cholesterol treatment options overview

Overview

Cholesterol is a fatty substance found in your blood. Your body needs a small amount to build healthy cells, but too much can stick to the walls of your arteries, making them narrow and increasing your risk of heart disease and stroke.

Yes, high cholesterol is very common. In the UK, around two in five adults have high cholesterol, though many have not been diagnosed.

Anyone can have high cholesterol, but it becomes more common as you get older. It can also run in families, so you may be more likely to have it if a parent or sibling does.

Symptoms

Common symptoms

• Most people with high cholesterol have no symptoms at all.
• High cholesterol is often discovered during a routine blood test or health check.

Symptoms in children

• Children usually have no symptoms either. In rare inherited conditions, some children may develop fatty lumps under the skin or around the eyes, but this is uncommon.

Symptoms in older adults

• Older adults typically have no specific symptoms. However, their risk of heart attack and stroke increases, so regular checks are especially important.

Causes

Main causes

• A diet high in saturated fats — found in red meat, butter, full-fat dairy, and fried foods.
• Inherited genes — a condition called familial hypercholesterolemia can cause very high cholesterol even in fit, healthy people.
• Certain health conditions, such as diabetes, an underactive thyroid, or kidney or liver disease.
• Some medicines, including certain blood pressure tablets and steroids.

Risk factors

• Age — risk increases as you get older.
• Family history of high cholesterol or early heart disease.
• Smoking, which damages blood vessels and lowers good cholesterol.
• High blood pressure or diabetes.
• Being overweight or living with obesity.
• Not getting enough physical activity.
• Eating a diet high in ultra-processed foods.

When to see a doctor

See a doctor urgently if:

• If you have any symptoms of a heart attack or stroke, call your local emergency number (such as 999 in the UK or 911 in the US) immediately.

Book a routine appointment if:

• Ask your healthcare provider for a cholesterol test if you are over 40.
• If you have diabetes, high blood pressure, or a family history of early heart disease, request a check sooner.
• If you have been told your cholesterol is high before, see your doctor regularly to review your plan.

Diagnosis

High cholesterol is diagnosed with a blood test called a lipid panel. A small sample of blood is taken, usually from your arm, and sent to a laboratory. You may be asked to fast for 9 to 12 hours beforehand.

Tests that may be done

• Lipid panel — measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.
• ApoB test — a more detailed measure of the particles that carry bad cholesterol.
• Coronary calcium scan — a CT scan that can detect calcium in your arteries if your doctor is worried about your heart risk.

What to expect at your appointment

Your doctor will discuss your results with you, often together with your blood pressure, age, smoking status, and family history, to estimate your overall risk of heart disease. They will tell you what your numbers mean and what steps to take next.

Treatment

Treatment for high cholesterol is about lowering your risk of heart attack and stroke. Your plan will depend on your numbers, your age, and your overall health. For most people, it starts with healthy lifestyle changes. If that's not enough, your doctor may suggest medication.

Self-care at home

• Cut down on saturated fat — swap butter and lard for olive oil or rapeseed oil.
• Eat more fruit, vegetables, wholegrains, beans, and lentils.
• Be physically active — aim for at least 150 minutes of moderate activity each week.
• Quit smoking and avoid secondhand smoke.
• Limit alcohol to recommended amounts.
• If you are overweight, losing even 5-10% of your body weight can improve your cholesterol.

Medical treatments

When lifestyle changes are not enough, doctors can prescribe medicines that lower cholesterol. Different types work in different ways: some reduce how much cholesterol your liver makes, some stop your gut from absorbing cholesterol from food, and some are injectable treatments for people with very high inherited risk. Your doctor will choose the most suitable option for you, explain how to take it, and tell you how often to have follow-up blood tests. Always follow your prescribed treatment and ask your pharmacist or doctor if you have questions.

When is surgery considered?

Surgery is rarely part of cholesterol treatment. A procedure called lipoprotein apheresis — similar to kidney dialysis but for filtering cholesterol from the blood — is sometimes used for people with severe inherited cholesterol problems that do not respond to medication. This is only done in specialist centres.

Living with this condition

Living with high cholesterol doesn't mean giving up all the foods you enjoy. It means making steady, realistic changes, such as choosing wholegrain bread, having fish once or twice a week, and walking more each day. Your pharmacist, practice nurse, or dietician can help you build a plan.

Lifestyle tips

• Build regular exercise into your week — even a 10-minute brisk walk after meals helps.
• Cook at home more often using fresh ingredients.
• Try to reduce stress with breathing exercises or hobbies you enjoy.
• Get enough sleep — poor sleep is linked to worse heart health.
• Keep a reminder in your calendar for blood tests and check-ups.

Diet and exercise

A heart-healthy diet is rich in fibre and heart-friendly fats. Oats, barley, beans, lentils, nuts, soya, and oily fish like salmon or mackerel are all good choices. Try to eat less red meat, butter, cakes, biscuits, and fried fast food. Pair this with daily activity — swimming, cycling, or brisk walking can raise your good cholesterol and help you feel more energetic.

Mental health and emotional wellbeing

It is normal to feel worried or down when you learn you have a health condition. But stress can affect your blood pressure and heart. Talk to your doctor if you feel anxious — they can point you to counselling or mindfulness resources. Connecting with friends and family also helps.

Prevention

You can't always prevent high cholesterol because genetics play a part. But you can lower your risk by eating a balanced diet, staying active, not smoking, and keeping your blood pressure and blood sugar in a healthy range. Even small changes make a difference.

Vaccines

There are no vaccines to prevent high cholesterol. However, staying up to date with vaccines such as the flu vaccine and COVID-19 vaccination is important for protecting your heart and lungs if you have untreated high cholesterol.

Screening programmes

If you live in England and are aged 40 to 74, you are eligible for a free NHS Health Check, which includes a cholesterol test and a heart risk review. In other countries, ask your doctor about a heart health screening when you are due.

Complications

If left untreated

• Narrowed and hardened arteries (atherosclerosis).
• Angina — chest pain caused by reduced blood flow to the heart.
• Heart attack.
• Stroke.
• Peripheral artery disease — poor circulation in the legs.

Long-term outlook

The outlook is positive. With early detection and the right plan, you can lower your cholesterol, protect your arteries, and greatly reduce your risk of heart attack and stroke. Many people manage high cholesterol successfully for decades with simple lifestyle habits and, if needed, a safe daily medicine.

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