Reducing your

blood cholesterol
Information for people with a high blood cholesterol level,
and for their family and friends
Produced by
British Heart Foundation
14 Fitzhardinge Street
London W1H 6DH
Phone: 020 7935 0185
Website: www.bhf.org.uk
Registered charity number: 225971

Heart information line: 0845 0 70 80 70 for confidential information on a

range of issues relating to heart disease

This booklet is one of the booklets in the Heart Information Series.

For a complete list of booklets see page 37.

Acknowledgements
Editor and Heart Information Series Director: Dr Vivienne Press

The British Heart Foundation would like to thank all the GPs,
cardiologists, and nurses who helped to develop the booklets in the
Heart Information Series. Thanks also to all the patients who
commented on the text and design.

Particular thanks for their work on this booklet are due to:
• Lee Hooper
• Lyndel Costain
• Medical Information Team, British Heart Foundation, and
• Wordworks, London W4 4DB, for plain English editing.
Contents
About this booklet 5
What are cholesterol, lipoproteins and blood lipids? 6
What part does cholesterol play in
coronary heart disease? 9
How is blood cholesterol measured? 10
When does a high blood cholesterol level matter? 12
What causes high blood cholesterol? 16
How can physical activity help to improve my
cholesterol level? 17
How can healthy eating help lower my
cholesterol level? 18
How can medication help? 24
Will I need to take medication? 27
FH (familial hyperlipidaemia) 29
For more information 36
About the British Heart Foundation 42
Technical terms 46
Index 48
About this booklet
This booklet is for people with a high blood
cholesterol level, and for their family and friends.
It explains:
• what cholesterol, lipoproteins and blood
lipids are
• the role of cholesterol in coronary
heart disease
• when a high blood cholesterol level matters
• what causes high blood cholesterol
• why smoking, physical inactivity and high
blood pressure are important
• how blood cholesterol is measured
• how physical activity and healthy eating can
help, and
• how medication can help.

It also gives information about the drugs that are

used to treat high blood cholesterol levels, and
about familial hyperlipidaemia (FH).

This booklet is not a substitute for the advice

your doctor, dietitian or cardiologist (heart
specialist) may give you based on his or her
knowledge of your condition.
What are cholesterol, lipoproteins
and blood lipids?
Cholesterol
Cholesterol is a fatty substance which is mainly
made in the body. The liver makes it from the
saturated fats in food. Very little cholesterol is
found in foods, except for eggs, liver and kidneys
which do contain some cholesterol.

Cholesterol plays a vital role in how every cell wall

works, throughout the body. It is also the material
which the body uses to make other vital chemicals.
However, too much cholesterol in the blood can
increase your risk of getting coronary heart disease.

Cholesterol has a special ‘transport system’ for

reaching all the cells which need it. It uses the
blood circulation as its ‘road system’ and is carried
on ‘vehicles’ made up of proteins. These
combinations of cholesterol and proteins are called
lipoproteins.

Lipoproteins
There are two main forms of lipoproteins.
• Low density lipoproteins (LDL), which carry
cholesterol from the liver to the cells.

6 ❘ British Heart Foundation

• High density lipoproteins (HDL), which return
the extra cholesterol that isn’t needed to the liver.

Blood lipids
You may also have heard the term ‘blood lipids’.
This is a name for all the fatty substances in the
blood, including HDL cholesterol, LDL cholesterol
and triglycerides.

If you have high levels of both triglycerides and

blood cholesterol, you run a greater risk of
coronary heart disease. The risk is particularly high
if you also have a low level of HDL cholesterol and
a high level of LDL cholesterol. (See the illustration
on the next page.) A high level of triglycerides also
increases the risk of coronary heart disease and
stroke.

British Heart Foundation ❘7

 How cholesterol is carried around the body

Your body produces more cholesterol if:

• you eat a diet that has a
lot of saturated fat, or LIVER
• you inherit certain
factors from
your parents.

HDL cholesterol LDL cholesterol

HDL returns the The amount of cholesterol removed
extra cholesterol TISSUES from the blood circulation is
which is not regulated by the cells which need
needed to the liver. cholesterol. In people with familial
hypercholesterolaemia (see page 29),

8 ❘ British Heart Foundation

the cholesterol is removed at a much
slower rate.
ARTERIES

If there is a high level of cholesterol in the blood, the artery

walls take up too much LDL. The risk of this happening is
greater if you smoke or have high blood pressure.
What part does cholesterol play in
coronary heart disease?
Coronary heart disease is caused when the blood
vessels to the heart (the coronary arteries) become
narrowed by a gradual build-up of fatty material
within their walls. This condition is called
‘atherosclerosis’. The fatty substance is called
‘atheroma’.

