Cholesterol - Optimum HMS · cholesterol levels are generally recorded more in young Aussie men...

Suite 39, Lincoln House 4 Ventnor AvenueWest Perth, WA 6005

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Phone 08 9321 9677 Facsimile 08 9321 9766

Graeme Wright

...Is Not A Dirty Word

Cholesterol

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IntroductionCardiovascular disease is a leading cause of death in Australia. Coronary heart disease is responsible for the majority of deaths and is associated with a range of risk factors - including elevated cholesterol levels and inflammation of arterial tissue.

The clear message is that heart disease is not just about high cholesterol levels as heart attacks do occur in people with normal cholesterol levels.

In Australia, the National Heat Foundation (NHF) recommend total cholesterol level be <4.0mmol/L. In addition there is an increasing emphasis on the cholesterol (lipid) sub fractions being measured and tracked. More on these sub fractions later in the module and at www.heartfoundation.org.au.

This module will look at the risk factors in heart disease with a focus on cholesterol levels. The other risk factors include; age, gender, family history, obesity, inactivity, smoking, high blood pressure (systolic), stress levels and heart muscle thickening.

So work through the module and find out: What is cholesterol? How you measure your cholesterol level. What all the numbers mean. How to manage your blood cholesterol level. What other factors should you monitor to manage your health profile?

REMEMBEREvery one percent you reduce your total cholesterol level;

you reduce your risk of a heart attack by two percent. A great return.


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What Is Cholesterol?Cholesterol is a wax like substance that travels around the body in the bloodstream. Cholesterol can not travel on its own. It is bound to and is carried by proteins in the body. Your body needs cholesterol and your liver makes enough to satisfy those needs.

Cholesterol is an essential building block of the body. Without adequate amounts of cholesterol; your tissues would not function properly, certain hormones would not be made, some digestion and absorption of fats may be impaired, memory could suffer, the brain may not function adequately as it contains a high level of cholesterol, serotonin may not work properly (if cholesterol levels are too low) and we would be without a powerful antioxidant. So in all these cases cholesterol is not a dirty word.

Some people on a diet high in saturated fats and dietary cholesterol can cause their blood cholesterol levels to rise. In combination with other coronary risk factors - it could be fatal. There is emerging evidence that this disease pathway is more closely linked to the inflammation within the body rather than cholesterol level on its own. In other literature there is also reference to high cholesterol levels being linked to hidden thyroid problems. So if you have elevated cholesterol levels and particularly if you are on cholesterol lowering medication (statins or fibrates) - it may be worth asking your doctor a few more questions about your management plan. In general these lipid lowering medications are tolerated but we are all different. Also given Australians spend nearly $1billion AUD on cholesterol lowering medications we have every right to ask some hard questions about our management plans.

The traditional view of cholesterol alone causing the hardening of the artery, fatty build upon artery walls and thereby blocking the flow of blood to vital organs, may need to be revisited. The blockage is referred to as atherosclerosis or hardening of the artery.

How Do You Measure Blood Cholesterol?You will need to give some blood to have your cholesterol level checked. This can be from the arm (cholesterol or lipid profile) or from the finger tip (cholesterol only). This profile could include three or four readings. These readings include the sub fractions that were mentioned earlier and they are:

• Total blood cholesterol

• HDL cholesterol

• Cholesterol/HDL cholesterol ratio

• LDL cholesterol

• Triglycerides.

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Total Blood Cholesterol

Total blood cholesterol level should be checked every 3-5 years in low risk people and every 6-12 months in those of a higher coronary risk profile. The higher the number, the more cholesterol there is in your blood and potentially the greater risk.

All Australian adults should know their blood cholesterol levels. Do you?

Fifty percent of adult Australia have values >5.5mmol/L. Twenty percent of the adult population have a reading >6.5mmol/L. This is a long way from the recommended National Heart Foundation (NHF) of <4.0mmol/L.

Depending upon your total cholesterol reading and other coronary risk factors you may need to determine the cholesterol sub-fractions, as well as your Cholesterol/HDL Ratio. Tracking your cholesterol level in the table below will assist in your management plan.

