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If you have already experienced a cardiovascular event, speak to your doctor about testing and managing your cholesterol levels.
HEART ATTACK: Blockage of blood vessels supplying blood to the heart
STROKE: Blockage of blood vessels supplying blood to the brain
How can high cholesterol lead to heart attack and stroke?
When there is plaque, your arteries become clogged and narrow, reducing blood flow. The problem is when the plaque ruptures, it can cause blood clot, and if a piece of the plaque travels in your blood stream, it may lead to a heart attack or a stroke.4
Did you know?
Coronary heart disease has been the #1 cause of death in the Philippines from 2015 to 2023.5
Getting your cholesterol checked is one of the first steps to minimize the risk of developing heart problems in the future.
Cholesterol adds up and increases your risk.
The longer you are exposed to high LDL, you increase your risk of having a heart attack earlier in life.6
There are usually no signs and symptoms that you have high cholesterol, and many people may be unaware they have high cholesterol for a long period of time until they develop serious health problems.7
LDL-C accumulates in your blood vessels eventually creating plaque that could obstruct blood flow resulting in the heart attack or stroke.
Want to know your risk?
Your accumulated years of exposure to LDL can be used as an estimate to your plaque burden and your average risk for the first heart attack.
As cholesterol and plaque builds up, the average age of the first heart attack goes down.
What other factors can increase risk?
Frequently Asked Questions on Cholesterol and Heart Health
What Causes Heart Attacks and Strokes?
Heart attacks and strokes are primarily caused by atherosclerosis, a condition where plaque builds up in the arteries. This plaque consists largely of cholesterol deposits that can restrict blood flow or break off, leading to clots that may cause a heart attack or stroke.
What causes plaque build-up in the arteries?
Several factors contribute to this process, including high LDL-C (bad cholesterol) levels, hypertension (high blood pressure), smoking, and diabetes13.
How Does Cholesterol Affect Heart Health?
Cholesterol is a fatty substance in your blood necessary for building healthy cells, but high levels can increase the risk of cardiovascular diseases. LDL (low-density lipoprotein) is often referred to as “bad” cholesterol because it can lead to plaque buildup in your arteries, whereas HDL (high-density lipoprotein) is the “good” cholesterol as it helps remove cholesterol from your bloodstream14.
Should I Take Cholesterol Medications?
Cholesterol-lowering medications, such as statins, are often prescribed when lifestyle changes aren’t enough to lower cholesterol levels. These medications are effective in reducing LDL levels and lowering the risk of heart disease. When statins alone are insufficient to achieve desired LDL-C levels, combination therapy can be effective, offering additional LDL-C reduction and improved goal attainment without significantly increasing adverse effects. It’s important to discuss with your doctor the best treatment plan for you15,16.
What causes high cholesterol levels?
High cholesterol is caused by genetics, an unhealthy diet rich in saturated fats, lack of physical activity, smoking, obesity, and some medical conditions or medications17.
What risk factors contribute to high cholesterol?
Risk factors include a poor diet, obesity, inactivity, smoking, excessive alcohol intake, and certain conditions like diabetes. Age and family history also play a role18.
How is high cholesterol diagnosed? What types of tests are used to measure cholesterol levels?
High cholesterol is diagnosed through a lipid panel blood test, which measures total cholesterol, LDL (“bad” cholesterol), HDL (“good” cholesterol), and triglycerides.
Key Questions To Ask Your Doctor
Effective communication with your cardiologist is essential to successfully reduce cardiovascular risk. Use these questions to guide your conversation, ensuring you understand your condition and the steps necessary to achieve better heart health.
Understanding Your Risk
- What is my current LDL-C level, and how does it compare to normal ranges?
- How does my high LDL-C level affect my overall cardiovascular risk?
- Are there any specific risk factors unique to my health profile that I should be aware of?
Treatment Options
- Do I need medication to manage my cholesterol? Can lifestyle changes alone be effective for me?
- If medication is needed for me, what treatment options are available to lower my LDL-C levels?
- How do these different medications work, and what are their potential side effects?
- With my risk factors (if any), what treatment combination will be most effective to manage my LDL-C levels?
Lifestyle Changes
- What dietary changes should I consider to help lower/manage my cholesterol?
- Can you recommend specific physical activities or exercises that would benefit my heart health?
- How does stress affect my cholesterol levels, and what stress management techniques do you recommend?
Monitoring and Follow-Up
- How often should I have my cholesterol levels checked?
- What signs or symptoms should prompt me to seek immediate medical attention?
- Are there any additional tests that can provide more information about my cardiovascular health?
Communication and Support
- Are there any local or online support groups you recommend for individuals managing high cholesterol?
- How can my family or caregivers support me in managing my cholesterol levels?
How to lower your cholesterol?
