cholesterol risks and benefits for patients

Overview

Cholesterol is a waxy, fat-like substance that your body needs to build cells and make vitamins and hormones. Your liver makes all the cholesterol you need, but you also get some from food. When you have too much of the 'bad' kind (LDL cholesterol), it can build up in your arteries and increase your risk of heart disease and stroke.

Yes, high cholesterol is very common. In the UK, about 2 in 5 adults have high cholesterol.

It can affect anyone, but it becomes more common as you get older. People with a family history of high cholesterol or heart disease are at higher risk, as are those who eat an unhealthy diet, are overweight, or do not get enough physical activity.

Symptoms

Common symptoms

• High cholesterol itself has no symptoms. Most people feel fine until complications develop.

Symptoms in children

• Children with very high cholesterol (such as from a genetic condition) may have fatty bumps on the skin or around the eyes, but most have no symptoms.

Symptoms in older adults

• Same as adults: no symptoms directly from high cholesterol. But older adults may notice signs of narrowed arteries, such as leg pain when walking (claudication).

Causes

Main causes

• Your body makes too much cholesterol, or you eat too many foods high in saturated and trans fats.
• A genetic condition called familial hypercholesterolemia can cause very high cholesterol from birth.

Risk factors

• Eating a diet high in saturated fats (fatty meats, butter, full-fat dairy, fried foods) and trans fats (some processed snacks).
• Not getting enough physical activity.
• Being overweight or having obesity.
• Smoking or using tobacco products.
• Drinking too much alcohol.
• Having diabetes, high blood pressure, or an underactive thyroid.
• Getting older — risk increases after age 40.
• Having a family history of high cholesterol or early heart disease.

When to see a doctor

See a doctor urgently if:

• If you have any signs of a heart attack or stroke — call your local emergency number immediately.
• If you have new chest pain or shortness of breath.

Book a routine appointment if:

• If you are over 40, ask your doctor about a cholesterol test as part of a routine health check.
• If you have a family history of high cholesterol or heart disease, talk to your doctor about getting tested earlier.
• If you have diabetes, high blood pressure, or other risk factors, get your cholesterol checked regularly.

Diagnosis

High cholesterol is diagnosed with a simple blood test called a lipid profile. It measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.

Tests that may be done

• Lipid panel (blood test) — usually done after fasting for 9–12 hours, though not always required.
• In some cases, your doctor may also check other markers like apolipoprotein B or lipoprotein(a).

What to expect at your appointment

A healthcare worker will take a small sample of blood from your arm. The results usually come back in a few days. Your doctor will explain your numbers and what they mean for your overall health.

Treatment

Treatment for high cholesterol focuses on lowering your LDL (bad) cholesterol to reduce your risk of heart attack and stroke. This usually starts with lifestyle changes, and if needed, medication is added.

Self-care at home

• Eat a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.
• Reduce saturated fats (red meat, butter, cheese) and avoid trans fats (processed foods).
• Get at least 150 minutes of moderate exercise each week, like brisk walking or cycling.
• Maintain a healthy weight.
• Quit smoking and limit alcohol.

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe a cholesterol-lowering medication. The most common type works by reducing the amount of cholesterol your liver makes. Other options include medications that help your body remove cholesterol or that block the absorption of cholesterol from food. Your doctor will choose a treatment plan based on your specific needs and risk factors.

When is surgery considered?

Surgery is not a treatment for high cholesterol itself. In rare cases, if cholesterol deposits block an artery, you may need a procedure like angioplasty or bypass surgery to restore blood flow. This would be discussed if you have heart disease.

Living with this condition

Living with high cholesterol means staying aware of your numbers and making heart-healthy choices part of your daily life. Most people manage it well with diet, exercise, and medication if needed.

Lifestyle tips

• Cook more meals at home using fresh ingredients.
• Read food labels and choose foods low in saturated and trans fats.
• Take a walk after meals or use stairs instead of the lift.
• Manage stress through relaxation techniques or hobbies.
• Stick to your medication schedule if your doctor prescribes one.

Diet and exercise

A heart-healthy diet includes plenty of vegetables, fruits, whole grains, nuts, seeds, and lean proteins like fish and poultry. Try to eat oily fish twice a week — it contains omega-3 fats that can help protect your heart. Replace butter with vegetable oils like olive or rapeseed oil. For exercise, aim for at least 30 minutes of moderate activity most days. Even small increases in activity help.

Mental health and emotional wellbeing

Being told you have high cholesterol can cause worry about your heart health. It's normal to feel anxious or stressed. But remember, it's a common condition and you can take steps to manage it. If you feel overwhelmed, talk to your doctor or consider seeing a counsellor. Anxiety can also affect your heart, so looking after your mental health is part of staying healthy.

Prevention

You can reduce your risk of developing high cholesterol by eating a healthy diet, staying active, not smoking, and limiting alcohol. If you have a genetic condition, you may not be able to prevent it entirely, but you can manage it with lifestyle and medication.

Screening programmes

If you are over 40, the NHS offers a free health check that includes a cholesterol test. If you have a family history of high cholesterol or early heart disease, talk to your doctor about being tested earlier.

Complications

If left untreated

• Atherosclerosis — narrowing and hardening of your arteries due to cholesterol plaque buildup.
• Heart attack — if a plaque in a coronary artery ruptures and blocks blood flow.
• Stroke — if a plaque in an artery to the brain ruptures or blocks blood flow.
• Peripheral artery disease — leg pain and reduced blood flow to your limbs.

Long-term outlook

With proper management, many people with high cholesterol can significantly lower their risk of heart attack and stroke. Treatment today is effective, and lifestyle changes can make a real difference. While you cannot always reverse existing plaque, you can stop it from getting worse and even stabilise it. The key is working with your healthcare team and sticking to your plan.

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