Total Cholesterol Level

Date

Reading

HDL Cholesterol

HDL cholesterol is a beneficial type of cholesterol carried in the blood by a high density lipoprotein (HDL). HDL is often called the good guy cholesterol. This is because your body uses it to form cells, to produce hormones, and to make the bile that digests fats. HDL doesn’t collect on artery walls. In fact, it helps protect the body from atherosclerosis. HDL carries the cholesterol from the artery and deposits the cholesterol in the liver. HDL cholesterol can be increased with regular activity, however, it is impossible to increase your HDL cholesterol if you smoke. Females tend to have more HDL cholesterol than males. The more HDL cholesterol you have then the better the risk protection. It is reported to be one of the reasons that females have less heart disease. HDL Cholesterol levels should be above 1.0mmol/L. Use the table below to track your HDL Cholesterol levels.

HDL Cholesterol Level

Date

Reading


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LDL Cholesterol Level

Date

Reading

TRIGLYCERIDE Cholesterol Level

Date

Reading

Cholesterol/HDL Ratio

Date

Reading

Cholesterol/HDL Cholesterol Ratio

The cholesterol/HDL cholesterol ratio is a relationship between the total blood cholesterol and HDL cholesterol. It is expressed as a whole number. A ratio of ≤4.0 is desired. This means that 25% of the total cholesterol is made up of the good guy. The objective is to lower the ratio by increasing the amount of HDL cholesterol, or decreasing total cholesterol, or both. Men struggle to have a risk ratio of 4.0 while it is not uncommon for women to have up to 50% of their total cholesterol made up of HDL cholesterol – a ratio of 2.0. Use the table below to track your Cholesterol/HDL ratio.

LDL Cholesterol

LDL cholesterol is a harmful type of cholesterol carried in the blood by a low density protein (LDL). It is considered the bad guy cholesterol. This is because it can block arteries and cause atherosclerosis. Primarily, LDL packs the cholesterol against the artery wall. The less you have of this factor the better. Men generally have a higher LDL component than women. A desirable level for those in the high risk category is <2.0mmol/L, while for those in the normal risk category a desirable level is <2.5mmol/L. Use the table below to track your LDL Cholesterol.

Triglyceride

Triglyceride is another type of blood fats and offers the final component of a complete lipid profile. High triglyceride levels can be related to diet and other risk factors not being managed. They can also be related to low levels of the HDL Cholesterol. When a high level of triglyceride is combined with a high level of LDL Cholesterol there is a further increase in the risk of heart disease. Triglyceride levels should be <2.0mmol/L for those of normal risk, or <1.5mmol/L in higher risk individuals. Use the table below to track your Triglyceride levels.

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What Do The Numbers Mean To The Average Aussie?

The average cholesterol level in Australia is around 5.6mmol/L for both men and women. Generally women have a lower level of blood cholesterol than men until they enter the menopause, at which time there is an exponential increase in their cholesterol level. Men on the other hand increase in their early years and then their cholesterol level plateaus in their mid forties to early fifties.

Women generally have a higher level of HDL Cholesterol then men at all ages. There are slight fluctuations in HDL Cholesterol levels across the decades in both genders. The average HDL levels are around 1.3mmol/L for men and 1.6mmol/L for women. The cholesterol/HDL cholesterol ratio in males is associated with high incidences of coronary disease.

Another blood fat (triglyceride) is part of the sub-fractions. Higher blood triglyceride and blood cholesterol levels are generally recorded more in young Aussie men than Aussie women.

It should be emphasised that any lowering of total cholesterol and LDL cholesterol levels, and increasing HDL cholesterol is likely to be beneficial, even if the recommended target is not reached.

Other Coronary Risk FactorsElevated blood cholesterol is one of several coronary risk factors. It is the combination of all the risk factors that needs to be managed and monitored. The more risk factors you have, the greater the potential of coronary risk. See how you go with your own Mini Health Check.

Per cent

Age group

0

10

20

30

40

50

60

70

80

Females

Males

75+65–7455–6445–5435–4425–34

Note: High blood cholesterol is total cholesterol of 5.5 mmol/L or more.

Source: AIHW analysis of 1999–2000 AusDiab.

