receiving adequate blood supply, which leads to the death of brain cells in the affected part. The severity of symptoms is related to where in the brain the disruption occurs, as this affects how much of the brain (and which area of the brain) is affected.

Sometimes, the blockages can be temporary. If symptoms last for less than 24 hours, the event is called a Transient Ischaemic Attack (also known as TIA or mini-stroke). These may be warnings for more severe strokes in the future and one should always seek medical attention – even if the symptoms go away quickly.

However, the impact of stroke can be greatly minimised if people act quickly and seek medical attention as soon as possible.

How can you tell if someone is having a stroke?

The F.A.S.T. is an easy way to detect some sudden signs and symptoms of a stroke and prompt immediate actions:

Face drooping: Does one side of the face droop? Ask the person to smile. Is the face symmetrical?

Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Speech difficulty: Is speech slurred, are they unable to speak or understand? Ask the person to repeat a simple sentence.

Time to call: Time to call an ambulance if the person shows any sign of these symptoms, even if the symptoms go away very quickly

Although two thirds of strokes occur without any warning signs, approximately one third of strokes do have warning signs, including transient ischaemic attack (TIA or mini stroke). An ambulance should be called immediately if any of the following symptoms occur (especially symptoms with sudden onset):

·         loss of strength (or sudden clumsiness – such as being unable to stand up, or dropping items) in some part of the body, espeically on one side, including the face, arm or leg;

·         numbness (sensory loss) or other unusual sensations in some part of the body, especially if one-sided;

·         complete or partial loss of vision on one side;

·         inability to speak properly or to understand language;

·         loss of balance, unsteadiness or an unexplained fall;

·         any other kind of transient spells (vertigo, dizziness, swallowing difficulties, acute confusion, or memory disturbances);

·         headache that is unusually severe, abrupt, or of unusual character (including unexplained change in the pattern of headaches);

·         sudden alterations of consciousness or convulsions/seizures etc.

These warning signs may occur alone or in any combination. They may last a few seconds or up to 24 hours and then disappear (TIA), or as a single episode during a day or repeated. During the first 24 hours it is impossible to know for sure if symptoms are due to stroke or due to TIA. However, symptoms can indicate a hidden problem with blood flow in the brain, which, if ignored, could result in a severe stroke.

What are the risk factors of stroke?

While stroke is a serious health issue, current research suggests that upto 80% of strokes are preventable.

The main risk factors for stroke are:

• High blood pressure (hypertension): The lower your blood pressure, the lower your risk of stroke. The usually recommended target for blood pressure reduction is blood pressure below 140/90 mm Hg (or below 130/80 mm Hg in diabetics). 
• Heart disease: People with heart disease, atrial fibrillation and left ventricular hypertrophy are at significantly higher risk of stroke. Regular medical advice on controlling these conditions are essential in reducing stroke risk.
• Diet and lifestyle: A healthy lifestyle and well balanced diet can significantly reduce your chances of having a stroke. What you eat and how often you exercise should be balanced to maintain a healthy body weight.
• Smoking and alcohol: Smoking tobacco makes you 4 times more likely to have a stroke. Smoking constricts and hardens the arteries throughout the body, thus reducing the blood flow, and makes the blood more likely to clot. Even second hand smoking (being in the same room as someone smoking) can increase your risk of stroke significantly.

There are some risk factors for stroke that we cannot control. Your age, sex, ethnicity and genetics can influence your risk of stroke, but the effects of these factors is greatly reduced if you the controllable risk factors are well managed.

How high is your risk?

Unfortunately, even if someone is trying to manage the risk factors, it is very hard to determine what their actual risk of stroke is. Until recently, the only way to determine if you were at risk of stroke was if your doctor told you. However, the National Institute for Stroke and Applied Neurosciences has recently developed an app that can calculate your risk of stroke. The Stroke Riskometer™ is available for both Android and iPhone platforms, and assesses both absolute risk (i.e. how likely you are to have a stroke in the next 5 or 10 years) as well as relative risk (i.e. how likely you are to have a stroke compared to someone your age and sex with no risk factors). Relative risk is particularly important in trying to determine whether you need to make any changes to your lifestyle, as the absolute risk (particularly for young people) can often be quite low. In addition to your risk factor, the app also lets you see what your risks are, and in the Pro version, gives you guidance on what you can do to minimise these risks. More information is available at www.strokeriskometer.com

Having a stroke is a serious incident with potentially devastating consequences. However, you can greatly lower your risk of having a stroke by being aware of what your risk factors are, and taking the correct steps to maintain a healthy lifestyle.

