Dr Dawn Harper explores some of the lesser-known things about cholesterol and makes some recommendations that could help all of us improve our cardiovascular health.

1. The good
   I doubt there is an adult in the UK who isn’t aware that high cholesterol levels are bad for you, but how many realise that not only is cholesterol good for us, it actually plays an essential role in the formation of cell membranes and the production of sex hormones - something few of us would wish to be without! Like most things in life, it’s a case of striking the right balance.
   Cholesterol is carried around the body by proteins. The combination of fat and protein are called lipoproteins, classified by weight into low density lipoproteins (LDLs) and high density lipoproteins (HDLs). LDLs are the main carrier of ‘bad’ cholesterol, whilst HDLs transport any excess away from the arteries and back to the liver, making them the ‘good’ cholesterol that can protect against heart disease.
2. The bad
   Problems develop when there is too much cholesterol in the blood stream so it settles in the artery walls, making them narrower and slowing the blood flow. Most people are surprised to learn that 80% of our cholesterol is made by our liver and in fact only 20% comes from our diet, but it’s this 20% we can do something about without resorting to medication. Following a few simple rules can significantly reduce cholesterol levels and as a direct knock-on effect may reduce the risk of heart disease by as much as 30%. Get into the habit of looking at fat contents of foods - there are two main sorts:
   • Saturated fats - these are animal fats and are "bad" fats.
   • Unsaturated fats - fats which help keep cholesterol levels down and are therefore ‘good’ fats (often of vegetable origin or from oily fish).
   It’s a simple rule of thirds - fats should account for no more than a third of your total daily calorie intake and you should keep saturated fats to a third of your total daily fat intake.
3. The ugly
   The ugly truth is that high cholesterol levels are at least partly responsible for nearly half of the 110,000 heart disease deaths in the UK every year. A tiny number of people with high levels develop fatty plaques around the eyes called xanthelasma (not attractive) but for the vast majority there are no tell-tale signs. I have known plenty of short, fat, dumpy people with low cholesterols and tall, thin, fit ones with very high levels.
   The bottom line is that if you don’t get it checked, you simply can’t predict what your cholesterol might be, so if you are over 40 and particularly if you have other risk factors for heart disease, make that appointment now.

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