Cholesterol

Cholesterol
Healthy Lives
Physiological Risk Factors
Adult Healthy Weight
CVD
Cardiovascular Conditions
Cardiovascular Disease
Cardiac Risk Factors
Cholesterol Management
Heart Health

introduction Introduction

What is Cholesterol?

Blood cholesterol is a waxy, fat-like substance produced by the liver essential for various bodily functions such as synthesising hormones and cell membrane formation. The body is able to produce all the cholesterol it needs, so dietary cholesterol is not an essential nutrient.1

Dietary cholesterol, in contrast, is found in animal-based products such as meat, seafood, poultry, eggs, and dairy products. Experts recommend limiting dietary cholesterol intake2. The rationale behind this is that increased blood cholesterol levels and elevated risk of heart disease can result from a diet rich in cholesterol, particularly saturated and trans fats.

Since cholesterol and another type of blood fat, triglycerides, cannot circulate freely in the blood, the liver packages them into “parcels” known as lipoproteins. Two types of lipoproteins include:

  1. Low-density lipoprotein (LDL), sometimes called “bad” cholesterol, as high levels contribute to plaque buildup in the arteries (atherosclerosis).
  2. High-Density Lipoprotein (HDL), sometimes considered the “good” cholesterol, as it helps remove LDL cholesterol from the arteries.3

These lipoproteins are released into the bloodstream to transport fats around the body to where they are required. Once in the bloodstream, some cholesterol will return to the liver and undergo breakdown. The liver uses cholesterol to produce bile acids, which are delivered into the intestines to aid digestion by breaking down the fats in diet. But most bile acids will be absorbed back into the blood, returned to the liver, and used again for digestion. In order to regulate excessive cholesterol, certain medications prevent bile from being reabsorbed into the bloodstream. To produce more bile acids, the liver needs to remove more cholesterol from the blood, which ultimately lowers cholesterol levels.

Cholesterol can bind with other substances to produce a thick, hardened deposit (plaque) on the inner lining of the arteries. This narrows and stiffens the arteries, resulting in a condition called atherosclerosis. As a result, the formation of a blood clot may obstruct one of these constricted arteries and cause a heart attack or stroke.

Raised total cholesterol, by age and sex

Raised total cholesterol is defined as total cholesterol equal to or greater than 5 mmol/L. No distinction is made between different types of cholesterol.

According to the Health Survey for England, in 2021 there was no statistically significant difference in prevalence of raised cholesterol between men and women. The prevalence of raised cholesterol differed by age and was highest among those aged between 45 and 64.4

What raises the risk for unhealthy blood cholesterol levels?

Unhealthy lifestyle habits

  • Poor dietary habits, which include consuming a high intake of saturated and trans fats, are a primary cause of raised “bad” LDL cholesterol. Fatty cuts of red meat and dairy products are high in saturated fat and should not exceed 10% of daily calorie intake.
  • Lack of physical activity is associated with an increased risk of unhealthy blood cholesterol levels. Activity helps to elevate “good” HDL cholesterol.
  • Smoking increases LDL cholesterol while lowering HDL cholesterol, especially in women.
  • Stress can lead to increased levels of hormones like corticosteroids. This may lead to raised cholesterol production in the body.
  • Excessive alcohol intake (more than two drinks for males and one drink for women each day) can increase total cholesterol level.

Family history

The cholesterol levels of family members are typically similar. This suggests that having unhealthy cholesterol levels may be inherited. Mutations or changes in genes that control cholesterol levels can cause familial hypercholesterolaemia. In individuals with family history of high blood cholesterol, the body may find it more difficult to eliminate LDL cholesterol from the blood or to break it down in the liver.

Age

Individuals of all ages are affected by unhealthy cholesterol levels, even young children. But the vast majority of those diagnosed with elevated cholesterol are between 40 and 59. The body’s metabolism alters with increasing age as the way the liver eliminates “bad” LDL cholesterol changes over time. These natural changes may raise the susceptibility to high blood cholesterol.

Race or ethnicity

The risk of high blood cholesterol may differ depending on race or ethnicity.

  • Overall, non-Hispanic White people are more likely than other groups to have high levels of total cholesterol.
  • Asian Americans, including those of Indian, Filipino, Japanese, and Vietnamese descent, are more likely to have high levels of “bad” LDL cholesterol than other groups.
  • Hispanic Americans are more likely to have lower levels of “good” HDL cholesterol than other groups.
  • African Americans are more likely than other groups to have high levels of “good” HDL cholesterol.

According to a study, higher HDL levels in some Black and White adults might not be as advantageous as previously thought. The health advantages of increased HDL levels may be outweighed by other risk factors like diabetes, obesity, or high blood pressure.5

Sex

Men are more likely than women to have high total cholesterol between the ages of 20 and 39. This risk increases with postmenopausal women. This is because female hormones that prevent excessive blood cholesterol are reduced during menopause. Following menopause, total and “bad” LDL cholesterol often increases.6

why is it important to population health Why is it important to Population Health?

The importance of cholesterol for population health:

Epidemiological Evidence

Large-scale population studies have consistently shown a strong association between high blood cholesterol levels and increased risk of cardiovascular disease, heart attacks, and strokes. These studies have helped establish cholesterol as a major modifiable risk factor for heart disease at the population level. By tracking cholesterol levels across different demographics, epidemiological research has guided population health interventions and policies targeting cholesterol management.

