Cholesterol Testing

 chlesterol testing

What is Cholesterol testing

Cholesterol testing is a crucial aspect of preventive healthcare, providing valuable insights into an individual's cardiovascular health. It involves measuring the levels of cholesterol in the blood, a fatty substance that plays a vital role in various bodily functions.

Why is Cholesterol level testing important

High levels of cholesterol, particularly low-density lipoprotein (LDL) cholesterol, are associated with an increased risk of heart disease and other cardiovascular problems.

How is a cholesterol testing performed

Cholesterol testing is typically performed through blood tests, either in a clinical setting or, more recently, with the convenience of home cholesterol test kits. These tests assess total cholesterol, high-density lipoprotein (HDL) cholesterol, and sometimes LDL cholesterol. Monitoring cholesterol levels is especially important for those with a family history of heart disease or individuals managing their cholesterol through lifestyle modifications or medications. Regular testing, along with consultation with healthcare professionals, empowers individuals to make informed decisions about their heart health and take proactive measures to mitigate potential risks. 

Frequently asked questions (FAQs) about cholesterol test kits:

  1. What is a cholesterol test kit? A cholesterol test kit is a home diagnostic tool designed to measure the levels of cholesterol in your blood. It typically includes test strips, a lancet for blood collection, and a meter or device to analyse the blood sample.
  2. How do cholesterol test kits work? These kits usually use a small blood sample, often obtained through a finger prick. The blood is applied to a cholesterol test strip, and the kit's device analyses the sample to provide cholesterol level readings.
  3. Why should I use a cholesterol test kit? Cholesterol test kits offer convenience, allowing you to check your cholesterol levels at home without visiting a doctor, clinic, pharmacy or other type of healthcare facility. Regular monitoring of cholesterol levels is important for individuals with a history of high cholesterol or those on cholesterol-lowering medications.
  4. Are home cholesterol tests accurate? While home cholesterol test kits can provide reasonably accurate results, they may not be as precise as laboratory tests. Factors such as user error, sample collection, and the quality of the cholesterol test kit can influence the accuracy of the cholesterol level results.
  5. When should I use a cholesterol test kit? Use a cholesterol test kit as directed by the manufacturer or your healthcare provider. It's often recommended by them for regular monitoring of cholesterol levels, especially if you have a family history of heart disease or if you're managing your cholesterol through lifestyle changes or medications.
  6. How often should I test my cholesterol at home? The frequency of testing depends on your healthcare provider's recommendations. Generally, individuals with known cholesterol issues may be advised to test more frequently, while others may check periodically for general health monitoring.
  7. Can I replace lab tests with home cholesterol tests? Home cholesterol tests can be a convenient supplement, but they may not completely replace laboratory tests. Periodic lab tests are crucial for a comprehensive assessment of your cholesterol levels and overall cardiovascular health.
  8. Do I need a prescription for a cholesterol test kit? Many cholesterol test kits are available over the counter and do not require a prescription. 
  9. What do the results of a cholesterol test kit mean? Results typically include readings for total cholesterol, HDL (high-density lipoprotein), and sometimes LDL (low-density lipoprotein). Some home cholesterol tests and meters like the Ecotest 5 in 1 cholesterol meter and test strips also give you a reading for triglycerides. You may need to consult with your doctor or medical provider to interpret the results and discuss any necessary actions that you should take.
  10. How should I interpret my cholesterol test kit results? Generally, desirable total cholesterol levels are below 200 mg/dL, while optimal LDL levels are below 100 mg/dL. Higher HDL levels are usually considered beneficial. However, individual targets may vary, and it's important to discuss results with your doctor or clinic for personalised advice.

How to check cholesterol at home without kit

It is not possible to check your cholesterol level at home without using a test kit. Determining whether you have high cholesterol levels usually requires a blood test.

However, there are certain signs and risk factors that may suggest elevated cholesterol levels. Here are some indicators and risk factors:

Signs and symptoms of high cholesterol levels:

  1. Most people have no visible symptoms of raised cholesterol: High cholesterol usually doesn't cause noticeable symptoms. Regular blood tests are essential to check your cholesterol levels.
  2. Xanthomas: In rare cases, fatty deposits called xanthomas can appear on the skin, especially around the eyes, indicating elevated cholesterol levels.
  3. Corneal Arcus: A white or grayish ring around the cornea (the clear front part of the eye) may be associated with high cholesterol levels.