Atheroma develops when LDL cholesterol is

chemically changed (a process known as ‘oxidation’)
and is taken up by cells in the coronary artery walls
where the narrowing process begins. On the other
hand, HDL cholesterol removes cholesterol from the
circulation, and appears to protect against coronary
heart disease. So, the ratio of HDL to LDL in your
body is important. The goal is to have a low level of
LDL and a high level of HDL.

The level of LDL cholesterol in the blood tends to

rise, and HDL falls, with the amount of saturated
fats you eat. On the other hand, unsaturated fats
have a good effect as they tend to lower LDL levels.
As part of a healthy diet, it is important to eat
unsaturated instead of saturated fats, and to reduce
the total amount of fat you eat. (For more on this,
see page 19.)

British Heart Foundation ❘9

How is blood cholesterol
measured?
Measuring blood cholesterol level involves a simple
blood test. This can be done in two ways.
• Either a blood sample is taken with a syringe and
needle and sent to a laboratory for analysis.
• Or a finger prick (capillary sample) is taken and
analysed on a desktop analyser.

If you are having your triglyceride level measured,

you will be asked not to eat anything for 12 hours
before you have the test.

The blood cholesterol, triglycerides, HDL and LDL

are measured in units called millimols per litre of
blood, usually shortened to ‘mmol/litre’ or ‘mmol/l’.
Your target is to have a total cholesterol level under
5 mmol/l, and an LDL level under 3 mmol/l.

There can be quite a lot of variation in the levels of

blood cholesterol and other blood fats – both from
day to day and at different times of the day. So
your doctor won’t be worried if you have one high
reading. He or she will not usually decide about
treating you with drugs until they have a series of
these readings.

10 ❘ British Heart Foundation

After a heart attack the blood cholesterol
measurement may give a falsely low reading. So, if
you have recently had a heart attack, you might not
have the blood test until about three months after
the attack.

British Heart Foundation ❘ 11

When does a high blood
cholesterol level matter?
The average blood cholesterol level of people living
in England is 5.5 mmol/l. This is high compared to
other countries. For example, in China the average
is 4.5 mmol/l.

A high level of cholesterol is one of the most

important risk factors for coronary heart disease.
(A risk factor is something that increases your
chances of getting the disease.) The other major risk
factors are:
• smoking
• high blood pressure, and
• not being physically active enough.
The higher your cholesterol level, the higher your
risk of heart disease.

Your overall risk of having a heart attack is much

greater if you have other major risk factors as well
as a high cholesterol level – for example if you
smoke or have high blood pressure, or if you are
not physically active. The more risk factors you
have, the higher your risk of having a heart attack.

12 ❘ British Heart Foundation

Other ‘lifestyle’ factors which increase the risk of
heart disease are:
• not getting enough omega-3 fats (which are
found in oily fish)
• not eating enough fruit and vegetables
• being overweight or obese (very overweight)
• drinking too much alcohol, and
• having too much salt.

The risk of having a heart attack is also increased if

you already have angina or diabetes or have already
had a heart attack. There is also a greater risk of
heart attacks among people who have familial
hyperlipidaemia – an inherited condition in which
the blood cholesterol level is very high. For more
information on this see page 29.

British Heart Foundation ❘ 13

How the individual risk factors add up
All people who died from coronary
heart disease (CHD) under the age of 75

CHD related to
lack of physical
activity 37% CHD related to
high blood
cholesterol
CHD related levels 46%
to obesity 6%

CHD related CHD related to

to high blood smoking 19%
pressure 13%

This diagram shows how important the individual risk factors – lack
of physical activity, obesity, high blood pressure, high blood
cholesterol level and smoking – are in coronary heart disease. For
example, 46% of the people who die from coronary heart disease
under the age of 75 have a high blood cholesterol level.

The more individual risk factors you have, the higher your risk of
coronary heart disease.

14 ❘ British Heart Foundation

What you can do to help yourself
• Smokers can halve their risk of a heart attack
within five years of quitting.
• Physical activity can halve the risk of a heart
attack.
• For people with high blood pressure, reducing
blood pressure by 5 mmHg can reduce the risk of
having a heart attack by about 16%.
• For people who are overweight, reducing weight
can reduce cholesterol level and also reduce the
risk of a heart attack.