1.         Feigin, V.L., et al., Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet, 2014. 383(9913): p. 245-254.

2.         Wahab, K.W., The burden of stroke in Nigeria. International Journal of Stroke, 2008. 3(4): p. 290-2.

WHAT IS STROKE?

By Phil Collis – Community Stroke Specialist   

         

A stroke is a brain attack. It happens when the blood supply to part of your brain is cut off. It can be caused by a blockage in one of the blood vessels leading to the brain or by a bleed in the brain.

Blood carries essential nutrients and oxygen to your brain. Without blood your brain cells can be damaged or die.

Strokes affect people in different ways depending on the part of the brain that is affected, how widespread the damage is and how healthy you were before the stroke. A stroke can affect the way your body functions as well as your thought processes and how you feel and communicate.

The BEFAST test can help you to recognize the symptoms of a stroke. These symptoms usually come on suddenly. Other symptoms include sudden weakness or numbness on one side of the body, sudden confusion, dizziness or unsteadiness.

A transient ischaemic attack or TIA is similar to a stroke but the symptoms are temporary – usually lasting from a few minutes up to 24 hours. A TIA is serious and should not be ignored. If you experience any of the symptoms described above you must call 911, as there is no way of telling whether you are having a TIA or a stroke when the symptoms first start.

Why am I more likely to have a stroke if I am black?

Studies show that if you are black and of African or Caribbean origin you are twice

As likely to have a stroke, and at a younger age, than white people. The reasons for

This are complex and not completely understood.

What we do know is if you are black and of African or Caribbean origin you are more

Likely to develop high blood pressure or diabetes or have sickle cell disease,

Which are all risk factors for stroke.  

Some of the lifestyle factors that increase your risk of developing some of these medical conditions, and therefore of having a stroke, are also known to affect some African and Caribbean people more than the rest of the UK population. These include carrying weight around your waist and smoking.

What factors will increase my risk of stroke?

 High Blood Pressure

High blood pressure is the most important risk factor, contributing to around 53% of all strokes. In the UK high blood pressure is more common among black Caribbean people than any other ethnic group.

Blood pressure is the measure of how strongly your blood presses against the walls of your arteries when it is pumped around your body. If this pressure is too high it puts a strain on your arteries and heart, which can cause health problems and lead to a stroke or heart attack.

High blood pressure (known as hypertension) develops when your blood pressure is consistently too high (140/90mmHg or higher).

High blood pressure puts a strain on all the blood vessels in your body, including the ones leading to your brain. This makes a blockage more likely to develop or a blood vessel in the brain to weaken and bleed, both of which could cause a stroke.

What can I do about high blood pressure?

High blood pressure does not have any symptoms so the only way to know if you have it is to have your blood pressure measured regularly.

Everyone over 40 should get their blood pressure checked at least once every five years, but as you’re more likely to have high blood pressure if you are black African or black Caribbean, you should get it checked more often, ideally once a year. This can be done by your GP or nurse, or you can check it yourself with a home testing kit.

Leading a healthy lifestyle can help to reduce your risk of high blood pressure. You can read more about this further on in this factsheet.

Diabetes

Diabetes is up to three times more common among black African and black  Caribbean people compared to the rest of the UK population.

Diabetes is a condition caused by too much sugar (known as glucose) in the blood. This is why people with diabetes may say they’ve “got sugar”. There are two main types of diabetes:

•           Type 1 develops when the body stops producing insulin, a hormone that helps your body to use up the glucose in your bloodstream. This type of diabetes usually begins in childhood or adolescence.

•      Type 2 diabetes develops when your body does not produce enough insulin or

When your body does not react to it in the right way. This type of diabetes is much

More common and tends to develop gradually, usually in adulthood.

Having diabetes doubles your risk of stroke. This is because high levels of glucose in the blood can damage your blood vessels, making them harder and narrower and more likely to become blocked. If this happens in a blood vessel leading to the brain it could cause a stroke.