Australia’s Health 2008: Proportion of adults with high blood cholesterol, 1999–2000


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Mini Health CheckAllocate your score for each risk factor:

YOUR TOTAL CARDIAC SCORE

Low risk Below average risk Average risk Above average risk High risk 0-9 10-17 18-25 26-34 35 plus

The first objective is to have a Total Cardiac Score <17, thereby placing you in the Below Average Risk Category. The ideal objective is to have a score <9. This profile plus many other health and wellbeing profiles can be accessed at www.optimumhms.com.au

1. CHOLESTEROL LEVEL: ______ mmol/L (a) 0-4.0........................................................0 (b) 4.1-4.9.....................................................1 (c) 5-5.5........................................................3 (d) 5.6-6.5.....................................................6 (e) 6.6 and above......................................132. BLOOD PRESSURE: _____ /_____ mmHgSystolic (the higher figure) (a) 0-130.......................................................0 (b) 131-150...................................................2 (c) 151 and above.......................................6Diastolic (the lower figure) (a) 0-85.........................................................0 (b) 86-90.......................................................2 (c) 90 and above.........................................63. SMOKING: (a) Never smoked.......................................0 (b) Ex-smoker..............................................2 (c) Smoke 0-19 per day..............................6 (d) Smoke 20 or above per day................204. WEIGHT: (a) Correct weight for height.....................0 (b) Overweight............................................2 (c) Obese.....................................................55. AGE: (a) 0-29.........................................................0 (b) 30-39........................................................1 (c) 40-49.......................................................2 (d) 50-59.......................................................4 (e) 60-69.......................................................7

6. FAMILY HISTORY: (a) No family members (parents, brothers, sisters) with heart disease......................0 Family member had a heart attack or diagnosed heart disease (b) After the age of 65..................................3 (c) Between 56 and 65.................................5 (d) At or above the age of 55......................87. PERSONAL HISTORY: (a) No history of heat disease.....................0 (b) Angina, bypass surgery, angioplasty, Stroke or blood vessel surgery............10 (c) Previous heart attack............................ 208. DIABETES: (TYPE II) (a) Non-Diabetic..........................................0 (b) Diabetic...................................................49. EXERCISE: (a) Aerobic exercise (brisk walking, jogging, swimming, cycling, aerobic dance) for at least 30 mins three times a week................0 (b) Aerobic exercise for 10 mins one or two times per week..................................... 2 (c) Non-aerobic activity (gardening, doubles tennis, manual work) for at least two hours per week..................................... 2 (d) Less activity than above.........................410. STRESS:Rate your level of stress (a) Very low................................................... 0 (b) Low.......................................................... 2 (c) Moderate................................................ 4 (d) High.........................................................5

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Some risk factors – your age, sex and family history can not be modified. The risk factors you can modify include the following:

Smoking

Smoking is a death sentence in itself. The facts are well documented. Smoking also affects blood cholesterol levels. There is information that indicates that the more you smoke the lower your HDL fraction. In simple terms, quit and your HDL level goes up, thereby reducing your coronary risk. Quitting halves your risk of a coronary event.

High Blood Pressure

1 in 6 Australians have high blood pressure. High blood pressure does not directly affect blood cholesterol but it does have a big impact on your overall risk of mortality and morbidity. Look at the relationship between high blood pressure, high blood cholesterol and smoking. It is quite a potent cocktail of ingredients.

Inactivity

Being inactive is an unnatural state. Regular activity decreases your risk of coronary heart disease. Lower blood cholesterol, triglycerides, LDL Cholesterol and cholesterol/HDL cholesterol plus increased HDL cholesterol levels are all well documented in the fit individual. Activity offers a positive way to manage your cholesterol level.

Getting active with low intensity and long duration bouts of exercise is the way to go. Activities that use the large muscle groups and allow you the opportunity to have fun such as; walking, jogging, cycling and swimming are good examples. See the Activity module for more details.


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To get the most out of your exercise think about the following;

• Make exercise a family affair.

• Incorporate activity into your busy family schedule. Include the kids and the pets.

• Participate in activities that you enjoy. Life is too short to not enjoy your activity.

• Recruit an activity buddy. It is unlikely you will both feel flat on the same day. A good buddy can also be a great motivator.

• Have several activity schedules; indoors, outdoors, in the water, on the bike, bad weather. Cover all contingencies.