British Heart Foundation ❘ 15

What causes high blood
cholesterol?
The most common cause of high blood cholesterol
levels in people in the UK is too much fat in the diet.

Some people have high cholesterol levels as a result

of an underactive thyroid gland, or chronic renal
(kidney) failure, or alcohol abuse. Also, 1 in 500
people have high cholesterol levels because of an
inherited disorder called familial hyperlipidaemia
(see page 29).

16 ❘ British Heart Foundation

How can physical activity help to
improve my cholesterol level?
Regular physical activity every day – such as brisk
walking, swimming or cycling – can help improve
your cholesterol level. Physical activity increases the
level of HDL cholesterol (the protective
cholesterol), but does not affect LDL cholesterol.

Physical activity also plays an important part in

helping you to maintain or reach a healthy weight.
People who are obese are the most likely to have
high cholesterol levels.

British Heart Foundation ❘ 17

How can healthy eating help
lower my cholesterol level?
It is possible to lower cholesterol levels by cutting
down on fats, and replacing some of the saturated
fats with unsaturated fats. Instead of fats, eat more
starchy foods – for example bread, pasta, rice and
cereals. Eat more fish too, especially oily fish. The
aim is to reduce your total cholesterol and raise
your level of HDL cholesterol (the ‘protective’
cholesterol). The effectiveness of eating a healthy
diet varies from one person to another, but it is
possible to reduce your cholesterol level by between
5% and 10% just by eating healthily.

Foods containing fat are made up of a combination

of saturated, polyunsaturated and monounsaturated
fats. Polyunsaturated fats are an essential part of
the diet and can help lower LDL cholesterol, but
they also lower HDL cholesterol (the ‘protective’
cholesterol). Monounsaturated fats can lower the
LDL level and do not lower the HDL cholesterol
level.

18 ❘ British Heart Foundation

Choosing healthier fats
To help reduce your cholesterol level you need to:
• cut right down on saturated fats and replace them
with moderate amounts of monounsaturated fats
and polyunsaturated fats (see the next page), and
• reduce the total amount of fat you eat, and fill up
on starchy foods like bread, pasta, rice, cereals
and potatoes.

The cholesterol found in foods (for example in

eggs, liver and kidneys) does not usually make a
great contribution to blood cholesterol levels,
although it is probably wise to limit the number of
eggs you eat to about three a week. It is more
important to eat food that is low in saturated fat.
Shellfish such as prawns and cockles contain some
cholesterol but as they are low-fat foods it is OK to
eat moderate amounts of them.

There is a fair amount of evidence that soya bean,

oatbran and diets rich in soluble fibre can lower
cholesterol. In recent years there have also been
reports that some foods – such as garlic, soya, oats,
protein and selenium-enriched cereals – can lower
blood cholesterol. However, all these studies were
carried out over a fairly short time period, and
there is no strong evidence that eating these foods

British Heart Foundation ❘ 19

will lower your risk of
coronary heart disease. Saturated fats
However, there may
well be benefit in
eating these foods as What Saturated fats increase
part of a healthy diet, effect do LDL cholesterol levels.
especially if they they have?
replace fatty foods in
your diet.

Which Saturated fats

foods are found in:
are they butter
found in? hard cheese
lard
dripping
coconut oil
palm oil.

20 ❘ British Heart Foundation

 Unsaturated fats
Polyunsaturated fats Monounsaturated fats Omega-3 fats

Polyunsaturated fats Monounsaturated fats Omega-3 fats are a

can help lower LDL can help lower LDL particular protective
cholesterol, but they levels and do not lower type of polyunsaturated
also lower HDL the HDL cholesterol fat. They can help
cholesterol (the level. prevent blood clotting,
‘protective’ and help reduce
cholesterol). triglyceride levels.

Polyunsaturated fats Monounsaturated fats Omega-3 fats are found

are found in: are found in: in:
cornflower oil olive oil fish oil
sunflower oil walnut oil oily fish such as herring,
soya oil rapeseed oil kippers, mackerel,
fish oil. avocado. pilchards, sardines,
salmon, fresh tuna, trout
Some margarines Some margarines and and anchovies.
and spreads are spreads are made from
made from monounsaturated fats. Our bodies can also
polyunsaturated fats. make omega-3 fats
from rapeseed oil.