These key steps can help you maintain a healthy lifestyle and reduce your risk of atherosclerosis, heart disease, and stroke.9
Manage your conditions19,22
- Your doctor may prescribe medications to help achieve your target level of blood cholesterol, sugar and/or blood pressure or any condition that put you at a higher risk of developing cardiovascular disease.
- Never stop your cholesterol-lowering medication or change its dose before consulting your doctor even if you have achieved your target cholesterol level.
Quit smoking & limit alcohol19
- Don’t smoke, vape, or use other tobacco products.
- Limit your intake of alcoholic beverages.
Make time to exercise19,20,21
- 150 minutes per week doing moderate intensity physical activity (e.g., tennis, bicycling, or brisk walking).
- Or 75 minutes per week doing vigorous exercise (e.g., running, swimming, or jumping rope).
- Always check with your doctor before starting a new exercise program, especially if you have any concerns about your fitness, haven’t exercised for a long time, have chronic health problems, such as heart disease, diabetes or arthritis.
Eat a heart-healthy diet19
- Eat fruits, vegetables, whole grains, legumes (e.g., beans, lentils), nuts, fish and seafood, and poultry.
- Limit sugary drinks and full-fat dairy products.
Dietary Recommendation on Fats
The type of fat (saturated or unsaturated fat) in your diet will affect the amount of good and bad cholesterols in your bloodstream.
Foods that are rich in animal-based saturated fats are also high in cholesterol content.
GOOD FATS
Monounsaturated & Polyunsaturated Fats
Functions
- Lower bad cholesterol level
- Lower the risk of heart disease and stroke
- Provide essential fats that the body needs but cannot produce itself
Source
Plant-based liquid oils, nuts, seeds and fatty fish.
Oils (such as corn, sunflower, soybean, canola, olive, peanut, sesame oils)
Avocado
Fatty Fish (such as mackerel, tuna, salmon, sardines, and jelawat)
Nuts & Seeds (such as chia seeds, sunflower seeds, flaxseeds, almond, walnuts)
BAD FATS
Saturated Fats
Hydrogenated Oils & Trans Fats
Functions
- Raise good and bad cholesterol levels
- Increase the risk of heart disease and stroke
Functions
- Raise bad cholesterol level
- Lower good cholesterol level
- Increase the risk of heart disease, stroke and diabetes mellitus
Source
Most come from animal sources, including meat and dairy, and from tropical oils.
Sources
Processed foods made with partially hydrogenated oil
Animal Fat
Butter
Cheese
Tropical Oils (such as coconut and palm oils)
Partially hydrogenated oils
Some baked goods
Fried foods
Hard margarines & shortenings
Saturated Fats
Hydrogenated Oils & Trans Fats
Functions
- Raise good and cholesterol levels
- Increase the risk of heart disease and stroke
Functions
- Raise bad cholesterol level
- Lower good cholesterol level
- Increase the risk of heart disease, stroke and diabetes mellitus
Source
Most come from animal sources, including meat and dairy, and from tropical oils.
Sources
Processed foods made with partially hydrogenated oil
Animal Fat
Butter
Cheese
Tropical Oils (such as coconut and palm oils)
Partially hydrogenated oils
Some baked goods
Fried foods
Hard margarines & shortenings
Treating High Cholesterol with Medicine
These are the medications that could be prescribed by your doctor to help lower your cholesterol. Your doctor will also guide you on how to take these medications and the specific dosage you should be taking.
Statins are the go-to medications for lowering “bad” cholesterol (LDL-C) in your blood. By reducing LDL-C levels, they help cut down your risk of heart disease and related problems—the more your LDL-C drops, the greater the heart health benefits9.
Combination therapy is often necessary alongside statins because some patients do not achieve their cholesterol goals with statins alone, and they may experience side effects at higher statin doses. Adding lipid-lowering agents can enhance cholesterol reduction without increasing statin dosage, thus minimizing potential side effects10,11.
Combination therapy is especially beneficial for patients with additional risk factors like diabetes or high blood pressure (hypertension), as it provides a more comprehensive approach to lowering LDL-C levels and mitigating cardiovascular risks12.
Lowers cholesterol in the blood by inhibiting an enzyme that makes cholesterol.
1 pill/day
Prevent cholesterol from being absorbed in the intestine.
1 pill/day
Lower triglyceride levels in the blood and has a mild effect in lowering LDL-C.
1 pill/day
Binds and inactivates a protein to lower LDL-C.
1 injection/2 weeks
Prevents the production of a protein in the liver to lower LDL-C.
1 injection/6 months
Disclaimer: The above information is not meant to replace medical advice by healthcare professionals. Kindly speak to a healthcare professional to know more details. Not all medications may be suitable or needed for all patients.
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Unblock barriers to heart health
Consult your doctor to discuss your current cholesterol levels, set targets, and develop a personalized plan for prevention. By taking proactive steps and seeking medical guidance, you can work towards better heart health and overall well-being.