Cholesterol Subtypes

LDL (low-density lipoprotein) cholesterol is considered “bad” as it contributes to plaque buildup. In contrast, HDL (high-density lipoprotein) cholesterol is often referred to as the “good” cholesterol, as it can help lower LDL levels. Monitoring the balance between LDL and HDL is crucial for assessing an individual’s and a population’s cardiovascular disease risk.

Genetic Factors

Certain genetic variations can predispose individuals to higher or lower cholesterol levels, irrespective of lifestyle factors. Understanding the genetic basis of cholesterol regulation has implications for targeted screening and interventions within specific populations. Advances in genomics allow for the identification of genetic markers that can help stratify population-level cholesterol risk.

Socioeconomic Disparities

Cholesterol levels and associated cardiovascular disease risk can vary across socioeconomic groups within a population. Factors like access to healthcare, diet quality, and physical activity levels can contribute to these disparities. Addressing the social determinants of health is essential for reducing cholesterol-related inequities and improving population-level outcomes.

Global Burden of Disease

Elevated cholesterol is a significant contributor to the global burden of disease, particularly in low- and middle-income countries undergoing epidemiological transitions. As these populations adopt more fatty diets and sedentary lifestyles, the prevalence of unhealthy cholesterol levels and associated cardiovascular diseases will continue to rise. Targeted interventions and population health strategies are needed to manage cholesterol and mitigate this growing global health challenge.

In summary, the importance of cholesterol for population health is multi-faceted, spanning epidemiological evidence, genetic factors, socioeconomic disparities, and the global burden of disease. Comprehensive approaches to cholesterol monitoring and management are essential for promoting long-term cardiovascular and metabolic health at the population level.

the derbyshire population approach The Derbyshire Population Health Approach

The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.

When considering the topic of cholesterol within The Derbyshire Population Health Approach:

• Prevention Prevention

Cholesterol management efforts focus on preventive strategies with the aim to reduce the incidence of cholesterol-related cardiovascular diseases and improve the overall cardiovascular health of the population. Universal routine cholesterol screening for all adults, not just those at high risk, allows for early identification of individuals with elevated cholesterol levels, even before the development of overt cardiovascular disease. Risk stratification, whereby individuals are categorised based on their overall cardiovascular risk, which includes their cholesterol levels, allows for targeted interventions and a personalised approach to prevention, ensuring that high-risk individuals receive more intensive management.

• Population Population

Based on the risk stratification of the population, targeted interventions to address the specific needs of different risk groups may include lifestyle modification programmes, medication management, and specialised care for individuals at higher cardiovascular risk. The involvement of community stakeholders, such as local government, schools, workplaces, and community organisations, to promote healthy behaviours and cholesterol management helps to create a supportive environment for population-level changes.

Ongoing monitoring and evaluation of the population-level impact of cholesterol management interventions allows for the identification of effective strategies and the adaptation of the approach based on the evolving needs of the population. Health equity considerations aim to address health disparities and ensure equitable access to cholesterol management services across different socioeconomic and demographic groups within the population. Adopting a population-level perspective seeks to improve the overall cardiovascular health of the community rather than focusing solely on individual-level interventions.

• Evidence Evidence

Population health practitioners rely on robust population-level data on cholesterol levels, cardiovascular risk factors, and disease burden within the Derbyshire region. This data helps to identify the scope of the problem and target the areas of greatest need. The interventions and cholesterol management strategies are aligned with evidence-based clinical guidelines, such as those from the National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC). This ensures that the approach is based on the latest scientific evidence and best practices in cholesterol management.

To ensure that the approach is sustainable and provides the best value for the healthcare system and the community, health economics analyses are conducted to consider the cost-effectiveness of the proposed interventions. This takes into account the potential longterm benefits of improved cholesterol management and reduced cardiovascular disease burden. By grounding the approach in a strong evidence base, proposed interventions aim to maximise the impact of cholesterol management strategies and improve the overall cardiovascular health of the community.

• Causes Causes

Cholesterol management efforts in population health focus on understanding the causes and risk factors of elevated cholesterol levels and cardiovascular disease. Recognising the significant impact of modifiable lifestyle factors, such as diet, physical activity, and smoking, on cholesterol levels and overall cardiovascular health leads to interventions that focus on promoting healthy lifestyle behaviours to address the root causes of high cholesterol. Socioeconomic determinants can influence an individual’s risk of developing high cholesterol and cardiovascular diseases. Strategies are implemented to address health disparities and ensure equitable access to cholesterol management services. By understanding the multifaceted causes of elevated cholesterol and cardiovascular disease, interventions can be tailored to address the underlying drivers of the problem at the population level.

• Collaboration Collaboration

Fostering collaborative partnerships across various sectors and stakeholders allows a coordinated and effective system to be created for improving cholesterol management and overall cardiovascular health within the community. This enables a comprehensive and integrated approach to cholesterol management, addressing the social, environmental, and economic determinants of cardiovascular health. Primary care providers play a pivotal role in cholesterol screening, risk assessment, and ongoing management. Active community engagement to promote cholesterol awareness, healthy behaviours, and access to services helps to reach and support individuals and communities, especially those at higher risk or with limited access to healthcare. Population health practitioners encourage the sharing of best practices, lessons learned, and innovative strategies with other regions and healthcare systems to foster the dissemination of evidence-based approaches and the continuous improvement of cholesterol management initiatives.


latest derbyshire data Latest Derbyshire Data


Trend Data


Derbyshire Quilt


Prevalence Maps of Derbyshire

The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.