British Heart Foundation ❘ 21

Foods with health claims
Recently some foods have been produced which
claim to reduce cholesterol levels, because of the
modified or added ingredients they contain.
Although there is evidence that certain of these
foods may reduce blood cholesterol levels, their
long-term safety has not been established. More
research is needed before foods with such health
claims can be recommended as a means to prevent
coronary heart disease.

Will eating sterol-enriched margarines and spreads

help reduce my cholesterol level?
There is evidence that substances called plant
sterols and stanols – which are added to certain
margarines and spreads – may reduce blood
cholesterol levels. More research is needed into the
long-term effects of having large quantities of plant
sterols and stanols. If it turns out that people need
to eat large amounts of these substances in order to
reduce blood cholesterol levels, the increase in
calories that this will involve may offset some of
the advantages.

22 ❘ British Heart Foundation

Other ways to eat more healthily
Although lowering cholesterol levels is important,
your heart will also benefit from:
• eating at least five portions of fruit and
vegetables a day (see below)
• cutting down on salt, and
• not drinking too much alcohol.
For more information, see our booklet Eating for
your heart.

Aim to eat at least five portions of fruit and vegetables a day.

What counts as a ‘portion’?

Fruit
Apple, orange or banana 1 fruit
Very large fruit (for example melon, or pineapple) 1 large slice
Small fruits (for example plums, kiwis, satsumas) 2 fruit
Raspberries, strawberries, grapes 1 cupful
Fresh fruit salad or stewed or canned fruit 2 to 3 tablespoonfuls
Dried fruit 1
⁄2 to 1 tablespoonful
Fruit juice 1 glass (150mls)

Vegetables
Raw, cooked, frozen or canned vegetables 2 tablespoonfuls
Salad 1 dessert bowlful

British Heart Foundation ❘ 23

How can medication help?
Statins
The main type of drug now used to reduce
cholesterol levels is statins. Statins are
cholesterol-lowering drugs which became available
in the mid-1990s. They can reduce total cholesterol
levels by more than 20%. Overall, statins reduce
the risk of dying from coronary heart disease by
around 25%. Treating people in their 70s with
statins is as effective as it is in middle-aged people.
They must be taken for at least five years.

There are several statins available in the UK. Many

of these have been tested in long-term trials that
have looked not just at the cholesterol levels they
produce but also at their effect on health and
long-term safety. So far the research has covered
over 10 years of treatment. We do not yet know the
balance of risks and benefits over periods longer
than 10 years. However, for people who are already
at high risk of having a heart attack, the benefits of
taking statins are likely to outweigh any possible
risk of side effects.

Statins are not used for people who have liver

disease or for women who are pregnant or

24 ❘ British Heart Foundation

breastfeeding. Before starting on statins you will
have a blood test to see how well your liver is
working. You will need to have this test again at
various times while you are having the treatment.

A rare side effect of statins is inflammation of the

muscles (myositis). So you should tell your doctor if
you have any unexpected muscle pain, tenderness
or weakness.

Other cholesterol-lowering drugs

There are two other types of drugs which can be
used when statins are not suitable. These are
fibrates and drugs which bind bile acids.

Fibrates
Fibrates come in tablet or capsule form. They
include bezafibrate (Bezalip, Bezalip Mono),
ciprofibrate (Modalim), fenofibrate (Lipantil) and
gemfibrozil (Lopid). Fibrates are used for people
who have a high level of both blood cholesterol and
triglycerides. You will not usually be given them if
you are also taking statins (see opposite), except
under strict medical supervision. If you are also
taking anticoagulants, your doctor will start you on
them cautiously.

British Heart Foundation ❘ 25

Drugs which bind bile acids
These drugs (which are also called ‘bile acid
binding drugs’) include cholestyramine (Questran,
Questran A) and colestipol (Colestid, Colestid
Orange). They come in powder form, in sachets.
You must soak some types in fruit juice before you
take them. Others are already mixed with fruit
flavouring and you just need to add water.

You should take these immediately before or during

a meal. You can make them up beforehand and
keep them in a tumbler of water or fruit juice in the
fridge. A convenient time to take them might be
before breakfast. A dose of two sachets before
breakfast is often a good starting point in treating
high blood cholesterol. At first this dose may make
you feel fuller than usual, but most people
gradually get used to this. Some people who take
these drugs may get heartburn or constipation, but
this is more likely with larger doses. These drugs
are not absorbed into the body, so they can also be
used safely by children and pregnant women.

26 ❘ British Heart Foundation

Will I need to take medication?
The choice of whether or not to take
cholesterol-lowering drugs depends on your overall
risk of coronary heart disease as well as your total
cholesterol level and LDL level.

