How To Lower Your Cholesterol

Overview

Cholesterol is a waxy, fat-like substance that travels in your blood. Your body needs some of it to build cells and make vitamins and hormones. But too much cholesterol — especially the 'bad' type — can slowly stick to the inside walls of your arteries (the tubes that carry blood to your heart and brain). This build-up is called plaque. Over time, plaque can narrow the arteries and make it harder for blood to flow, which raises the risk of heart attack and stroke. The good news is that most people can lower their cholesterol with everyday changes, and sometimes with help from a healthcare professional.

Yes. High cholesterol is very common among adults worldwide, and most people who have it do not know it. Because it causes no symptoms, it is often picked up during a routine health check or blood test.

Anyone can have high cholesterol, including children. Levels tend to rise as people get older. It is more likely if you have a close relative with high cholesterol or early heart disease, if you smoke, have diabetes, high blood pressure, kidney or thyroid problems, or if you carry extra weight around your middle. Some families carry a gene that causes very high cholesterol from a young age. This is uncommon but important to find early, so relatives can be tested too.

Symptoms

Common symptoms

• Usually no symptoms at all — most people feel completely well.
• You cannot see or feel cholesterol building up in your arteries.
• Most people only find out from a blood test, often at a routine health check.
• In rare cases, very high inherited cholesterol can cause fatty lumps on the skin (often around the eyes, elbows or knees) or a pale ring around the coloured part of the eye. These need a doctor's check.

Symptoms in children

• Children with high cholesterol almost never have symptoms and usually grow and play normally.
• A child may be tested if a parent or close relative has very high cholesterol or early heart disease.
• Finding it early in childhood is helpful because healthy habits started young can last a lifetime.

Symptoms in older adults

• Still usually no symptoms — high cholesterol stays silent at any age.
• Older adults are more likely to have other things that add to heart risk, such as high blood pressure or diabetes, so regular checks matter.
• Some people first notice a problem when they develop chest pain or shortness of breath with activity, which needs a doctor's review.

Causes

Main causes

• Eating a lot of saturated fat — found in fatty meat, butter, cheese, cream, pastries, cakes and some coconut and palm products.
• Not being active enough, which lowers 'good' cholesterol.
• Carrying extra weight, especially around the waist.
• Smoking, which lowers 'good' cholesterol and damages artery walls.
• Genes — some people inherit a tendency to make too much cholesterol, even with a healthy lifestyle.
• Other health conditions, such as an underactive thyroid, kidney disease, liver disease and diabetes.
• Some medicines can raise cholesterol. If you are worried about a medicine you take, speak to your doctor or pharmacist — do not stop it on your own.

Risk factors

• Getting older.
• A close family member with high cholesterol, or a heart attack or stroke at a young age.
• High blood pressure.
• Type 2 diabetes or prediabetes.
• Being overweight or having a large waist.
• Smoking or using other tobacco products.
• Drinking more alcohol than is recommended.
• A diet high in saturated fat and low in fibre, fruit and vegetables.
• Being physically inactive.
• South Asian heritage, which is linked to a higher risk of heart disease.

When to see a doctor

See a doctor urgently if:

• Chest pain, tightness or pressure that is new, severe or not settling — call your local emergency number rather than waiting.
• Sudden shortness of breath, fainting, or signs of stroke such as face drooping or slurred speech — call emergency services.
• Chest discomfort that now happens with light activity and eases with rest — arrange same-day medical advice.

Book a routine appointment if:

• You are over 40 and have not had a cholesterol check or NHS Health Check in the last few years.
• A parent, brother, sister or child has very high cholesterol or had a heart attack or stroke young.
• You have diabetes, high blood pressure, kidney disease or an underactive thyroid.
• You would simply like to know your numbers and talk about your heart risk.
• You have fatty lumps on your skin or a pale ring around the eye.

Diagnosis

High cholesterol is found with a simple blood test called a lipid profile or lipid panel. A small sample of blood — sometimes just a finger-prick — is measured for total cholesterol, LDL ('bad'), HDL ('good'), non-HDL and triglycerides (another type of blood fat). Your doctor will look at these numbers alongside your age, blood pressure, smoking status and family history to estimate your overall risk of a heart attack or stroke over the next 10 years.

Tests that may be done

• A lipid profile blood test (total, LDL, HDL, non-HDL cholesterol and triglycerides).
• Blood pressure measurement.
• Blood tests for diabetes and kidney and thyroid function, which affect cholesterol and heart risk.
• Your weight, waist measurement and body mass index (BMI).
• Questions about your diet, activity, smoking, alcohol and family history.
• A risk score calculation, such as the one used in the NHS Health Check.

What to expect at your appointment

You may be asked whether to fast beforehand, but often you do not need to. Results usually come back within a few days. Your clinician will explain what your numbers mean in plain language, whether you need a repeat test, and whether lifestyle changes alone are enough or whether medicine could help. You are always part of that decision.