• Stick to your commitment of regular activity. If you don’t feel like doing your normal workout – then just do a gentle session. It is the doing that counts. The habit needs to be practised. Most importantly always listen to your body and act accordingly.

• Keep track of what you are doing. Use what works for you – chart, graph, log, spreadsheet or book. It will help you appreciate your improvement.

• Reward yourself for achieving your activity targets. Select your reward when you commence the activity regime and go for it.

What Else Can You Do To Manage Your Cholesterol Levels?There have already been many positive steps outlined in the module to help you manage your blood cholesterol levels. Other things that will influence your cholesterol level are; body fat/weight, waist, Body Mass Index (BMI) as well as the dietary intake of cholesterol, saturated fats and fibre intake. Managing your stress level will also help cholesterol management. See the stress module for more details. You may also want to have a thyroid function test, particularly if your have a high cholesterol level. Ask your GP about the link between thyroid problems and cholesterol levels.

Body Weight / Body Fat

Excessive body weight and body fat is associated with an increase risk of coronary disease and morbidity. It can also be associated with increased blood cholesterol, LDL cholesterol and triglycerides levels, as well as a reduction of HDL cholesterol, thereby increasing the cholesterol/HDL cholesterol ratio.

On the other hand as you lose body weight your blood cholesterol level decreases. If you are overweight or obese, you do not necessarily have high blood cholesterol, however, once your weight is lost, your blood cholesterol is reduced. Our data shows about a 10% reduction in total cholesterol occurs over a 6 month period following an 18% reduction in body weight.

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Body Waist

Body waist measure is an indicator of coronary risk. The World Health Organisation (WHO) classifies men at increased risk with a waist >94cm and substantially increased risk >102cm. Women are at increased risk with a waist >80cm and substantially increased risk >88cm. Basic metabolic functioning is impaired once your waist reaches these levels.

Body Mass Index

The calculation of your Body Mass Index (BMI) will give you an indication as to where you may be in terms of coronary risk. BMI is calculated by dividing your weight in kilograms by your height in meters squared.

BMI = weight (kg) / height (m2)

A BMI ≥ 25 is classified as being overweight or about 10 kilograms above ideal body weight. A BMI ≥ 30 is classified as obese or about 20 kilograms above ideal body weight. 40% of Australians are overweight and 20% are obese. Together, 60% of adults aged over 25 are either overweight or obese. Being normal weight in Australia means you are in the minority.

Example:

100 kg person is 1.8 m tall Weight = 100 kgHeight = 1.8m2 (1.8 x 1.8) = 3.24

BMI = weight (kg) height (m2) = 100 3.24 = 30.86

What is your BMI?

Weight = __________

Height = __________

BMI = weight (kg) height (m2) = =


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Dietary IntakeCholesterol

Blood cholesterol levels are more influenced by the saturated fats we eat than the cholesterol content of certain foods. However, countries such as Japan, with daily intake of cholesterol below 200mg per day, have a death rate three times lower than Australia that has a cholesterol intake above 500mg per day. The blood cholesterol factor that increases most in response to increased dietary cholesterol intake is the LDL cholesterol. It increases about six times that of the increase in HDL. This is not the desired trend.

Foods that are high in dietary cholesterol (>400mg/100g) include offal and egg yolk. Flesh in the form of red meat, poultry, fish, seafood is around 50 – 250 mg/100g. This is similar for whole milk dairy products such as cheese, butter and ice cream. This is not to say do not eat these foods but be aware of their make up. The focus should be on the level of saturated fat in the diet not the amount of cholesterol in the food.

Fats

Dietary fat is needed and plays an important role in health. We all need some dietary fat to transport certain fat-soluble vitamins, to make hormones and to regulate other body functions. Most people in Australia get 32 percent of their calories from fat, ideally, this should be 25-30 percent.

While we can state that not all fats are bad for you it is important to identify which fats to eat. There are three basic types of dietary fats; saturated, monounsaturated and polyunsaturated.

i) Saturated fats

These fats are hard at room temperature, and the more saturated the fat, the harder it is at room temperature. They are the less healthy category of fat and increase total and LDL Cholesterol, thereby increasing your potential risk.

The major sources of saturated fats include;

• Fatty red meats and sausage.

