Interview with A/Prof Monique Watts about Cholesterol

Interview with A/Prof Monique Watts about Cholesterol

Interview carried out with Dr Linda Worrall-Carter (Founder & CEO) and A/Prof Monique Watts, Her Heart Adviser

We are thrilled to be working with you at her Heart, and would love for others to hear a little more about you and why you are so passionate about women’s heart health.

For many years assumptions were made that women’s hearts and men’s hearts were the same. This sadly resulted in many women being undiagnosed, untreated and falsely reassured when they presented with heart attacks that didn’t look the same as heart attacks in men. Lack of awareness, diagnosis and treatment results in poorer outcomes, not to mention confusion and frustration with no answers as to the cause of very real symptoms and pathology. When I began private practice some years back, I found I was seeing a disproportionate number of women without a firm diagnosis but with clear symptoms and pathology and I realised there that there exists a large unmet need in the area of Women’s Cardiology and that we needed to do better for our female patients. The Alfred Women’s Heart Clinic was established in response to this to provide specialised care to women who are at risk of and have heart disease. In particular, we specialise in conditions more frequently seeing in women. These conditions include Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA), Spontaneous Coronary Artery Dissection (SCAD), coronary microvascular dysfunction, coronary artery vasospasm and Takotsubo cardiomyopathy. The clinic not only provides a clinical service for women at risk of and with heart disease, but a source of much-needed education about women’s heart disease for patients, physicians and doctors and the wider community. The clinic ensures much-needed research into women’s heart disease can be undertaken. 

Why Cholesterol is important?

Cholesterol is one of the most talked about topics in healthcare today, and having high cholesterol is a serious health concern that can increase your risk of developing cardiovascular disease. If we think about risk factors, there are some things that we cannot change such as our genetic makeup but the good thing about Cholesterol is that it can be managed. 

Tell us more about Cholesterol and how it works:

Cholesterol is a waxy substance that’s naturally produced by the liver and found in many foods. It helps build cells, hormones, and Vitamin D in the body. However, too much of it is the problem as it increases your risk of heart disease. Our total body cholesterol includes both “good” and “bad” cholesterol. The high-density lipoprotein (HDL) are the “good kind” and help protect against heart disease by carrying cholesterol away from the arteries and back to the liver where it can be broken down. Whereas the Low-density lipoprotein (LDL) are the “bad” cholesterol that contributes to plaque build-up in the arteries, which can lead to heart disease.

You might also hear the term Triglycerides; these are a type of fat (lipid) found in the bloodstream and stored in fat cells throughout the body, which is used as a source of energy by the body. High levels of triglycerides are often associated with other risk factors for heart disease, such as low levels of “good” cholesterol (HDL), high levels of “bad” cholesterol (LDL), and high blood pressure. 

You might also read about LDL-C. LDL-C stands for low-density lipoprotein cholesterol. It’s called LDL-C because it refers specifically to the cholesterol that is carried by low-density lipoprotein particles (LDL particles), which are often referred to as “bad” cholesterol as it’s the cholesterol that leads to blockages in the heart arteries. This is where the LDL-C is measured as part of a lipid panel, which also includes measurements of total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. The results of a lipid panel can help healthcare providers assess a person’s overall risk of developing heart disease and determine the best course of treatment to manage their cholesterol levels.

How can we get Tested for Cholesterol? 

Your doctor will perform a simple fasting blood test that measures the amount of HDL, LDL and triglycerides in your bloodstream. Based on those results and your other risk factors, your doctor will determine whether further testing or treatment is necessary for you to stay healthy.

Knowing your cholesterol level is important because elevated levels may not cause any symptoms but put you at increased risk for developing heart disease or having a stroke. By understanding what cholesterol is, how it’s tested and interpreted, and being proactive with regular screening with your doctor—you can take control of your health and make sure that your risk of heart disease is minimised. 

What are the levels that we need to be aware of?

The ideal levels of cholesterol and triglycerides vary depending on an individual’s specific needs and medical history and this is something you should discuss with your doctor. However, for individuals who aren’t at elevated risk, your total cholesterol score should ideally be less than 5.0mmol/L which includes both HDL & LDL levels combined together. Your HDL cholesterol needs to be more than 1.0mmol/L and your “bad” LDL cholesterol less than 2.0mmol/L, and Triglycerides, less than 1.5mmol/L. 

What can we do to improve our Cholesterol?

There are a number of things you can do, but two of the most important are to maintain a healthy diet and exercise. This means eating a balanced diet that is low in saturated fat, trans fat, and cholesterol, and high in fibre, fruits, vegetables, and lean protein. The Australian Guide to Healthy Eating recommends reducing the total amount of fat in the diet to less than 30% of total energy intake. Less than 10% of total energy intake should come from saturated fat. In terms of physical activity, making sure you undertake regular exercise (30 minutes at least 3, but ideally most days of the week) helps to lower cholesterol levels, raise HDL levels and improve the body’s sensitivity to insulin.

Can you tell us a little about Cholesterol-Lowering Medications?

It’s not uncommon for doctors to prescribe cholesterol-lowering medications. The most commonly prescribed cholesterol medications are “statins.” These medications function by preventing the production of “bad” cholesterol (LDL) and/or eliminating it from the bloodstream by binding with bile acids in the gut before they are reabsorbed into the bloodstream. There are different classes of cholesterol medications, another newer class is a class called PCSK9 inhibitors. These are injectable agents rather than tablets and result in a greater ability of the liver to bind cholesterol, leaving less to be absorbed into the bloodstream. With consistent use, cholesterol-lowering medications can lower LDL levels in the body over time. Additionally, they can boost the production of “good” cholesterol (HDL), which aids in removing excess LDL from the arteries and reducing inflammation in the body. 

Are there any other things that we should consider with Cholesterol?

High cholesterol causes no symptoms – which is why regular blood tests are so important when monitoring your health. A cholesterol and blood pressure check should be part of your regular heart health check, which is recommended once you turn 45, or 35 for First Nations People. Being overweight increases your risk for high cholesterol but not everyone who has high cholesterol is overweight or obese. Genetics play an important role in determining a person’s risk for high cholesterol – even those at a normal weight can develop unhealthy levels from poor diet or hereditary factors. Again, regular testing is key in knowing where you stand with your health specifically related to your risk for high cholesterol.