Robert returned home a few weeks ago from his family doctor feeling annoyed. He had gone for a routine check-up. He was told that all seemed well, except that he needed to lose 10kg to reach his ideal weight.

Today, he received the results from the blood tests. Everything was fine except for his cholesterol. The doctor said his cholesterol was too high and he was given a referral to see a dietician.

"I feel fine," said Robert. "I am just a bit overweight. What is cholesterol anyway? What's all this fuss about?"

What is high cholesterol?

Robert has hypercholes-terolaemia or high concentrations of low-density lipoprotein-cholesterol (LDL-C) in his blood. Low-density lipoproteins (LDL) are the particles that transport most of the cholesterol in the blood. Cholesterol is usually made in the liver or absorbed from animal foods. Robert's liver is responsible for overproduction of LDL-C as well as decreased LDL uptake from his blood.

What causes it?

The most common cause of high blood cholesterol is genetic and lifestyle related. A susceptible genotype superimposed on excessive consumption of saturated fats, trans fat and cholesterol, as well as obesity and an inactive lifestyle, has led to a rise in LDL-C in the world's peoples. As populations become more Westernised, access to fast foods increases and there is a rise in LDL-C. A few people suffer from an inherited abnormality of cholesterol levels.

Why the concern?

The most important consequence of high LDL-C is an increased risk of coronary heart disease. The LDL-cholesterol accumulates on the inner walls of the arteries creating cholesterol plaques. These cause a clot to develop, leading to blockage of the arteries. Studies of large groups have shown that elevated levels of LDL-C are associated with heart attacks, strokes and death. This increase in LDL-C is common in men younger than 55 years and in postmenopausal women. High cholesterol levels increase with advancing age.

What can I do?

Everyone should be screened for high LDL-C levels from age 20 years. The US National Cholesterol Education Program Adult Treatment Panel 111 recommends screening every five years. The screening requires the man to fast overnight (nine to 12 hours) before doing the full lipid blood test.

Managing your diet

Persons diagnosed with elevated LDL-C should change their diet and increase physical activity. The diet should consist of fruits, vegetables, peas, beans, lean meats, poultry and fish. High-fat foods are to be avoided. These include whole milk, ice cream, butter, egg yolks and cheese. Organ meats (liver, kidney and brain) and processed meats such as sausage, bologna, and salami are not recommended.

Dietary supplements

Persons with elevated LDL-C should receive dietary counselling from a registered nutritionist or dietician. Fish oil which contains two or three grams of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) will help to lower LDL-C levels. Some people will require medication and medical care from a physician.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.