What you need to know about Cholesterol

What is good and bad cholesterol?

Cholesterol is an essential component of the cells that form the building blocks of all our organs. It is needed for good health. The problem is people sometimes have too much cholesterol in their blood. People with high cholesterol have a higher risk of heart attacks, strokes, and other problems with their circulation. These disease are known as ‘cardiovascular diseases’ The higher your cholesterol, the higher your risk of cardiovascular disease.

LDL carries cholesterol to the parts of your body that need it. It’s sometimes referred to as “bad cholesterol” because if you have too much of it in your bloodstream, it can cling to the walls of your arteries, eventually clogging them. This will raise your risk of cardiovascular disease.

HDL is known as “good cholesterol” because it picks up cholesterol and takes it back to the liver for disposal. People with high HDL levels tend to have a lower risk of cardiovascular disease.

How does cholesterol affect your chance of having a stroke or heart attack?

At least 1 in 3 people will experience a heart attack or stroke that kills the person or damages heart or brain. The risk of this is highest in persons with diabetes, hypertension (high blood pressure), elevated cholesterol, obesity and in smokers.

The  build-up of cholesterol inside the arteries is known as atheroma. The cholesterol deposit can cause a narrowing or completely block the artery. If an artery that supplies the heart (coronary artery) is blocked a heart attack results. Similarly, blockage of an artery that supplies that brain causes a stroke.

How do I treat my cholesterol?

Diet:  A “heart-healthy” diet includes lots of fruits and vegetables, fibre, and healthy fats (like those found in fish and certain oils). It also means limiting sugar and unhealthy fats.

Lifestyle: Be more active and lose weight (if you are overweight)

Medication: Medications are commonly needed to lower cholesterol levels and ‘statins’ are the most powerful and widely used medications available.

What are statins?

Statins are medicine that your doctor will prescribe to lower your cholesterol. Statins reduce the production of cholesterol in the liver, which causes your liver to remove cholesterol from your blood.

For every 1.0mmol/l reduction of ‘bad cholesterol’ (LDL-cholesterol) the risk of suffering a heart attack or stroke decreases by approximately 20%. The risk of dying from heart disease has fallen dramatically since 1997. While the decrease is not entirely due to statins, they have certainly contributed to saving the lives of innumerable patients who would otherwise have died from heart attacks and strokes.

The most commonly used statins are Simvastatin (Zocor), Atorvastatin (Lipitor) and Rosuvastatin (Crestor).

Are statins safe and what are the side effects?

In the USA More than 30% of patients over the age of 40 years are on statins and we thus have an enormous amount of information on their benefits as well as their side effects.

While statins have been shown to be safe, some patients experience side effects and are unable to take them.

  1. Muscle related side effects

The most common side effects are muscle pains, aches, stiffness, weakness or cramps in the legs , shoulders or arms. These side effects may occur in 1 in 10 patients taking a statin. While in many patients, the side effects are not severe enough to stop treatment, some patients are unable to tolerate the side effects.

Very rarely, the muscle pains may be associated with severe muscle breakdown called rhabdomyolysis. Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death.

  1. Type 2 Diabetes

There is a very small risk that your blood sugar level may increase when you take a statin, which can lead to developing Type 2 Diabetes. The benefits of taking statins and thus lowering the risk of heart attacks and strokes far outweighs the risk of developing diabetes which is rare.

  1. Erectile dysfunction (Impotence)

While researchers have looked into the possibility of statins as a cause for Erectile Dysfunction, evidence has suggested otherwise. Erectile dysfunction is usually caused by the clogged arteries (as a result of high cholesterol) rather than the side effects of the statin.  A study done in 2014 found that over time, Erectile Dysfunction actually improved among men who were taking statins for high cholesterol.

  1. Cancer

There is no convincing evidence that statins increase or decrease the risk of cancer.

  1. Liver damage

There is no evidence to support the concerns regarding permanent damage to the liver.

  1. Insomnia

A large study (2015) which looked at sleep patterns and sleep disturbances in patients taking statins showed no evidence that statins caused insomnia or other sleep disturbances.

  1. Memory loss/ Alzheimer’s disease

Although scientifically designed trials have not confirmed memory loss from statins, continuing evidence suggests statins have the ability to cause reversible memory loss in some patients. Paradoxically, statins have also been shown to decrease the risk of dementia, Alzheimer’s disease, and improve memory loss in some cases.

What can I do if I experience side effects to statins?

  1. Try another statin

It’s possible, although unlikely, that one particular statin may cause side effects for you while another statin won’t.

  1. Change the dose of the statin

If you lower the dose of the statin, or take in on alternative days,  you may reduce the side effects. But this will also reduce the cholesterol lowering benefits.

  1. Take Supplements

While supplements such as Vitamin D and Q10 claim to reduce statin side effects, their benefits remain questionable.

  1. Other cholesterol lowering medication

Unfortunately we don’t have good alternative therapies that have been shown to be as effective as statins.

Ezetrol can lower cholesterol but its effect is mild and it is most effective when combined with a statin.

Niacin, which is a B-group vitamin and is available over the counter, improves the ‘good (HDL-) cholesterol’.

Fibrates (e.g Bezalip, Lipanthyl) may also have benefit in certain patients with high triglycerides.

These options should be discussed with your doctor.

  1. Join a Clinical Trial

Much research is being done and a clinical research study on the effect of a new non-statin cholesterol lowering medication in persons with diabetes or a previous heart attack or stroke and who are unable to tolerate statins is being conducted in South Africa.

For more information on this study follow the link below:


All studies have been approved by SAHPRA and relevant Ethics committee




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