What are the risk factors for having raised blood cholesterol levels on testing:

  1. Diet: A diet high in saturated and trans fats, found in animal products and many processed foods, is probably the main driver contributing to high cholesterol levels in most western populations.
  2. Family history: If close relatives (parents or siblings) have a history of high cholesterol or heart disease, you may be at an increased risk. However this is not inevitable. Poor diet and lifestyle choices are often passed down in families, and may contribute significantly to this. Diet and lifestyle modifications will reduce cholesterol in most individuals, even those who have a family history of raised cholesterol.
  3. Age and Gender: People tend to think Cholesterol levels tend to rise with age, but this is not inevitable and is probably related to poor diet and lifestyle choices. Men often have higher cholesterol levels than premenopausal women, but this equalises after menopause.
  4. Physical Inactivity: Lack of regular physical activity is a risk factor for high cholesterol. Exercise helps raise HDL (good) cholesterol and lower LDL (bad) cholesterol.
  5. Obesity: Being overweight or obese can lead to higher cholesterol levels. Being overweight is often an indicator of poor lifestyle choices regarding diet and exercise
  6. Smoking: Smoking damages blood vessels and lowers HDL cholesterol. It also makes the heart work harder, increasing the risk of heart disease.
  7. Diabetes: People with diabetes often have unhealthy cholesterol levels.
  8. Race or ethnicity: Race can be a factor that contributes to variations in cholesterol levels among different populations. However, it's important to note that the relationship between race and cholesterol levels is complex and influenced by various factors, including genetics, lifestyle, diet, and socio-economic factors.

Getting tested:

If you suspect high cholesterol or have risk factors, it's crucial to get a blood test, specifically a lipid panel.

This test measures:

  1. Total Cholesterol: The overall amount of cholesterol in your blood.
  2. Low-Density Lipoprotein (LDL) Cholesterol: Often referred to as "bad" cholesterol, as it can contribute to plaque buildup in arteries.
  3. High-Density Lipoprotein (HDL) Cholesterol: Known as "good" cholesterol, as it helps remove LDL cholesterol from the bloodstream.
  4. Triglycerides: A type of fat in the blood that, when elevated, can also contribute to heart disease.

Recommended cholesterol testing frequency:

  • Adults who are not known to have raised lipid levels should generally have their cholesterol levels checked at least once every five years (starting in some cases as young as age 18, if there are known and pre-existing risk factors)
  • If you have risk factors or a family history of high cholesterol or heart disease, your healthcare provider may recommend more frequent testing. This is where home cholesterol testing can be helpful.

If you have raised blood cholesterol levels, your doctor will determine the appropriate frequency for monitoring based on your individual health status, risk factors, and the effectiveness of any lifestyle  interventions or treatments. Generally, the frequency of cholesterol checks may vary, but some common guidelines are:

  1. Initial Assessment: If you've just been diagnosed with a high cholesterol or have known risk factors, your doctor may initially recommend more frequent cholesterol monitoring. This could involve checking your cholesterol levels every three to six months.
  2. Stable cholesterol levels: Once your cholesterol levels are within a healthy range and you have implemented lifestyle changes or started medications, your doctor may adjust the frequency of monitoring. In stable situations, an annual checkup with your doctor or clinic may be sufficient. If you wish you may decide to check your cholesterol levels more frequently at home using a home cholesterol test kit.
  3. Under medication: If you're taking cholesterol-lowering medications, you may be advised to monitor your cholesterol levels more regularly, especially initially to assess the effectiveness of the medication. Once stable, monitoring may become less frequent.
  4. Individualised approach: The frequency of cholesterol checks is highly individualised. Factors such as age, overall health, family history, and the presence of other cardiovascular risk factors influence the monitoring schedule.
  5. Changes in health status: If there are significant changes in your health status, such as weight gain, development of diabetes, or other health conditions, you may need to adjust the frequency of cholesterol monitoring.

It's advisable to consult with a medical professional such as your doctor or a clinical dietician for personalised advice based on your health history, risk factors, and overall well-being. They can interpret your cholesterol levels and provide guidance on lifestyle changes or medication if necessary.

How to prevent raised Cholesterol levels

When it comes to Cholesterol, prevention is better than cure. Preventing raised cholesterol levels for most of us involves adopting a healthy lifestyle that includes a healthy diet mainly plant based, regular physical activity, and other positive healthy habits.

Here are some strategies to help you maintain healthy cholesterol levels:

1) Eat a healthy diet to prevent high cholesterol:

  • Eating a predominantly whole food plant based diet has been shown in numerous clinical studies, to be effective in reducing cholesterol levels and improving health generally most individuals. 
  • Limit saturated and trans fats in your diet: Reduce the intake of saturated and trans fats found in meat, full-fat dairy products, fried foods, and many processed foods.
  • Increase omega-3 fatty acids: Include plant based sources of omega-3 fatty acids in your diet like flaxseeds, chia seeds, and walnuts. Although fish can be a good source of omega 3 most fish contains high levels of toxins and heavy metals, and so should be eaten only in moderation or avoided. 
  • Fiber-rich foods: Consume a diet rich in soluble fiber, which can help lower LDL (bad) cholesterol. Foods like oats, beans, lentils, fruits, and vegetables are excellent sources.
  • Reduce the amount of oil you use in cooking, and choose healthier cooking oils: Poach in water rather than frying and use oils, such as olive oil, canola oil, and avocado oil, in place of saturated or trans fats.
  • Limit fat and cholesterol intake: Reduce dietary fat and cholesterol by moderating the consumption of egg yolks, organ meats, and high-cholesterol foods. 
  • Limit processed foods: Processed foods often contain unhealthy fats and high levels of sodium. Choose whole, unprocessed foods whenever possible.

