Living with cholesterol

Overview

Cholesterol is a waxy, fat-like substance found in your blood. Your body needs some cholesterol to build healthy cells, but too much can stick to your artery walls and narrow or block them, which raises your risk of heart disease and stroke.

Yes, high cholesterol is very common. In the UK, about two out of five adults have high cholesterol. Many people have it without knowing.

High cholesterol can affect anyone, but it becomes more common as you get older. People with a family history of high cholesterol, those who eat a diet high in saturated fats, are overweight, or don't get enough exercise are at higher risk.

Symptoms

Common symptoms

• High cholesterol itself does not cause symptoms. Most people only find out about it from a routine blood test.

Symptoms in children

• In children, high cholesterol usually has no symptoms. Rarely, if a child has a severe genetic form, they may have yellowish fatty deposits under the skin called xanthomas.

Symptoms in older adults

• Older adults with high cholesterol may not have any specific symptoms, but they are at higher risk of heart attacks and strokes.

Causes

Main causes

• Eating too many foods high in saturated fats and trans fats (like red meat, butter, fried foods)
• Not being active enough
• Smoking tobacco
• Drinking too much alcohol
• Being overweight or obese

Risk factors

• Age (risk increases as you get older)
• Family history of high cholesterol or heart disease
• Having diabetes, high blood pressure, or an underactive thyroid
• A diet high in unhealthy fats and low in fibre
• Lack of exercise

When to see a doctor

See a doctor urgently if:

• If you have any emergency symptoms like chest pain, shortness of breath, or stroke signs — call your local emergency number immediately.

Book a routine appointment if:

• If you are over 40, ask your doctor about a cholesterol check as part of an NHS Health Check.
• If you have a family history of high cholesterol or heart disease, talk to your doctor about screening earlier.
• If you are concerned about your lifestyle or heart health, book a routine appointment.

Diagnosis

High cholesterol is diagnosed with a simple blood test called a lipid profile. You may need to fast (not eat or drink anything except water) for 9–12 hours before the test for more accurate results, but non-fasting tests are also used.

Tests that may be done

• Lipid profile (blood test that measures total cholesterol, LDL 'bad' cholesterol, HDL 'good' cholesterol, and triglycerides)
• Sometimes a second test after a few weeks to confirm

What to expect at your appointment

Your doctor or nurse will take a small sample of blood from your arm. The results show your cholesterol levels in millimoles per litre (mmol/L) or milligrams per decilitre (mg/dL). Your doctor will explain what your numbers mean and whether you need treatment.

Treatment

Treatment for high cholesterol focuses on lowering your risk of heart disease and stroke. Most people start with lifestyle changes. If these aren't enough, your doctor may recommend medications. The goal is to reduce your LDL (bad) cholesterol and improve your overall heart health.

Self-care at home

• Eat a heart-healthy diet with more fruits, vegetables, whole grains, and lean proteins, and less saturated fat.
• Aim for at least 150 minutes of moderate exercise each week, like brisk walking.
• If you smoke, get help to quit.
• Limit alcohol to no more than 14 units per week for both men and women.
• Maintain a healthy weight.

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe a medicine to lower your cholesterol. The most common type is a statin, which helps reduce the amount of cholesterol your liver makes. Other medicines work in different ways. Your doctor will choose the right treatment for you based on your cholesterol levels and overall health risk. Always take any prescribed medicine exactly as directed and discuss any side effects with your healthcare team.

When is surgery considered?

Surgery is not usually used to treat high cholesterol directly. However, if high cholesterol has already caused narrowed arteries (like in the heart), procedures such as angioplasty or bypass surgery may be needed to restore blood flow. Your doctor will discuss these options if they are appropriate.

Living with this condition

Living with high cholesterol is all about making small, steady changes. You can still enjoy meals out and social events — just learn to make heart-friendly choices. Taking any prescribed medicines consistently is key. Most people get used to their new routine quickly and feel healthier as a result.

Lifestyle tips

• Plan your meals to include more vegetables, fruit, and whole grains.
• Cook with healthy oils like olive or rapeseed oil instead of butter or lard.
• Stay active every day — even a short walk helps.
• Schedule regular check-ups to monitor your cholesterol and heart health.
• Learn to read food labels to spot hidden saturated fats.

Diet and exercise

A heart-healthy diet and regular exercise are the foundation of managing cholesterol. Eat plenty of fibre (oats, beans, apples) which can help lower cholesterol. Include healthy fats from nuts, seeds, and fish. Limit processed foods, fried foods, and sugary drinks. For exercise, find activities you enjoy — like dancing, cycling, or gardening — and aim to do at least 30 minutes most days.

Mental health and emotional wellbeing

Finding out you have high cholesterol can feel worrying, but try not to stress — it is a very manageable condition. Some people feel anxious about starting medication or making big lifestyle changes. Talk to your doctor about your concerns. Managing your mental health is just as important as managing your cholesterol. Simple stress-relief techniques like deep breathing, meditation, or talking to a friend can help.

Prevention

You can reduce your risk of developing high cholesterol by maintaining a healthy diet, staying active, not smoking, and limiting alcohol. If you have a family history, you cannot prevent it entirely, but you can still take steps to keep your levels in a healthier range.

Screening programmes

In the UK, the NHS offers a free Health Check for adults aged 40–74 which includes a cholesterol test. If you have a family history of heart disease or high cholesterol, your doctor may recommend earlier or more frequent checks.

Complications

If left untreated

• Narrowed and hardened arteries (atherosclerosis), which can lead to heart disease.
• Heart attack, if a coronary artery becomes blocked.
• Stroke, if a blood vessel in the brain becomes blocked.
• Peripheral artery disease, causing pain in your legs when walking.

Long-term outlook

The outlook for people with high cholesterol is very good, especially when you take action early. With lifestyle changes and, if needed, medication, you can significantly lower your cholesterol and keep your heart and arteries healthy for years to come. Most people live full, active lives.

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