Treatment

Treatment has two parts: everyday habits that lower cholesterol, and — for some people — medicine to bring it down further. Which route suits you depends on how high your cholesterol is and on your overall risk of heart attack and stroke. Many people start with food, movement and stopping smoking, then review the numbers in a few months.

Self-care at home

• Cut back on saturated fat — choose lean meat, lower-fat dairy, and swap butter for small amounts of unsaturated oils such as olive or rapeseed.
• Eat more fibre: oats, barley, beans, lentils, fruit and vegetables all help lower cholesterol.
• Eat oily fish such as salmon, mackerel or sardines once or twice a week if you eat fish.
• Try foods with added plant stanols or sterols — some spreads, yoghurts and drinks contain them.
• Aim for at least 150 minutes of moderate activity a week — brisk walking, cycling, swimming or dancing all count, and it can be broken into short chunks.
• If you smoke, stopping is one of the most powerful things you can do. Ask your doctor or pharmacist what support is available.
• Keep alcohol within recommended limits and watch portion sizes if you are carrying extra weight.
• Get your cholesterol checked again when your clinician advises, so you can see what is working.

Medical treatments

If your risk is high, or lifestyle changes alone are not enough, your doctor may suggest medicine. The most commonly used group is called statins; they reduce how much cholesterol your body makes. Other types of cholesterol-lowering medicine are available for people who cannot take statins or who need more help. Your clinician will talk through the benefits and possible side effects with you and find what suits you. Never start, stop or change a medicine without speaking to your doctor or pharmacist, and tell them if you notice muscle aches or other new symptoms.

When is surgery considered?

Surgery is not used to treat high cholesterol itself. In some people who already have narrowed arteries, procedures such as a stent or bypass may be needed — but that is treatment for the artery disease, not for cholesterol.

Living with this condition

High cholesterol rarely changes how you feel day to day, so the main work is building habits you can keep. Think small and steady rather than perfect. A weekly shop with a few swaps, a short daily walk, and a reminder to take any medicine as prescribed will do more than a strict plan you cannot maintain.

Lifestyle tips

• Plan meals around vegetables, beans, whole grains and lean protein.
• Read food labels: look at the saturated fat per 100g and choose lower.
• Find an activity you enjoy and build it into your routine, such as walking after meals.
• Keep a simple diary of what you eat and how much you move for a week — it helps you spot easy wins.
• Protect your sleep and manage stress where you can; both affect heart health.
• Ask your household to make the changes with you — it is much easier together.

Diet and exercise

A heart-friendly way of eating is not about cutting out all fat. It is about swapping saturated fats for unsaturated ones and eating more fibre. Try porridge or wholegrain toast with fruit at breakfast; beans, salad or vegetable soup at lunch; and fish, chicken, tofu or lentils with plenty of vegetables at dinner. For movement, aim for something that makes you breathe a little faster and feel warmer — a brisk walk, a bike ride, gardening or dancing. Build up gradually, and if you have a heart condition or joint problems, ask your clinician what is safe for you.

Mental health and emotional wellbeing

Being told you have high cholesterol can bring up worry, especially if a relative has had a heart attack. Some people feel guilty about past habits, or anxious about test results. These feelings are normal and worth talking about. If low mood, anxiety or worry about your health is affecting your sleep, appetite or daily life, tell your doctor — support is available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line in your country straight away.

Prevention

Often, yes — or at least delayed and lowered. Eating less saturated fat, eating more fibre, staying active, not smoking and keeping to a healthy weight all help keep cholesterol in a healthier range. Some people have a strong family tendency that cannot be prevented, but even then, early testing and treatment greatly reduce the risk.

Vaccines

There is no vaccine for high cholesterol. Staying up to date with routine vaccinations, including flu vaccination if your clinician recommends it, helps protect your heart and general health.

Screening programmes

In England, the NHS Health Check offers adults aged 40 to 74 a cholesterol and heart risk check every 5 years. Similar programmes exist in other countries. If you have a strong family history of very early heart disease or very high cholesterol, ask your doctor whether you and your relatives should be tested sooner.

Complications

If left untreated

• Buildup of plaque in the arteries (atherosclerosis), which narrows them and reduces blood flow.
• Angina — chest pain or tightness brought on by activity.
• Heart attack, when plaque blocks blood flow to the heart muscle.
• Stroke, when blood flow to part of the brain is blocked.
• Narrowed arteries in the legs, which can cause calf pain when walking.
• Damage to the kidneys and eyes over many years in people with very high risk.

Long-term outlook

The outlook is genuinely encouraging. Cholesterol responds well to everyday changes, and if you need medicine, modern treatment lowers the risk of heart attack and stroke substantially. Many people bring their numbers into a healthier range within months. The key is to know your numbers, keep your follow-up appointments, and make changes you can stick with for the long term.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.