High cholesterol

Cholesterol is a fatty substance in your blood that helps to build and maintain healthy cells. It combines with proteins to form lipoproteins, which carry the cholesterol around your body in your blood. There are two main types of lipoproteins:

• HDL (high-density lipoproteins) — often referred to as good cholesterol — carries cholesterol back to your liver where it is broken down and removed from your body; higher levels help protect against cardiovascular disease
  
  
• LDL (low-density lipoproteins) — or bad cholesterol — carries cholesterol to your cells and if you have too much, it tends to stick around and increase your risk of developing cardiovascular disease

As cholesterol levels increase, fatty LDL cholesterol builds up in your arteries, increasing your risk of serious heart or circulation problems and stroke.

Men are more likely to have high cholesterol, although going through menopause early increases the risk for women.

High cholesterol is usually caused by:

• Being overweight
• Eating too much fatty food
• Drinking too much alcohol
• Not exercising enough
• Smoking

High cholesterol can also run in families. 

High cholesterol is usually symptomless but can be diagnosed with a cholesterol test, which is a blood test.

Your GP may recommend you have a cholesterol test if they think you are at risk of having high cholesterol levels. Risk factors include your age, other medical conditions and weight.

Once spotted, high cholesterol levels can be lowered by making simple lifestyle changes and/or taking medication.

If you have a condition that is affected by or raises cholesterol levels, your GP will regularly test your cholesterol.

If you’re over the age of 40 or concerned about your cholesterol levels, ask your GP about cholesterol testing.

Your GP will discuss your lifestyle, family history and general health, including any heart or circulatory problems. If needed, your GP will arrange for you to have a cholesterol test to check your cholesterol levels.

This test involves taking a small sample of your blood. This can be done in two ways: 

• Pricking your finger to collect a drop of blood that is put onto a special strip of paper, which is then fed into a machine to check your cholesterol levels — results take a few minutes
• Using a needle to take blood from your arm, which is sent to a lab to check your cholesterol levels — results take several days

In either case, for an accurate result, you can’t eat for up to 12 hours before your cholesterol test. The results of your test may also suggest your risk of having a heart attack or stroke in the next 10 years.

Your cholesterol test may measure:

• HDL (good cholesterol) — this helps protect against cardiovascular disease and reduces your risk of having a heart attack or stroke
• LDL (bad cholesterol) — this  increases your risk of developing cardiovascular disease or having a heart attack or stroke
• Total cholesterol — the total amount of cholesterol in your blood, including good and bad cholesterol
• Triglycerides — another type of fat that is similar to bad cholesterol

When your doctor gives you your results, they may only tell you your total cholesterol but you may be able to get the results for your LDL, HDL and triglyceride levels.

The best way to know what cholesterol levels you should aim for is to speak to your doctor or nurse, as these levels may be different from the guidelines below:

• HDL (good cholesterol) — one or above
• LDL (bad cholesterol) — three or below
• Non-HDL (bad cholesterol) — four or below
• Total cholesterol — five or below
• Triglycerides — 2.3 or below

The general rule is that the higher your LDL levels, the greater the risk to your health. Measuring only total cholesterol can therefore be misleading as it may be high due to high HDL (good cholesterol) levels, which is good for your health. 

Your LDL levels are only one factor in assessing your overall cardiovascular health risk and should be considered alongside your HDL levels and other health risk factors. 

There are many different reasons for high cholesterol levels.

Your lifestyle plays a major part in your cholesterol levels being too high. Factors include:

• Being overweight
• Drinking too much alcohol
• Eating unhealthily — this includes a diet high in salt
• Not doing enough exercise
• Smoking

Other risk factors that you cannot change (fixed risk factors) include:

• Your age — you’re more likely to develop high cholesterol as you get older
• Your sex — being male increases your risk of developing high cholesterol 
• Your genes — a family history of heart disease, stroke or high cholesterol increases your chance of having high cholesterol
• Your ethnic group — if you’re of Indian, Pakistani, Bangladeshi or Sri Lankan descent, you have an increased risk of developing high cholesterol

If you have a fixed risk factor, you may want to put more effort into minimising the effects of your lifestyle risk factors. 

There are also several conditions that can raise your cholesterol levels, including:

• Diabetes
• Gout
• High blood pressure (hypertension)
• Kidney or liver disease
• Underactive thyroid (hypothyroidism)

High cholesterol increases your risk of cardiovascular disease. However, even if your risk is low, it is important to maintain a healthy lifestyle to keep your risk of cardiovascular disease low. 

High cholesterol can be successfully treated. Your GP will tell you how to lower your cholesterol by changing your lifestyle, including following a healthy, balanced, low cholesterol diet. 

A low cholesterol diet involves eating more:

• Brown rice, bread and pasta
• Fruits and vegetables — these are good sources of fibre
• Nuts and seeds
• Oily fish, such as mackerel and salmon, and avocados — these are all good sources of omega-3 fatty acids

A low cholesterol diet also involves eating less: 

• Butter, lard and ghee
• Cakes and biscuits
• Cream and hard cheese
• Fatty meat, meat pies and sausages
• Food containing coconut oil or palm oil

Other lifestyle changes that can help lower high cholesterol levels include:

• Losing any excess weight and/or maintaining a healthy weight
• Stopping smoking and keeping to the recommended limits for alcohol
• Taking regular exercise, ideally 30 minutes every day — try out different exercises to find those you like as you'll be more likely to keep exercising if you enjoy it; you can start by trying: 
  
  
• Cycling
• Swimming
• Walking — walk fast enough to make your heart beat faster

If lifestyle changes fail to lower your cholesterol levels, or you're at a high risk of having a heart attack or stroke, your GP may prescribe cholesterol-lowering medication called statins. Statins reduce your body's production of cholesterol and are taken as tablets once a day, usually for the rest of your life. 

Alternatively, your GP may recommend: 

• Aspirin 
• Bile acid sequestrants (resins)
• Fibrates — these reduce triglyceride levels
• Injections (eg alirocumab, evolocumab)
• Medication to prevent cholesterol building up in your arteries
• Medication to prevent cholesterol from being absorbed (eg ezetimibe) 

If you need to lose a lot of weight, your GP may consider whether obesity surgery, such as a gastric bypass, might help.