Hyperlipidemia

Blood lipids: cholesterol and triglycerides

Fats are present in the body in different forms: free fatty acids, cholesterol and triglycerides. Cholesterol circulates in the blood both in free form and bound to lipoproteins.

• Low-density lipoprotein cholesterol (LDL, “bad” cholesterol) carries cholesterol produced in the liver. It accumulates mainly in the arteries supplying the heart and narrows them. As a result, blood flow to the heart decreases, the heart muscle does not receive enough oxygen, and a myocardial infarction may occur.
• High-density lipoprotein cholesterol (HDL, “good” cholesterol) prevents cholesterol from building up in the arteries and protects against heart disease.
• Triglycerides are another type of blood lipid. High levels increase the risk of heart disease; they may also rise with a high-fat diet, diabetes and other conditions.

Testing and reference values

People over 20 are advised to have their total cholesterol, LDL and HDL cholesterol and triglycerides checked every 5 years. Results can be compared with the values below (mg/dL).

• LDL cholesterol: below 100 — optimal; 100–129 — near optimal; 130–159 — borderline high; 160–189 — high.
• Total cholesterol: below 200 — optimal; 200–239 — borderline high; 240 and above — high.
• HDL cholesterol: below 40 in men and below 50 in women — low; 60 and above — high.
• Triglycerides: below 150 — desirable; 150–199 — borderline high; 200 and above — high.

What raises blood cholesterol?

• Diet: foods rich in saturated fat and cholesterol, such as butter, egg yolks, fatty meat, fatty chicken eaten with the skin, milk, yogurt and cheese; fat making up more than 35% of the daily diet.
• Excess weight: losing weight lowers total cholesterol, LDL cholesterol and triglycerides and raises HDL cholesterol.
• Lack of physical activity: a sedentary lifestyle raises LDL cholesterol. Regular exercise lowers “bad” lipids and increases “good” ones.

Dietary advice

Choose foods low in saturated fat and cholesterol. Of your daily energy intake, 25–35% should come from fat, 55–60% from carbohydrates and 12–15% from protein.

With an average intake of 1,500 calories a day, butter should be limited to 1 dessert spoon, sunflower and corn oil to 1.5 dessert spoons, and olive and hazelnut oil to 3 dessert spoons. Margarine may be used only rarely, choosing a soft, low-calorie type. Clarified butter, tail fat and fried foods should be avoided.

Food choices

• Bread and grains. Good choice: wheat bread, wholegrain bread and flour, rye and oat bread, bulgur, legume, vegetable and bulgur dishes cooked with olive oil, oatmeal. Moderate choice: rice and vegetable dishes cooked with olive oil, vegetable oil or soft margarine, pasta, white bread. Not recommended: baked goods high in fat and sugar (cakes, biscuits, crackers).
• Fats. Best choice: olive oil, hazelnut oil, vegetable oil. Good choice: soft and low-calorie margarine, hazelnut, peanut and walnut oils. Not recommended: butter, tail fat, hard margarine, sweetened hazelnut and peanut spreads.
• Meat, poultry, fish and legumes. Best choice: fish, skinless white poultry meat, legume dishes cooked with olive or vegetable oil. Good choice: dark poultry meat, lean beef and lamb. Moderate choice: legume dishes with meat. Not recommended: sausages, frankfurters, qovurma (preserved fried meat), fatty red meat, fried meat, poultry wings and poultry with skin.
• Milk and dairy products. Good choice: low-fat or fat-free dairy products, brine cheese and other cheeses made from low-fat milk, desserts made from fat-free or low-fat milk. Not recommended: full-fat dairy products, fatty cheeses, cream-based ice cream, milk-chocolate sweets, puddings.
• Vegetables and fruit. Best choice: leafy greens (coriander, parsley, lettuce, rocket, etc.), cabbage, capers, cauliflower, tomatoes, broccoli, spinach, peaches, berries, strawberries. Good choice: other fresh fruit and vegetables.

Weight, physical activity and medication

• Keep your body weight under control. Weight is assessed with the body mass index (BMI = weight, kg / height², m²); the best range is 18.5–25 kg/m².
• Regular physical activity: at least 40 minutes of moderate-intensity exercise a day.
• If the target blood lipid levels (LDL cholesterol below 100 mg/dL) are not reached despite a proper diet and physical activity, medication is needed. The most commonly used drugs are statins.