The higher your risk of coronary heart disease, the

more likely it is that your doctor will recommend
cholesterol-lowering drugs. Doctors prescribe
statins for people who have high blood cholesterol
levels and who are at greatest risk of suffering from
coronary heart disease. People at highest risk are:
• those who have already had a heart attack
• those who have angina or peripheral vascular
disease, and
• those who have had bypass surgery or angioplasty.

Your doctor may also consider that your risk is

sufficiently high to justify having statin treatment if
you have high cholesterol levels as well as other
major risk factors such as being a smoker, having
high blood pressure, or having diabetes. Your age is
also relevant, as cholesterol levels usually rise with
age. Your sex is relevant too, as women’s risk of
coronary heart disease lags about 10 years behind
that of men.

British Heart Foundation ❘ 27

There are various sets of guidelines to help doctors
decide whether to recommend you to take
cholesterol-lowering drugs. This means that people
with a wide range of cholesterol levels may be
treated with cholesterol-lowering drugs. For
example, a man of 40 who had four major risk
factors would be treated with statins if his
cholesterol level was higher than 5.5 mmol/l.
However, a man with no risk factors would not be
treated with statins even if his cholesterol level were
much higher.

Statins are a long-term and effective treatment.

However, it is important to lower your overall risk
of coronary heart disease as much as possible. This
includes getting your lifestyle right as well as taking
statins. Stopping smoking, changing your diet,
taking regular physical activity, controlling your
weight and making sure your blood pressure is
normal, will all help.

28 ❘ British Heart Foundation

FH (familial hyperlipidaemia)
What is familial hyperlipidaemia?
About 1 in 500 people in the UK have inherited a
high blood cholesterol level due to a condition
called ‘familial hyperlipidaemia’ or FH. This
condition is also sometimes called ‘familial
hypercholesterolaemia’.

In people with FH, the way LDL cholesterol is

removed from the blood circulation works only
about half as effectively as normal. This means that
their blood cholesterol level roughly doubles. So an
adult with FH may have a cholesterol level of
between 9 and 12 mmol/l, and sometimes higher.
Children and young women may have lower levels,
but the level is usually above 6.7 mmol/l in children
and above 7.5 mmol/l in adults.

How is FH passed on?

FH is almost always inherited from a parent.
(‘Familial’ means running in the family.) One parent
may have had a heart attack or developed angina at
an early age. Angina and heart attacks are
increasingly common in people in the UK from their
mid-60s onwards. If they happen at an earlier age,
they are considered as happening ‘prematurely’.

British Heart Foundation ❘ 29

Even if the parent with FH has not had any heart
trouble, he or she will have raised blood cholesterol.

FH is a ‘dominantly inherited’ disorder. This means

that if you have FH, your brothers and sisters and
your own children will each have an even (50/50)
chance of having FH too.

If you have been told you have FH, it is important to

tell other members of your family to tell their doctor
and have their blood cholesterol levels measured.
Many people with FH are not obese and may not
have any other risk factors for coronary heart
disease. If you are related to someone with FH, don’t
put off asking for a blood cholesterol test just
because you feel you are fit and well at the moment.
Anyone with FH who has a child should find out as
early as possible if their child has inherited FH. It is
important to find out at least by the time the child is
five because even at this age, healthy eating is
important. As the child gets older it is particularly
important that he or she does not start to smoke.

Treatment for FH
The treatment for FH is very similar to the
treatment used for other more common types of
high blood cholesterol described on pages 17 to 28.

30 ❘ British Heart Foundation

FH is very unlikely to respond to diet alone, and
many people will need to take cholesterol-lowering
drugs as well as keeping to a healthy diet. Children
may need medication if there is a particularly
strong family history of FH.

Ideally, you should see a doctor who has a specialist

knowledge of FH. This will help make sure that
you get the most appropriate treatment. A specialist
can also tell if you have any symptoms or signs of
heart trouble, or if you may develop them.

What are the signs of FH?

If a child has a blood cholesterol higher than
6.7 mmol/l and has normal triglyceride levels, it is
almost certain that he or she has FH.

Among adults, certain tell-tale signs of FH may

develop, which in themselves carry no risk. These
include hard lumps in the tendons at the back of
the ankles and often also in the tendons which run
near the knuckles on the back of the hands. The
lumps at the back of the ankles can be troublesome
because they can get inflamed and painful and this
can make it very uncomfortable to wear shoes. A
white ring may also develop around the outside of
the coloured part of the eye. However, this is not a

British Heart Foundation ❘ 31

feature just of FH. It can also happen in more
common kinds of high blood cholesterol and
sometimes even in people who do not have high
blood cholesterol.

