High Cholesterol
Also known as Hyperlipidaemia, Hypercholesterolaemia
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is high cholesterol?
High cholesterol means too much fatty material circulating in the blood, which gradually deposits in artery walls and narrows them. It causes no symptoms at all, so it is found on a blood test rather than by feeling unwell. It matters because it is a major and highly treatable cause of heart attack and stroke.
Causes
- Diet high in saturated fat
- Physical inactivity and obesity
- Genetics, including familial hypercholesterolaemia
- Type 2 diabetes and metabolic syndrome
- Underactive thyroid
- Kidney or liver disease
- Some medicines
Symptoms
- No symptoms in almost all cases
- Fatty lumps around the eyelids in severe inherited forms
- A pale ring around the iris at a young age
- Fatty deposits over tendons in familial hypercholesterolaemia
- Symptoms only appear once heart or artery disease develops
Risk factors
- Family history of early heart disease
- Obesity and inactivity
- Smoking, which lowers protective HDL
- Diabetes
- Excess alcohol
- Increasing age
Diagnosis
- Blood lipid profile with total, LDL, HDL and triglycerides
- Non fasting testing is acceptable in most cases
- Cardiovascular risk calculation such as QRISK
- Thyroid, kidney and liver tests to exclude secondary causes
- Genetic testing where familial hypercholesterolaemia is suspected
Treatment
- Diet lower in saturated fat, higher in fibre and unsaturated fats
- Regular physical activity
- Weight management and stopping smoking
- Statins, which reduce heart attack and stroke risk
- Ezetimibe added where statins are insufficient
- PCSK9 inhibitors for very high risk or familial disease
Self care
- Swap saturated fats for olive, rapeseed and other unsaturated oils
- Eat more oats, beans, pulses, fruit and vegetables
- Include oily fish twice a week
- Aim for 150 minutes of moderate activity weekly
- Limit alcohol, which raises triglycerides
- Take statins at the same time each day and report muscle pain
- Do not stop a statin without discussing it first
When to see a doctor
Book an appointment if:
- Family history of heart attack or stroke under 60
- Muscle aches after starting a statin
- To have cholesterol checked if you are over 40
- Known diabetes, kidney disease or high blood pressure
- Fatty lumps on the skin or tendons
- Cholesterol remaining high despite diet and medication
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Eat a Mediterranean style diet
- Stay physically active and keep to a healthy weight
- Stop smoking
- Limit alcohol
- Have cholesterol checked periodically from age 40
- Screen relatives if familial hypercholesterolaemia is diagnosed
Outlook
Lowering cholesterol substantially reduces the risk of heart attack and stroke, and statins have a large and well established benefit for people at raised risk. Because the condition is symptomless, the main obstacle is adherence over years. Familial hypercholesterolaemia needs lifelong treatment from a young age and family screening, since untreated it causes very early heart disease.
Common questions
Do statins cause muscle problems?
Genuine muscle injury is rare. Trials where neither patient nor doctor knew who was taking the statin found muscle aches at almost the same rate as placebo. Report muscle pain so it can be assessed, but do not stop without advice.
Can diet alone fix high cholesterol?
Diet and exercise typically lower LDL cholesterol by around 10 to 15 percent, which is meaningful but often not enough for people at high cardiovascular risk or with an inherited cause. Both approaches are usually combined.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.