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References:
- Packard C, et al. Intensive low-density lipoprotein cholesterol lowering in cardiovascular disease prevention. Heart 2021;107(17):1369–1375.
- M Hiles MD et.al. Atherosclerotic Cardiovascular Disease in Women: Providing Protection With Lipid-altering Agents. Clinical Therapeutics Vol. 45, Issue 11, Pages 1127-1136. November 2023. https://doi.org/10.1016/j.clinthera.2023.08.021
- Rosenblit, P.D. Extreme Atherosclerotic Cardiovascular Disease (ASCVD) Risk Recognition. Curr Diab Rep 19, 61 (2019).
- American Heart Association. My cholesterol guide. Available at: https://www.heart.org/-/media/files/health- topics/cholesterol/my-cholesterol-guide-english.
- Philippine Statistics Authority. Causes of Deaths in the Philippines (Preliminary): January to May 2023. 2023 Causes of Deaths in the Philippines (Preliminary as of 31 July 2023) | Philippine Statistics Authority | Republic of the Philippines (psa.gov.ph).
- Ference BA, Graham I, Tokgozoglu L, Catapano AL. Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series. J Am Coll Cardiol. 2018 Sep 4;72(10):1141-1156. doi: 10.1016/j.jacc.2018.06.046. PMID: 30165986.
- High Cholesterol – Symptoms, Causes & Levels. British Heart Foundation. Available from: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol#SYMP. Last accessed January 2025.
- Gonzales-Santos, LE, et al. Journal of the ASEAN Federation of Endocrine Societies. Executive Summary of the 2020 Clinical Practice Guidelines for the Management of Dyslipidemia in the Philippines.
- A. Brautbar, C. Ballantyne. Pharmacological strategies for lowering LDL cholesterol: statins and beyond. Nature Reviews Cardiology volume 8, p.253–265 (2011). https://www.nature.com/articles/nrcardio.2011.2, accessed Jan 2025
- M Silverman et.al. Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions, A Systematic Review and Meta-analysis. JAMA. 2016;316(12):1289-1297. doi:10.1001/jama.2016.13985.
- K. Ray et.al. Use of combination therapy is associated with improved LDL cholesterol management: 1-year follow-up results from the European observational SANTORINI study. European Journal of Preventive Cardiology, Volume 31, Issue 15, October 2024, Pages 1792–1803, https://doi.org/10.1093/eurjpc/zwae199.
- K.K. Ray, et.al. World Heart Federation Cholesterol Roadmap 2022. Global Heart Journ. 17(1), 75. https://doi.org/10.5334/gh.1154
- Atherosclerosis. Cleveland Clinic. Available from https://my.clevelandclinic.org/health/diseases/16753-atherosclerosis-arterial-disease. Accessed Jan 2025
- High Cholesterol. Mayo Clinic. Available from https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800. Accessed Jan 2025
- K Gudzune et.al. Effectiveness of Combination Therapy With Statin and Another Lipid-Modifying Agent Compared With Intensified Statin Monotherapy: A Systematic Review. Annals of Internal Medicine Vol.160, No.7. April 2014. https://www.acpjournals.org/doi/full/10.7326/M13-2526
- M Sharma et.al. Systematic Review: Comparative Effectiveness and Harms of Combination Therapy and Monotherapy for Dyslipidemia. Annals of Internal Medicine Vol.151, No.9. (2009). https://www.acpjournals.org/doi/full/10.7326/0003-4819-151-9-200911030-00144
- U. Ravnskov. Is atherosclerosis caused by high cholesterol? QJM: An International Journal of Medicine, Volume 95, Issue 6, June 2002, Pages 397–403. https://doi.org/10.1093/qjmed/95.6.397
- Ira S. Nash, et.al. Contemporary Awareness and Understanding of Cholesterol as a Risk Factor Results of an American Heart Association National Survey. Arch Intern Med. 2003;163(13):1597-1600. doi:10.1001/archinte.163.13.1597
- Reduce Your Risk of ASCVD. American Heart Association. Available from: https://www.heart.org/- /media/Files/Health-Topics/Cholesterol/Reduce-ASCVD-risk.pdf, last accessed January 2025.
- Exercise: 7 benefits of regular physical activity. Mayo Clinic. Available from: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389, last accessed January 2025.
- American College of Sports Medicine; American Heart Association. Exercise and acute cardiovascular events: placing the risks into perspective. Med Sci Sports Exerc. 2007;39(5):886-897.
- Cholesterol Medications. American Heart Association. Available from: https://www.heart.org/en/health- topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications, last accessed January 2025.
- Punekar RS, Fox KM, Richhariya A, Fisher MD, Cziraky M, Gandra SR, Toth PP. Burden of First and Recurrent Cardiovascular Events Among Patients With Hyperlipidemia. Clin Cardiol. 2015 Aug;38(8):483-91. doi: 10.1002/clc.22428. Epub 2015 Jun 23. PMID: 26100722; PMCID: PMC6711069.