The effects of FH
The main medical problem for people with FH is
that they may develop heart trouble. FH affects
men and women equally. However, its effect on the
risk of coronary heart disease is rather different.
Without treatment, most men and half of women
with FH will suffer angina or a heart attack before
they are 60. Even at the age of 70 some women
who do not have treatment are free of heart
trouble, whereas this would be very rare for a man.
So, a man who inherits FH from his mother may
develop heart trouble long before she does. This is
probably the most common reason why some men
with FH have no apparent family history of angina
or heart attacks.

Many women with FH may, after talking it over

with their doctor, choose to put off treatment with
drugs until there is no longer any chance of them
becoming pregnant while on medication. However,
pregnant women can safely take bile acid binding
drugs, as these are not absorbed by the body. But it

32 ❘ British Heart Foundation

would not be sensible to carry on without
medication right up to the menopause if the
woman’s mother or sister had developed heart
trouble before the age of 50.

What you can do to help yourself

if you have FH
Healthy eating and treatment with
cholesterol-lowering drugs are clearly important (see
pages 18 and 24). However, it is not possible to say
that treatment from an early age will completely
remove the risk of heart trouble. Also, at present in
the UK, most people with FH do not discover that
they have it until they are in middle age or already
have heart trouble. People with FH can benefit from
the many remarkable advances that there have been
in treating coronary heart disease, both with drugs
and surgery. If you have FH and you experience any
chest discomfort, especially with exercise or stress,
you should report it promptly to your doctor.

If you have FH and are thinking

of having a child
There is an extremely rare cause of particularly
high blood cholesterol in childhood called
‘homozygous FH’. This can happen if both parents
have FH. If you have FH and are thinking of

British Heart Foundation ❘ 33

having children, your partner should ask the doctor
to check his or her blood cholesterol level. The
chance of your partner having FH is very small
(about 1 in 500). However, if he or she does have
FH, you will need special genetic counselling to
advise you about the risk of your child being
seriously affected. If your partner does not have
FH, each of your children will have an even (50/50)
chance of inheriting your type of FH.

Being diagnosed early and modern treatments are

likely to be effective, so you should not make FH a
major reason for limiting your family, certainly
until you have had one or two children.

For more information

For more information on familial hyperlipidaemia
(FH), contact the Family Heart Association,
7 North Road, Maidenhead SL6 1PL.
Phone: 01628 628638.
Website: www.familyheart.org.uk

34 ❘ British Heart Foundation

For your own notes
For more information
British Heart Foundation website
www.bhf.org.uk
For up-to-date information on the BHF and its
services.

Heart information line 0845 0 70 80 70

For confidential information, from the British Heart
Foundation, on a range of issues relating to heart
disease.

Publications and videos

The British Heart Foundation produces a range of
publications and videos. You can order these
through our website. The address is www.bhf.org.uk

For a complete publications list and order form,

please contact:
British Heart Foundation
14 Fitzhardinge Street
London W1H 6DH.
Phone: 020 7935 0185 extension 240
E-mail: [email protected]

Many of our booklets are free to members of the

public, but a donation would be welcome.

36 ❘ British Heart Foundation

Heart Information Series
This booklet is one of the booklets in the Heart
Information Series. The other titles in the series are
as follows.

1 Physical activity and your heart

2 Smoking and your heart
3 Reducing your blood cholesterol
4 Blood pressure
5 Eating for your heart
6 Angina
7 Heart attack and rehabilitation
8 Living with heart failure
9 Tests for heart conditions
10 Coronary angioplasty and bypass surgery
11 Valvular heart disease
12 Having heart surgery
13 Heart transplantation
14 Palpitation
15 Pacemakers
16 Peripheral arterial disease
17 Medicines for the heart
18 The heart – technical terms explained

British Heart Foundation ❘ 37

For more information on eating well
You can get the following booklets and books from
the British Heart Foundation.
So you want to lose weight ... for good. A guide to
losing weight for men and women
Food should be fun
A taste of low fat Asian foods
The everyday light-hearted cookbook
Price £10.99 plus £1.50 postage and packing.
The light-hearted cookbook
Price £10.99 plus £1.50 postage and packing.
For more information on statistics quoted in this booklet
Where you can find out
Statement
more about this
Page 14 From Monitoring the progress of the
How the individual 2010 target for coronary heart disease
risk factors add up mortality. By A Britton and K
(diagram) McPherson. To be published by the
National Heart Forum. In press.
Page 15 From ASH Factsheet Number 11,
Smokers can halve February 2000.
their risk of a heart
attack within five
years of quitting.

