cholesterol overview for patients

Overview

Cholesterol is a waxy, fat-like substance that your body needs to build cells and make vitamins and other hormones. But too much cholesterol can stick to the walls of your arteries and narrow or block them, increasing your risk of heart disease and stroke.

Yes, high cholesterol is very common. About 2 in 5 adults have it, and many don’t know it because it doesn’t cause symptoms.

Anyone can have high cholesterol, but it becomes more common as you get older. You are at higher risk if you eat a lot of saturated fat, are overweight, smoke, or have a family history of high cholesterol.

Symptoms

Common symptoms

• High cholesterol itself does not cause symptoms.
• If it narrows your arteries, you may develop chest pain (angina), shortness of breath, or pain in your legs when walking.

Symptoms in children

• High cholesterol in children usually has no symptoms, but it can sometimes cause yellowish fatty bumps on the skin.

Symptoms in older adults

• In older adults, high cholesterol is also symptomless until complications occur, such as a heart attack or stroke.

Causes

Main causes

• Eating too much saturated fat and trans fat (found in fried foods, baked goods, and red meat).
• Lack of physical activity.
• Smoking or exposure to tobacco smoke.
• Having a family history of high cholesterol (genetics).

Risk factors

• Being overweight or obese.
• Eating a diet high in processed foods and low in fruits, vegetables, and whole grains.
• Having diabetes or prediabetes.
• Having high blood pressure.
• Being age 40 or older (men) or 50 or older (women).

When to see a doctor

See a doctor urgently if:

• If you have any symptoms of a heart attack or stroke (see emergency symptoms above), call your local emergency number immediately.

Book a routine appointment if:

• If you are age 40 or older, ask your doctor about a cholesterol check during a routine health visit.
• If you have a family history of high cholesterol, diabetes, or heart disease, get screened earlier and more often.
• If you are worried about your cholesterol level, make an appointment for a blood test.

Diagnosis

A simple blood test called a lipid panel or lipid profile measures your total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.

Tests that may be done

• Lipid panel (fasting blood test – you may be asked not to eat or drink anything except water for 9–12 hours before the test).
• Sometimes a non-fasting test is used; your doctor will tell you which one is best.

What to expect at your appointment

A healthcare professional will take a small sample of blood from your arm. The test is quick and causes only a brief pinch. Results are usually available within a few days. Your doctor will explain what your numbers mean and what steps to take.

Treatment

Treatment for high cholesterol focuses on lowering your LDL (bad) cholesterol and raising your HDL (good) cholesterol. This is done through lifestyle changes first, and if further lowering is needed, medicines may be added.

Self-care at home

• Eat a heart-healthy diet low in saturated fats, trans fats, and cholesterol. Include plenty of fruits, vegetables, whole grains, and healthy fats like olive oil and nuts.
• Get at least 150 minutes of moderate exercise each week (such as brisk walking, cycling, or swimming).
• Maintain a healthy weight or lose weight if you are overweight.
• If you smoke, seek help to quit. Avoid secondhand smoke.
• Limit alcohol to no more than one drink per day for women and two for men.

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe a medicine called a statin. Statins help lower LDL cholesterol and reduce the risk of heart attack and stroke. Other types of cholesterol-lowering medicines are also available. Your doctor will choose the best option based on your health and cholesterol levels. Never start or stop a cholesterol medicine without talking to your doctor.

When is surgery considered?

Surgery is not a treatment for high cholesterol itself. However, if high cholesterol has severely narrowed arteries, you may need a procedure such as angioplasty (opening the artery with a balloon) or bypass surgery to restore blood flow. These are treatments for the complications of high cholesterol, not the condition itself.

Living with this condition

Living with high cholesterol means making heart-healthy choices every day. This includes eating well, staying active, taking any prescribed medicines regularly, and keeping up with doctor visits. It is a long-term condition that needs ongoing management, but many people successfully keep their cholesterol under control.

Lifestyle tips

• Plan your meals around vegetables, fruits, whole grains, lean protein (like fish and skinless poultry), and healthy fats.
• Read food labels to avoid saturated and trans fats.
• Move more: aim for at least 30 minutes of activity most days.
• Manage stress with relaxation techniques like deep breathing, meditation, or talking to a friend.
• Get enough sleep – aim for 7–9 hours each night.

Diet and exercise

A diet rich in soluble fiber (from oats, beans, apples, and carrots) can help lower cholesterol. Replace butter and lard with vegetable oils like olive or canola oil. Choose low-fat or fat-free dairy. Exercise helps raise HDL cholesterol and improves heart health. Even a short daily walk can make a difference.

Mental health and emotional wellbeing

Worrying about your health or having to make big lifestyle changes can be stressful. It is normal to feel anxious or frustrated. If you feel overwhelmed, talk to your doctor or a mental health professional. Remember, you are not alone, and there is support available. If you are having thoughts of harming yourself, please contact a crisis helpline or call your local emergency number.

Prevention

You can reduce your risk of developing high cholesterol by eating a healthy diet, staying physically active, maintaining a healthy weight, not smoking, and limiting alcohol. However, some people have a genetic condition that causes high cholesterol no matter how healthy their lifestyle is. In those cases, medicines are often needed.

Screening programmes

Routine blood tests for cholesterol are recommended for adults starting at age 40, or earlier if you have risk factors like diabetes, high blood pressure, or a family history of early heart disease or high cholesterol.

Complications

If left untreated

• Narrowing of the arteries (atherosclerosis), which can lead to chest pain (angina).
• Heart attack – when a blood clot blocks blood flow to the heart.
• Stroke – when blood flow to the brain is blocked.
• Peripheral artery disease – pain and numbness in the legs due to reduced blood flow.

Long-term outlook

With proper management, most people with high cholesterol can reduce their risk of complications and live a long, healthy life. Lifestyle changes and medicines are very effective at lowering cholesterol. The key is to work closely with your healthcare team and stick with your treatment plan. Small steps add up to big benefits.

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