2) Regular Physical Activity:

  • Make exercise a part of your daily lifestyle. Engage in regular aerobic exercise, such as brisk walking, jogging, cycling, or swimming. Aim for at least 150 minutes of moderate-intensity exercise per week.

3) Maintain a Healthy Weight:

  • Achieve and maintain a healthy weight through a combination of a healthy diet and regular physical activity.
  • Intermittent fasting (where you only eat in an eating window) can also be a helpful tool for weight loss for many people.
  • Losing excess weight can help improve cholesterol levels.
  • There are lots of tools that can help you with weight loss. One we particularly like is the Lose It App. 
4) Quit Smoking:
  • Smoking damages blood vessels and lowers HDL (good) cholesterol. Quitting smoking can have numerous health benefits, including improving cholesterol levels.
5) Limit Alcohol Intake:
  • There is probably no healthy level of alcohol consumption and it would probably be better for our health not to drink it at all. If you do consume alcohol, try to do so in moderation. For most adults, this means up to one drink per day for women and up to two drinks per day for men.
  • If you are looking to reduce your alcohol intake, and have more drink free days, there is a free NHS app that can help, called Drink Free Days that we love.
6) Regular cholesterol testing:
  • Schedule regular checkups and monitor your cholesterol levels either with your doctor or at home.
7) Medication, if necessary:
  • For most people lifestyle changes, particularly dietary changes will lower cholesterol levels. 
  • It is important to understand that most doctors have had little or no training on diet modification for reducing cholesterol, and will be more used to prescribing statins to reduce cholesterol, than offering dietary advice. 
  • If lifestyle changes alone are insufficient to manage cholesterol levels, or you are unable to stick with the changes, your doctor may recommend medication, especially if you have other risk factors or a history of cardiovascular disease.
8) Stay hydrated:
  • Drinking plenty of water supports overall health and may contribute to a healthy lifestyle.

It's important to note that individual responses to lifestyle changes can vary. Therefore, it's advisable to work closely with your doctor or healthcare provider to develop a personalised plan based on your health status, risk factors, and goals. Regular monitoring of your cholesterol levels and adjustments to your lifestyle can contribute to long-term cholesterol management and overall improved cardiovascular health.

What is Familial hypercholesterolemia 

Familial hypercholesterolemia (FH) is a genetic disorder characterised by significantly elevated levels of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is often referred to as "bad" cholesterol because elevated levels can contribute to the buildup of plaque in the arteries, leading to a higher risk of cardiovascular diseases, including heart attacks and strokes. FH is an inherited condition, meaning it is passed down from parents to their children through specific genetic mutations.

Key features of familial hypercholesterolemia include:

  1. Genetic basis: FH is primarily caused by mutations in genes responsible for regulating cholesterol metabolism, particularly the LDL receptor gene or the APOB gene. These mutations lead to impaired removal of LDL cholesterol from the bloodstream.
  2. Early onset: Individuals with FH often have elevated cholesterol levels from a young age, even in childhood. This early onset of high cholesterol significantly increases the risk of developing cardiovascular diseases at a younger age.
  3. Familial pattern: FH tends to run in families. If one parent carries a gene mutation for FH, there is a 50% chance of passing it on to each child. If both parents have FH, the risk is higher.
  4. Clinical presentation: The clinical presentation of FH can vary, but individuals with this condition typically have cholesterol levels well above the normal range. Physical signs, such as xanthomas (cholesterol deposits under the skin) and corneal arcus (a white or grayish ring around the cornea), may also be present in some cases.
  5. Increased cardiovascular risk: FH significantly increases the risk of premature cardiovascular diseases. Individuals with untreated FH are at a much higher risk of heart attacks and other cardiovascular events compared to the general population.
  6. Screening and diagnosis: Screening for FH involves a combination of cholesterol testing, family history assessment, and genetic testing. Genetic testing can confirm the presence of specific mutations associated with FH.
  7. Treatment: The management of familial hypercholesterolemia often involves a combination of lifestyle modifications and medication. Statins and other cholesterol-lowering medications are commonly prescribed. In some cases, more advanced therapies may be considered.
  8. Cascade screening: Cascade screening involves identifying and testing relatives of individuals with FH to identify others at risk. Early detection and intervention can help prevent or delay the onset of cardiovascular diseases in family members.

Cholesterol testing information page last reviewed and updated by Dr Kate Garside 22/1/24

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