38 ❘ British Heart Foundation

 Where you can find out
Statement
more about this

Page 15 From ‘Physical activity and the

Physical activity can incidence of coronary heart disease’.
halve the risk of a By KE Powell et al. Published in the
heart attack. Annual Review of Public Health in 1987,
volume 8, pages 253-287.

Page 15 From ‘Blood pressure, stroke and

For people with high coronary heart disease: Part 1
blood pressure, Prolonged difference in blood
reducing blood pressure: prospective observational
pressure by 5 mmHg studies corrected for the regression
can reduce the risk of dilatation bias’. By S MacMahon, R
having a heart attack Peto, S Cutler et al. Published in The
by about 16%. Lancet in 1990, volume 115, pages
765-774.

From ‘Blood pressure, stroke and

coronary heart disease: Part 2 Short-
term reductions in blood pressure:
overview of randomised drug trials in
their epidemiological context’. By R
Collins, R Peto, S MacMahon et al.
Published in The Lancet in 1990,
volume 135, pages 827-838.

British Heart Foundation ❘ 39

 Where you can find out
Statement
more about this

Page 15 From A Handbook of Hyperlipidaemia

For people who are by GR Thompson. Published in 1989
overweight, reducing by London Current Science.
weight can reduce
cholesterol level and
also reduce the risk of
a heart attack.

Page 18 From ‘Changes in risk factors explain

It is possible to changes in mortality from ischaemic
reduce your heart disease in Finland.’ By E
cholesterol level by Vartiainen, P Puska, J Pekkanen et al.
between 5% and 10% Published in 1994 in the British
just by eating Medical Journal, volume 309, pages
healthily. 23-27.

Page 24 From ‘Randomised trials of cholesterol

[Statins] can reduce lowering in 4444 patients with
total cholesterol coronary heart disease: the
levels by more than Scandinavian Simvastatin Survival
20%. Overall, statins Study (4S)’, by the Scandinavian
reduce the risk of Simvastatin Survival Study Group.
dying from coronary Published in 1994 in The Lancet,
heart disease by volume 344, pages 1383-39.
around 25%.

40 ❘ British Heart Foundation

Heartstart UK
For information about a free, two-hour course in
emergency life-support skills, contact Heartstart UK
at the British Heart Foundation. The course teaches
you to:
• recognise the warning signs of a heart attack
• help someone who is choking or bleeding
• deal with someone who is unconscious
• know what to do if someone collapses, and
• perform cardiopulmonary resuscitation (CPR) if
someone has stopped breathing and his or her
heart has stopped beating.

British Heart Foundation ❘ 41

About the British Heart
Foundation
The British Heart Foundation (BHF) is the leading
national charity fighting heart and circulatory
disease – the UK’s biggest killer. The BHF funds
research, education and life-saving equipment, and
helps heart patients return to a full and active way
of life.

We rely entirely on donations to continue our vital

work. If you would like to make a donation, please
ring our credit card hotline on 0870 606 3399, or
fill in the form opposite.

42 ❘ British Heart Foundation

✁

We need your help. Please send a donation today. Your personal information
The British Heart Foundation (BHF)
Please accept my donation of: values your support. We will use the
£50 £25 £15 £12 £Other information you have given us for
administration and marketing
If you are sending a cheque, please make it payable to purposes. We may contact you by post
or occasionally by phone or E-mail.
British Heart Foundation. This may include passing on news and
Or, you can ring our credit card hotline on 0870 606 3399. information on our charitable work
(for example how we spend our
I want to donate using: MasterCard Visa CAF Card money, and heart health information),
BHF events and related products and
services from our subsidiary
companies such as Christmas gift
Card number Expiry date catalogues. Please tick the box if you
do NOT want to hear from us at all.
107
Date Occasionally we may pass on your
details to other carefully-selected
organisations we are working with.
Signed
They may send you information on
their events, products and services.
Name (Mr/Mrs/Miss/Ms/other) Please tick the box if you do NOT want
your details passed on in this way.
108
Address Thank you for your support.
Please send your donation to:
Supporter Services, British Heart
Foundation, 14 Fitzhardinge Street,
London W1H 6DH.
Registered charity number: 225971

09/2001
Postcode Please turn over.