How can I manage diabetes?

It is important that you get checked by a GP or other health professional, especially if you have other major risk factors for developing the condition i.e.

You are over 40 years of age.

There is a history of diabetes in your family.

You are overweight or obese (check your BMI).

You have had diabetes during pregnancy.

If you have diabetes, you must have regular checkups with your GP or at a diabetes clinic to make sure your blood glucose and blood pressure stay at healthy levels.

Although there is no cure, diabetes can often be managed by making changes to your lifestyle i.e. altering your diet, doing more exercise.

Sickle Cell Disease

Sickle cell disease is a disorder that affects red blood cells. Blood cells are normally round and flexible, but in people with sickle cell disease they become stiff and sickle shaped. This can lead them to block blood vessels, often causing pain. This is known as a ‘sickle cell crises’. If sickle cells block the blood supply to the brain this can lead to stroke. Research shows that around 24% of people with sickle cell disease will have a stroke by the age of 45.

In the UK around 10,000 people have sickle cell disease and it predominantly affects people of African, Caribbean, Asian and Mediterranean origin. Sickle Cell disorders can be detected with a blood test. (All newborn babies in the UK are checked for sickle cell disease). Although Sickle Cell Disease cannot be cured, treatment can reduce its symptoms and the complications that result from it, like stroke. Specialist health professionals can help you manage the condition by providing regular checks to monitor your risk.

If you are diagnosed with Sickle Cell it is likely that you will have a TCD (Transcranial Doppler Scan) every year from the age of 3. This type of scan uses ultrasound to measure the flow of blood through the brain and can indicate whether a blockage may be forming. If the scan shows that you are at a high risk of stroke. Your doctor or health professional may recommend that that you have more regular scans or a blood transfusion, which can significantly reduce your risk. Some things are known to trigger a sickle cell crisis and can be avoided. These include very hot or very cold temperatures, stress and smoking cannabis.

Atrial Fibrillation (A/F)

This is a term used for people who have a type of irregular heartbeat that can cause blood clots to form in the heart. If these clots move up into the brain it can lead to stroke. Some studies have shown that people of African origin are less likely to have A/F, however if you do have A/F it is probable that you are likely to have other possible risk factors (i.e. High blood pressure and diabetes) Which will very possibly increase your risk of stroke. Your doctor or health professional can test whether you have A/F by checking your pulse and performing an Electrocardiogram (ECG) – a simple and painless test that records the rhythm and electrical activity of your heart.  If you have A/F you can be treated with blood thinning medication such as Warfarin or drugs called novel oral anticoagulants which can reduce your risk of stroke by 50 – 70%.

Managing your lifestyle can help reduce your risk of stroke. Risk factors that you cannot control include your age, gender, ethnic background and family history of stroke.

Making lifestyle changes can significantly reduce your risk of stroke.

Smoking- doubles your risk of stroke: the more you smoke the greater your risk – smoking damages artery walls and makes blood more likely to clot.

Alcohol – regularly drinking large amounts of alcohol greatly increases your risk of stroke. ‘Binge’ drinking in particular is dangerous as it can cause blood pressure to rise very quickly.

Weight – Some studies have shown that women of African origin are more likely to carry weight around their waist which makes them more likely to have high blood pressure, diabetes or other health problems.

Diet - Eating a healthy balanced diet can help to lower blood pressure and control diabetes. Cholesterolis a fatty substance that can be absorbed from foods.

Salt – be aware that salt intake can have a significant effect on controlling blood pressure. Many of today’s foods already contain significant amounts of salt. Salt fish a favorite of African and Caribbean communities should be eaten in moderation, oily fish are a more suitable alternative.

Plenty of fresh fruit and vegetables in a balanced diet improve overall health and wellbeing.

Check out your own Stroke risk using this useful score card for you and your family.

Information Sources and where further information can be found:

www.stroke.org.uk

www.afiya-trust.org

www.diabetes.org.uk

www.nutrition.org.uk

www.bhf.org.uk

www.bdaweightwise.com

www.bloodpressureuk.org

http://www.strokeassociation.org/STROKEORG/ (American heart and stroke association)

http://www.atrialfibrillation.org.uk/

http://ish-world.com/index.htm   (International Society Hypertention)