High cholesterol

• High cholesterol is when you have too much of a fatty substance called cholesterol in your blood.
• You're more likely to get high cholesterol if you're over 50, a man, you've been through the menopause, or you're of South Asian or sub-Saharan African origin. It can also run in families.
• It can also be caused by eating fatty food, not exercising enough, being overweight, smoking and drinking alcohol.
• You can lower your cholesterol by eating healthily and getting more exercise. Some people also need to take medicine.
• Too much cholesterol can block your blood vessels. It makes you more likely to have heart problems or a stroke.
• High cholesterol does not usually cause symptoms. You can only find out if you have it from a blood test.

HEART UK has information about inherited high cholesterol that starts at a young age (familial hypercholesterolaemia).

 Getting tested High cholesterol 

Check if you have high cholesterol

High cholesterol does not usually cause symptoms. You can only find out if you have it from a blood test.

Your GP might suggest having a test to check if your cholesterol level is high.

This may be because of your age, weight or a condition you have (like high blood pressure or diabetes).

 Ask your GP surgery for a cholesterol test if: 

• you have not had a test before and you're over 40, overweight, or high cholesterol or heart problems run in your family

You're more likely to have high cholesterol.

You can also get a cholesterol test at a pharmacy, but you might have to pay for it.

Having a cholesterol test

There are 2 ways of having a cholesterol test.

Taking blood from your arm

Some blood will usually be taken from your arm with a needle.

This is sent to a lab to check your cholesterol level. You should get the result in a few days.

You might be asked not to eat anything (to "fast") for up to 12 hours before the test. But most people do not need to fast.

Finger-prick test

This is a check-up that can help spot early signs of problems like heart disease and diabetes.

The test can be done by pricking your finger. A drop of blood is put on a strip of paper. This is put into a machine that checks your cholesterol in a few minutes.

View your results online

Results of tests you had at your GP surgery, and results that have been shared with your GP surgery, may be available in your online GP health record.

View test results in your GP health record

What happens next

If you have high cholesterol, a doctor or nurse will talk to you about how you can lower it.

This might include things like changing your diet or taking medicine.

They may also work out your risk of having a heart attack or stroke in the next 10 years.

Lowering your cholesterol can help lower your risk of having a heart attack or stroke.

 Cholesterol levels High cholesterol 

About your cholesterol result

A cholesterol test can measure:

• total cholesterol – the overall amount of cholesterol in your blood
• good cholesterol (called HDL) – this may make you less likely to have heart problems or a stroke
• non-HDL cholesterol – the difference between total cholesterol and HDL

When you get your result, you may just be told your total cholesterol.

You might be able to get separate results for your HDL and non-HDL cholesterol too. Ask your doctor or nurse.

View your results online

Results of tests you had at your GP surgery, and results that have been shared with your GP surgery, may be available in your online GP health record.

View test results in your GP health record

How your GP uses your results

Your GP will use your cholesterol levels along with other factors, such as your age, blood pressure and health conditions, to estimate your risk of cardiovascular disease.

They may give you a score (called a QRISK score) which estimates how likely you are to have a heart or circulation problem over the next 10 years.

What your cholesterol levels should be

What is a good target level for you depends on things like your age, whether you have any health conditions and your risk of cardiovascular disease.

These levels are a guide for healthy adults. If you have been ill, are taking some medicines, or have recently had a baby, your levels may be lower or higher. It does not make much difference to these levels whether you have eaten before your test or not.

Guide to healthy levels for different types of cholesterol 

 Result  Healthy level
 | Total cholesterol | Below 5mmol/L
 | HDL (good cholesterol) | Above 1.0mmol/L for men or above 1.2mmol/L for women
 | Non-HDL (bad cholesterol) | Below 4mmol/L

 How to lower your cholesterol High cholesterol 

Ways to lower your cholesterol

Eat less fatty food

To reduce your cholesterol, try to cut down on fatty food, especially food that contains a type of fat called saturated fat.

You can still have foods that contain a healthier type of fat called unsaturated fat.

Check labels on food to see what type of fat it has in it.

Try to eat more:

• oily fish, like mackerel and salmon
• olive oil, rapeseed oil and spreads made from these oils
• brown rice, wholegrain bread and wholewheat pasta
• nuts and seeds
• fruits and vegetables

Try to eat less:

• meat pies, sausages and fatty meat
• butter, lard and ghee
• cream and hard cheese, like cheddar
• cakes and biscuits
• food that contains coconut oil or palm oil

Exercise more

Aim to do at least 150 minutes (2.5 hours) of exercise a week.

Some good things to try when starting out include:

• walking – try to walk fast enough so your heart starts beating faster
• swimming
• cycling

Try a few different exercises to find something you like doing. You're more likely to keep doing it if you enjoy it.

Stop smoking

Smoking can raise your cholesterol and make you more likely to have serious problems like heart attacks, strokes and cancer.

If you want to stop smoking, you can get help and support from:

• your GP

They can give you useful tips and advice about ways to stop cravings.

Cut down on alcohol

Try to:

• avoid drinking more than 14 units of alcohol a week
• have several drink-free days each week
• avoid drinking lots of alcohol in a short time (binge drinking)

Ask your GP for help and advice if you're struggling to cut down.

 Medicines for high cholesterol High cholesterol 

Medicine to lower your cholesterol

You might need medicine to lower your cholesterol if:

• your cholesterol level has not gone down after changing your diet and lifestyle
• you're at a high risk of having a heart attack or stroke

Ask your doctor about the medicines you can take.

Statins

Statins are the most common medicine for high cholesterol.

They reduce the amount of cholesterol your body makes.

You take a tablet once a day. You usually need to take them for life.

Other medicines for high cholesterol

Other medicines may be used if statins do not work or you do not want to take statins.

These include:

• other tablets – such as ezetimibe, fibrates, bile acid sequestrants (also called resins) and bempedoic acid
• injections – such as alirocumab, evolocumab and inclisiran