Almost three-quarters of adults over the age of 45 have hypercholesterolaemia - raised cholesterol - and it is one of the major causes of heart disease. Lisa Fuller explores the condition
People are becoming increasingly aware of the dangers of obesity, poor diet and lack of exercise. One of the most common consequences of one or more of these factors is raised cholesterol. Seven out of 10 adults over the age of 45 have raised cholesterol and over half a million children in the UK are obese. This represents a very worrying statistic for the health of the nation's future adults and therefore a key topic for both underwriting and the general public.
Raised cholesterol is one of the major causes of chronic heart disease and other related conditions affecting the heart and blood vessels. Yet, cholesterol is actually an important fat found in the blood of all humans and animals. People need a certain level of it in their blood to stay healthy, as it plays an important role in digestion, metabolism and cell building. Some of it comes from what people eat but the majority is manufactured by the liver.
The main health risks of raised cholesterol are that it greatly increases the chances of having a heart attack or stroke. People may be completely unaware that their cholesterol levels are raised, as it does not tend to produce any symptoms until quite high.
Cholesterol is carried in the blood stream by molecules called lipoproteins. There are several different types of lipoproteins, but two of the main ones are low-density lipoproteins (LDL), and high-density lipoproteins (HDL).
LDL is often called the 'bad' cholesterol. When LDL levels are high, fat seeps into the walls of the arteries in all parts of the body. Here it causes thickening and hardening, narrowing the artery walls, which in turn hinders the flow of blood. This condition is called arteriosclerosis. The lining of the artery also becomes roughened, causing blood cells to stick to the inside wall of the artery and, as a result, blood clots can form.
Blood clots can block arteries or become dislodged and slide further down the artery directly into the organ that it is supposed to be supplying with fresh blood. When this happens it is called an embolism. If the organ is the brain, then the result will be a stroke. If the organ is the heart, it will produce angina or a heart attack. It can also affect the arteries of the legs, causing pain when walking and even gangrene. All arteries of the body share the risk but some more so than others.
The good type of cholesterol, HDL, helps protect arteries by moving some of the bad cholesterol away from cells and to the liver where it can be broken down or passed from the body as a waste product. Men tend to have naturally lower HDL levels than women. Smoking is also known to decrease HDL levels.
Triglycerides are another type of fatty substance in the blood, found in foods such as dairy products, meat and cooking oils. They can also be produced in the body either by the body's fat stores or in the liver. People who are very overweight, eat a lot of fatty and sugary foods, or drink too much alcohol are more likely to have a high triglyceride level. A high level of triglycerides also causes arteriosclerosis and the risk of premature heart disease and stroke.
About one in 500 of the European population has familial hypercholesterolaemia. This inherited condition accounts for about 5% of patients with premature ischaemic heart disease. Incidence of this condition is higher in some populations such as South Africans. It is caused by an inherited faulty gene and means that the person has higher levels of LDL and is more likely to suffer from premature heart disease. Because the condition is present from birth it can go undetected unless the person has a blood test or presents with symptoms.
Symptoms
Most people with raised cholesterol will be unaware that they have the condition until it is picked up by a blood test. Normally, by the time people start having symptoms it can be dangerously high. These are some of the symptoms:
- Angina caused by narrowed arteries in the heart.
- Leg pain on exercising due to narrowing of the arteries that supply the lower limbs.
- Blood clots and ruptured blood vessels, which can result in a stroke or transient ischaemic attack - a mini-stroke.
- Ruptured plaques, which can lead to a blood clot forming in one of the arteries delivering blood to the heart (coronary thrombosis), and may lead to heart failure if a significant amount of heart muscle is damaged.
- Thick yellow patches (xanthomas) around the eyes or elsewhere on the skin. These are cholesterol deposits and can often be seen in people with familial hypercholesterolaemia.
- A white ring on the cornea of the eye called an arcus.
Tests
Nowadays, it is very easy to get cholesterol levels checked. The best way to do this is with a doctor. They will be able to provide an accurate result and advise if people need to review their cholesterol levels or start treatment. However, it is now possible to get cholesterol tested at a pharmacy or sometimes at the workplace. People can also buy home kits to test themselves. Although, these tests will give a good indication of whether levels are raised, they are not as accurate as the blood tests a doctor can carry out.
The following people should have a cholesterol test:
- Anyone with cardiovascular disease or diabetes.
- Anyone with a family history of familial hypercholesterolaemia.
- Anyone aged 35 or over, especially if they have one or more of the following risk factors: family history of early heart disease, diabetes, high blood pressure or if they smoke.
When cholesterol is tested, the main figure given will be the total cholesterol reading. The following figures show what various cholesterol readings mean:
- Normal or ideal: less than 5mmol/l.
- Mildly high cholesterol: between 5mmol/l and 6.4mmol/l.
- Moderately high cholesterol: between 6.5 mmol/l and 7.8mmol/l.
- Very high cholesterol: above 7.8mmol/l.
Prevention
- Eat a well balanced diet that avoids too much fatty food.
- Keep weight within a healthy range.
- Take regular exercise as it can decrease LDL and increase HDL levels.
- Be mindful of any family history of raised cholesterol or heart disease.
- Moderate alcohol intake.
- Not smoke.
- People who are diabetic should take particular care as they will be more prone to developing raised cholesterol.
- Take any medication recommended by a doctor to help lower cholesterol.
- People should be mindful of their age as cholesterol levels rise naturally with age and get their cholesterol checked regularly.
Treatment
Some people are able to reduce cholesterol levels by modifying their diet and eating less fatty food, doing more exercise and reducing their alcohol intake. However, this does not always work satisfactorily.
Statin is the most widely used treatment a doctor could prescribe. Statins lower cholesterol by helping the liver clear LDL cholesterol from the bloodstream and therefore decreasing blood cholesterol levels in a short space of time.
However, prevention is much better than cure. Statins, like any form of medication, can occasionally have side effects. Doctors will regularly carry out blood tests on those taking statins to ensure the treatment is working and there are no adverse side effects.
Did you know?
Statistics confirm that bringing cholesterol levels down to normal if someone is under age 60 could reduce their chance of having a heart attack or stroke by as much as 30% to 40%.
It is estimated that 50% of coronary heart disease in developed countries is due to excess cholesterol levels.
About four million people in the UK currently take statins. Doctors are recommended to prescribe the drugs to anyone with a 20% risk of having a heart attack or stroke in the next 10 years.
People should not bury their heads in the sand anymore. It is easy to get cholesterol levels checked out - a few minutes may just save a life.
Sources:
Swiss Re Life Guide
www.bhf.org
www.nhsdirect.nhs.uk
www.Heartforum.co.uk
www.bupa.co.uk
Lisa Fuller is life and disability underwriter at Aegon Scottish Equitable
Underwriting implications
Raised cholesterol is frequently disclosed by people applying for all kinds of insurance protection. Underwriters will always ask if a client has had raised cholesterol or any family history of premature heart disease or stroke and investigate their medical history with this is mind. Some common questions that could be asked are:
- How long have they had raised cholesterol?
- What medication do they take?
- When did they last have their blood levels checked?
- Do they have raised blood pressure?
- Do they smoke?
- Have they had any heart problems?
- Are they overweight?
- Do they have any family history of premature heart disease or stroke?
All insurance companies have their own set of underwriting guidelines when it comes to assessing clients with raised cholesterol. However, if cholesterol levels are controlled, with or without treatment, without any complications, people will generally find that insurance companies are able to offer their best rates. However, someone with familial hypercholesterolaemia may be offered substandard rates as this condition has a greater effect on mortality and morbidity.
