Cholesterol Levels

Overview

Cholesterol is a waxy, fat-like substance in your blood. Your body needs some cholesterol to build cells and make hormones. Your liver makes most of it, and the rest comes from food. The problem is when there is too much LDL cholesterol, often called 'bad' cholesterol, because it can build up in artery walls. HDL cholesterol, often called 'good' cholesterol, helps carry cholesterol away from arteries. Triglycerides are another type of fat in the blood.

Very common. Many adults have higher cholesterol than is healthy, and most do not know it because it usually causes no symptoms.

Anyone can have high cholesterol. It is more likely as you get older, if it runs in your family, or if you have certain health conditions or lifestyles. Children can have it too, especially if there is a strong family history of very high cholesterol.

Symptoms

Common symptoms

• Usually no symptoms at all. You cannot feel high cholesterol.
• It is found by a blood test, often during a routine health check or heart risk assessment.
• Some people first find out after a heart problem or stroke, which is why testing and prevention matter.

Symptoms in children

• Most children with high cholesterol have no symptoms.
• A rare inherited form can cause fatty bumps on the skin or tendons, but this is uncommon.
• Testing may be suggested if there is a strong family history of very high cholesterol or early heart disease.

Symptoms in older adults

• Usually no symptoms. The chance of high cholesterol and heart disease rises with age.
• Symptoms in older adults are more likely to come from related heart or blood vessel problems, not from cholesterol itself.

Causes

Main causes

• Eating a lot of saturated fat, such as in butter, fatty meat, and pastries, and trans fat, found in some processed foods.
• Not being active enough.
• Being overweight.
• Smoking.
• Drinking too much alcohol.
• Genes and family history — some people make too much cholesterol even with healthy habits.
• Other health conditions, such as diabetes, thyroid problems, kidney disease, or liver disease.
• Some medicines can raise cholesterol. Ask your pharmacist or healthcare provider about your medicines.

Risk factors

• Getting older.
• A family history of high cholesterol or early heart disease.
• Diabetes or prediabetes.
• High blood pressure.
• Kidney disease or thyroid problems.
• Smoking.
• Overweight or obesity.
• An unhealthy diet and not enough physical activity.
• Some ethnic backgrounds have a higher risk of heart disease.

When to see a doctor

See a doctor urgently if:

• If a home or pharmacy cholesterol test shows a very high result, arrange an urgent appointment with a healthcare provider.
• If you have very high triglycerides and develop severe belly pain with vomiting, seek same-day urgent care.
• If you have new breathlessness, palpitations, or swelling that worries you, contact urgent care.

Book a routine appointment if:

• Book a routine check if you have not had your cholesterol checked and you have risk factors such as family history, diabetes, high blood pressure, or smoking.
• If you already have heart disease, diabetes, or kidney disease, keep your routine appointments and cholesterol checks.
• If you want advice on healthy eating, weight, or quitting smoking, ask your healthcare team.

Diagnosis

High cholesterol is found with a blood test called a lipid profile. Your healthcare provider also asks about your health, family history, and lifestyle. They may estimate your chance of having a heart attack or stroke in the next 10 years.

Tests that may be done

• Lipid profile: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol.
• Blood glucose or HbA1c to check for diabetes.
• Liver, kidney, and thyroid tests if needed.
• Blood pressure and weight checks as part of heart risk assessment.

What to expect at your appointment

A small blood sample is usually taken from a vein in your arm. Some cholesterol tests do not need you to fast, but follow any instructions you are given. Results often come back in a few days. Your provider will explain what the numbers mean for you and whether treatment is needed.

Treatment

Treatment aims to lower your chance of heart attack and stroke, not just to change a number. It starts with healthy habits. If your risk is high, your healthcare provider may also suggest medicine. Your provider will consider your whole risk, not one cholesterol result alone.

Self-care at home

• Eat more vegetables, fruit, beans, whole grains, nuts, and healthy oils.
• Choose foods lower in saturated fat and avoid trans fats.
• Be active in a way you enjoy and can keep up. Aim for regular movement most days if your health allows.
• Lose weight if you are overweight — even a small amount can help.
• Stop smoking. Ask your healthcare team or pharmacist for support.
• Limit alcohol.
• Get enough sleep and find ways to manage stress.
• Take any prescribed medicine as directed and go for follow-up blood tests.

Medical treatments

If healthy habits are not enough, or if your risk of heart attack or stroke is high, your healthcare provider may prescribe cholesterol-lowering medicine. These medicines work in different ways. Your provider will choose one based on your health, other medicines, and your risk. You may need blood tests to check how it is working and to watch for side effects. Never start, stop, or change a medicine without advice. If side effects bother you, tell your provider — there may be other options.

When is surgery considered?

Surgery is not used to treat high cholesterol itself. If cholesterol has led to heart or blood vessel disease, a specialist may discuss procedures separately. Your provider will explain if this applies to you.

Living with this condition

High cholesterol is usually managed over the long term. Keep your appointments, know your numbers, and follow your agreed plan. If you are prescribed medicine, take it regularly and do not stop without asking. Small daily habits add up more than perfect days.

Lifestyle tips

• Build meals around vegetables, fruit, beans, and whole grains.
• Replace some saturated fats with unsaturated fats, such as olive oil, nuts, and seeds.
• Find movement you like — walking, cycling, swimming, dancing, or gardening.
• Stay smoke-free and avoid secondhand smoke.
• Keep alcohol within low-risk limits, or ask your provider what is right for you.
• Keep a simple routine for medicines and appointments if you take treatment.

Diet and exercise

A heart-healthy eating pattern is rich in vegetables, fruit, beans, whole grains, nuts, and fish. It limits saturated fat, processed meats, fried foods, sugary drinks, and salty snacks. Regular activity helps raise HDL ('good') cholesterol and lower triglycerides. Aim for moderate activity most days if you can, but any movement is better than none. Start where you are and build up slowly.

Mental health and emotional wellbeing

It can be worrying to hear you have high cholesterol, especially because it has no symptoms. Stress and low mood can also make healthy habits harder. Talk to your healthcare provider if you feel anxious or overwhelmed. If you ever have thoughts of harming yourself, contact your local crisis line or emergency services right away.

Prevention

Often high cholesterol can be prevented or lowered. Genes play a part, so some people need medicine even with healthy habits. Healthy habits still help everyone and are worth starting at any age.

Vaccines

There is no vaccine for high cholesterol.

Screening programmes

Cholesterol is checked with a blood test. When to start and how often to check depends on your age, risk factors, and local guidance. In the UK, eligible adults may be offered an NHS health check that includes cholesterol. Ask your healthcare provider what screening is right for you.

Complications

If left untreated

• Fatty deposits called plaques can build up in arteries and narrow them.
• Heart attack.
• Stroke.
• Peripheral artery disease — narrowed arteries in the legs can cause pain when walking.
• Very high triglycerides can cause pancreatitis, a painful swelling of the pancreas.

Long-term outlook

The outlook is hopeful. Most people can lower their cholesterol and heart risk with healthy habits and, if needed, treatment. It is never too late to start, and small steps count.

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