• High-fat dairy products such as full cream milk, cream, hard cheeses, ice cream, and butter.

• Foods that are fried or prepared with coconut oil (the highest saturated fat source) or palm oil. i.e. most take aways.

• Processed or packaged foods, such as baked goods that list lard, coconut oils, palm oil or coco butter in ingredients.

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ii) Monounsaturated fats

Monounsaturated fats tend to more selectively lower LDL cholesterol and maintain the level of HDL cholesterol. This appears to occur only if the monounsaturated fats replace the saturated fats in your diet. Monounsaturated fats are mainly in oils and margarine made from canola, olives, peanuts and avocados. Generally the monounsaturated fats cause relatively small changes in blood cholesterol levels compared to saturated and polyunsaturated fats. This is a healthier fat and helps you lower your risk.

iii) Polyunsaturated fats

The most well known is the omega-3 fats in foods of marine origin. This fat can not be made by humans; it is a healthier fat that can reduce your coronary risk.

Omega-3 is thought to have a mild anti-platelet clotting action, therefore, reducing the progression of arthrosclerosis or hardening of the arteries. Studies completed in Holland suggest that Dutch people who consumed fish regularly had a reduced incidence of coronary heart disease. As the consumption of fish went up, the incidence of coronary disease - decreased. The death rate was 50% lower in those that had eaten 30 grams of fish per day and 66% lower in those that eat 3-4 meals (36grams) of fish per week. There may be preventive factor built into consuming 1-2 meals of fish per week. NHF recommend Australians eat 2-3 oily fish meals per week with a serving size of 150 grams (size of your entire hand).

Australian fish have a very high proportion of omega-3. Fish consumption is a positive health move and will assist manage blood lipids. Omega-3 is thought to also reduce blood triglycerides levels and increase HDL cholesterol as well as decreasing total blood cholesterol.

Preparing Nutritious Foods

Foods can lose many nutritional benefits depending on the method of preparation. Choosing the appropriate cooking method is an easy way to reduce or control fat in your diet. A little experimentation and practise on how to cook delicious, low-fat, low-cholesterol foods can make all the difference. You may wish to try the following suggestions.

DO ADD USE

Poach

Bake

Grill

Steam

Wine

Herbs and spices

Lemon or lime juice

Water

Low-fat yoghurt

Crushed tomatoes

Fruit juice

Teflon pots and pans

Wok

Baking pans with a rack

Casseroles

Steamer

Poacher

Griller

Barbeque


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Fibre

Dietary Fibre is the indigestible part of plant foods. It is often called roughage. Fibre can be a natural factor in the fight against blood cholesterol. As it passes through the intestines, fibre helps to eliminate waste products more rapidly. A high soluble fibre intake can bind some cholesterol and fat and remove if from your system. Remember cholesterol has to be transported by something. Most Australians eat <20 grams/day of fibre instead of a healthier 25-25 grams /day for adults and 15-20 grams/day for kids.

There are two types of fibre;

i) Insoluble Fibre

Insoluble Fibre is found in the cell walls of most grain, vegetables, and fruits. Adequate intakes of insoluble fibre have been shown to reduce the risk of intestinal problems such as constipation, hemorrhoids, diverticula disease, as well as cancer of the colon.

ii) Soluble Fibre

Soluble Fibre is present in certain grains, fruits, and in most vegetables and legumes, such as beans and peas. Soluble fibre can significantly reduce blood cholesterol levels.

To increase your fibre consumption gradually do so over several weeks. During this time it is best to avoid fibre supplements.

The general recommendation is one or two servings of foods high in dietary fibre at each meal. This would include fruits, oats, bran and vegetables. Check the list of foods highest in soluble fibre and match this against your current intake.

For more information, go to www.heartfoundation.org.au.