Please tick if you would like us to send you a Gift Aid form to make your donation work harder at no extra cost to you.
✁

Please send me information about the following.

BHF publications

Giving regular donations

Regular donations through a standing order give us the long-term support we need. Just tick
for information on how to set up a standing order.

Remembering us in your Will

Many people choose to leave a legacy to their favourite charities in their will. We can send you
a useful information pack to tell you how to go about it.

Local fundraising activities and sponsored events

Payroll giving
How you and your work colleagues can donate from your salaries before tax.

Buying BHF Christmas cards and gifts

Becoming a volunteer in a British Heart Foundation shop

Please send your form to the British Heart Foundation. The address is over the page.
For your own notes
Technical terms
atheroma Fatty material that can build up within the walls
of the arteries.
atherosclerosis The build-up of fatty material within the walls of
the arteries.
blood cholesterol Cholesterol found in the blood.
blood lipids Fatty substances found in the blood.
cholesterol A fatty substance mainly made in the body by
the liver.
coronary heart When the walls of the arteries become
disease narrowed by a gradual build-up of fatty material
called atheroma.
ECG See ‘electrocardiogram’.
electrocardiogram A test to record the rhythm and activity of the
heart. Also called an ECG.
familial hyper- Another term for ‘familial hyperlipidaemia’.
cholesterolaemia
familial An inherited condition in which the blood
hyperlipidaemia cholesterol level is very high.
HDL High density lipoprotein.
The ‘protective’ cholesterol.
hypertension High blood pressure.
LDL Low density lipoprotein.
The more ‘harmful’ cholesterol.
lipids Fatty substances in the blood.
lipoproteins Combinations of cholesterol and proteins.

46 ❘ British Heart Foundation

 mmHg A unit for measuring blood pressure.
mmol/l Millimols per litre. Used for measuring
cholesterol and other fats in the blood.
omega-3 fat A protective oil found in certain types of fish.
triglycerides A type of fatty substance found in the blood.

British Heart Foundation ❘ 47

Index
activity .................................................................................................. 12, 17
assessment .................................................................................................. 10
bile acid binding agents ........................................................................ 26
blood pressure .................................................................................... 12, 15
children .......................................................................................... 29, 31, 33
cholesterol .................................................................................................. 6
in foods .................................................................................................... 19
measurement of .................................................................................. 10
role in coronary heart disease ........................................................ 9
cholesterol test .......................................................................................... 10
diet ................................................................................................................ 18
drugs ............................................................................................................ 25
eggs .............................................................................................................. 19
exercise ................................................................................................ 12, 17
familial hypercholesterolaemia .......................................................... 29
familial hyperlipidaemia ........................................................................ 29
fats .................................................................................................................. 18
FH .................................................................................................................. 29
fibrates .......................................................................................................... 25
genetic counselling ................................................................................ 34
HDL .............................................................................................................. 7, 9
healthy eating ............................................................................................ 18
homozygous FH ........................................................................................ 33
kidney failure ............................................................................................ 16
LDL .............................................................................................................. 7, 9
lipids .............................................................................................................. 7
lipoproteins ................................................................................................ 6
measurement of cholesterol ................................................................ 10
medication .................................................................................................. 25
omega-3 fats ........................................................................................ 13, 21

48 ❘ British Heart Foundation

physical activity .................................................................................. 12, 17
pregnancy ............................................................................................ 24, 33
relatives ........................................................................................................ 30
risk of heart disease .......................................................................... 12, 14
saturated fats .................................................................................. 9, 18, 20
smoking ................................................................................................ 12, 15
stanols .......................................................................................................... 22
statins ............................................................................................................ 24
sterols ............................................................................................................ 22
thyroid gland .............................................................................................. 16
treatment .................................................................................................... 24
triglycerides ................................................................................................ 7
unsaturated fats ........................................................................................ 21
weight ............................................................................................ 15, 18, 21

British Heart Foundation ❘ 49

British Heart Foundation
14 Fitzhardinge Street
London W1H 6DH
Phone: 020 7935 0185
Heart information line: 0845 0 70 80 70 for confidential
information on a range of issues relating to heart disease
Website: www.bhf.org.uk
Registered charity number: 225971

© British Heart Foundation 2001

We update this booklet regularly. However, you may find more
recent information on our website.

Heart Information Series Number 3 September 2001