Heart Health

29 November 2012

Cholesterol: understanding the figures

Cardiovascular disease (CVD) is a leading cause of death and disability in South Africa.


Cardiovascular disease (CVD) is a leading cause of death and disability in South Africa. The prevalence of CVD is increasing in all our population groups.  The blood cholesterol level is directly linked to the risk of suffering a heart attack, stroke or sudden death.

Today we help you understand your risk by explaining LDL cholesterol and showing how to effectively reduce your risk.

By using your age, sex, blood cholesterol analysis, blood pressure and cigarette smoking status we calculate your 10 year relative risk of having a cardiovascular event.  This is called the  Framingham Risk Score.  According to an individual’s score, you may be classified as having a:

  • low - < 3% 10 year risk
  • moderate - 3-15% 10 year risk
  • high - 15-30 % 10 year risk or
  • very high risk - > 30% 10 year risk of a cardiovascular event.

We do not need to score people who have established vascular disease like those who are diabetic, have had a heart attack, a stroke, or suffer from kidney disease. We look upon these people  as being at very high risk .

Once we know your risk, what can we do about it?

We target a reduction in your LDL cholesterol to a level that we know will reduce death, heart attack, stroke, and heart failure.

If you are in the very high risk group, then your LDL-Cholesterol level  must be lowered to and then remain  < 1.8 mmol/l.

The level of LDL-Cholesterol is measured by the analysis of a  blood sample after an overnight 10 hour fast. This will detail the  total cholesterol and LDL-Cholesterol levels. 

If you think you may be at risk ask your doctor to assess your Framingham Cardiovascular Risk and then target your LDL-C level.

This applies to all South Africans and not just the very high risk group. Individuals who may be smokers, have high blood pressure, a family history of heart disease or other cardiovascular risk factors are all at risk.

If you are considered to be at high risk then your LDL-C should be < 2,5 mmol/l.

People with moderate or low risk need to target a LDL-Cholesterol level of <  3 mmol/l.

Target LDL-Cholesterol levels can be achieved by a reduced saturated fat and refined sugars diet. Where necessary, especially the high and very high risk people, a doctor will recommend drug therapy (statin medication).

Whilst following lifestyle advice and taking medication where advised, it is critical to know your individual goal level of LDL-Cholesterol that you are trying to achieve. Know your risk category, and follow your doctor’s advice to get to your LDL-Cholesterol target and prevent a cardiovascular event.


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