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Foods High In Soluble Fibre

VEGETABLES (grams)

Potato, 1 small peeled 2.2

Peas, ¾ cup, fresh 4.5

Onions, 1 med 2.3

Spinach, ½ cup 1.7

Capsicum, 1 large 1.5

Squash, button 2.2

Cucumber, ½ cup slices 0.3

Lettuce, 2 leaves 0.4

Tomato, 1 medium 1.6

FRESH FRUIT

Pear, 1 medium 4.5

Banana, 1 medium 3.0

Apple, 1 medium, skin on 4.5

Plums, 1 medium 1.7

Strawberries, 10 medium 1.4

Peach, 1 medium 2.0

Blackberries, ½ cup 3.5

Grapefruit, ½ medium 2.7

Kidney beans, 100g 6.0

Soy beans, ckd, ½ cup 4.0

CEREALS (grams)

All Bran, 1/3 cup 8.6

Corn Flakes 1.0

Muesli, ¼ cup 2.1

Porridge, ¾ cup 2.5

Rice Bubbles, 1/12 cup 0.3

Special K, ¾ cup 0.9

Weetbix (2) 3.3

BREADS

White bread, 1 slice 0.8

Brown bread, 1 slice 1.3

W/meal bread, 1 slice 1.8

Rye bread, 1 slice 0.4

NUTS – SHELLED

Almonds, 25-30g 4.3

Peanuts, 30g 2.5

Walnuts, 30g 1.5

Source: Borushek - Calorie & Fat Counter, 2009


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If Your Blood Cholesterol Remains HighIf your blood cholesterol remains high, or if your doctor determines there is a genetic cause for your high cholesterol, you will probably need to have further tests done. Your doctor will be the one to advise you on what action is needed. If you need to take medication to reduce your cholesterol do not forget the role that diet and regular activity play in preventing disease and keeping you well.

The NHF promote a low saturated fat diet that includes poly and monounsaturated fats and oils, marine and plant omega-3, with a wide variety of fruits, vegetables and wholegrain cereal. This regime reports lowering cholesterol levels by 15%.

There are many options at your disposal to manage your blood cholesterol level. Make sure you explore them all.

So What Now?Like the control of other major coronary risk factors, controlling or managing your blood cholesterol levels calls for positive action. If you are going to make a series of lifestyle changes to improve your cholesterol level, set a time frame to achieve your objective.

Take charge of your health – don’t wait for something to happen.

We can help you get started at www.optimumhms.com.au.

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Where do I start?There is no simple answer. To help you get going - consider the following segments and commit to do something with some or all of the segments.

Your dietary profile. By now you probably know if your diet is high in saturated fats and cholesterol. See a dietitian if you need to get an accurate assessment of your profile. In the meantime start using low-fat products and high fibre foods. Look at food you enjoy that fits under the healthy choice banner. Review your cooking style. To improve my dietary profile I will:

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Your activity level. If you are either very inactive or exercise occasionally then you are in need of improving your health profile. Regular activity is one of the more positive health habits you can adopt. To improve my activity level I will:

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Your weight/fat. If you feel your weight/body fat needs better management then think long term and look at introducing a range of behaviours that can improve your weight management.To improve my weight management I will:

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Your stress level. If you feel that your stress levels are not being managed well then now is a good time to implement positive strategies. To improve my stress management I will:

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Your lifestyle. A vital aspect to any sort of health management strategy is that you are enjoying your lifestyle. If it is out of balance then this can reflect in a poor health profile. A healthy lifestyle needs things in moderation, little bits often, most things are OK type thinking, so what does that mean to you? It is your choice. To improve my lifestyle choices I will:

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………

Start doing: ………………………………………………………………………………………………


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If you find it difficult to break your lifestyle into segments, then please consider the following as a starting point to help manage your cholesterol.

So With All This In Mind, Are You Ready For Change?If you’re ready for change, congratulations! GO FOR IT! Take it one step at a time. Put together a plan to maximize your success. Enthusiasm is important, but you’ve also got to have a clear idea where you’re going, anticipate road-blocks, and plan how to get around them.

Tips To Go1. Eat more fruit and vegetables.

2. Maintain a regular activity pattern.

3. Maintain your weight at a level were you feel healthy and in control.

4. Eat 5-6 small meals per day rather than 2-3 large meals.

5. Manage your stress levels with regular relaxation sessions.

6. Limit dietary cholesterol intake to 300 mg per day.

7. Reduce saturated fats by eating low fat dairy food, trimming some fat from meats, eating less take-aways, and using mono and polyunsaturated fats.

Cholesterol - Optimum HMS · cholesterol levels are generally recorded more in young Aussie men...

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