questions to ask before cholesterol

Overview

Cholesterol is a waxy, fat-like substance that your body needs to build cells and make hormones. But when you have too much cholesterol in your blood, it can stick to the walls of your arteries and narrow or block them. This is called high cholesterol, and it raises your risk of heart attacks and strokes. The good news is that high cholesterol usually has no symptoms, so a simple blood test is the only way to know your levels.

Yes, high cholesterol is very common. Around 2 in 5 adults have high cholesterol, and it becomes more common as you get older. Many people with high cholesterol don't know they have it.

High cholesterol can affect anyone, but it is more common if you are over 40, have a family history of high cholesterol or heart disease, eat a diet high in saturated fats, are overweight, or do not get enough physical activity.

Symptoms

Common symptoms

• High cholesterol usually has no symptoms. The first sign might be a heart attack or stroke, which is why regular checks are important.

Symptoms in children

• Children can have high cholesterol, especially if it runs in the family. Like adults, they usually have no symptoms. Doctors may recommend a blood test if there is a family history of very high cholesterol or early heart disease.

Symptoms in older adults

• Older adults are more likely to have high cholesterol, but it still does not cause symptoms. However, arteries can become stiffer and more narrowed over time, raising the risk of heart problems.

Causes

Main causes

• Eating too many foods high in saturated and trans fats (like fatty meats, butter, fried foods, and processed snacks)
• Not being physically active enough
• Being overweight or obese
• Smoking or exposure to tobacco smoke
• Drinking too much alcohol

Risk factors

• Age – risk increases after 40
• Family history of high cholesterol or early heart disease
• Certain medical conditions such as diabetes, high blood pressure, or underactive thyroid
• Some medicines (like certain diuretics or steroids) can raise cholesterol levels

When to see a doctor

See a doctor urgently if:

• If you have any symptoms of a heart attack or stroke (see emergency section), call your local emergency number right away.
• If you have new chest pain that comes and goes with activity or stress, see a doctor within a day or two.

Book a routine appointment if:

• All adults should have a cholesterol check at least every 5 years starting around age 40, or earlier if you have risk factors.
• If you have a family history of high cholesterol or heart disease, ask your doctor about having a test earlier.
• If you have diabetes, high blood pressure, or are overweight, your doctor may check your cholesterol more often.

Diagnosis

High cholesterol is diagnosed with a blood test called a lipid profile or lipid panel. This test measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides (another type of fat in the blood). The test is usually done after you have fasted (not eaten or drunk anything except water) for 9 to 12 hours, but some labs now allow non-fasting tests.

Tests that may be done

• Lipid profile (blood test)
• Sometimes a test for lipoprotein(a), a genetic type of cholesterol that can increase risk

What to expect at your appointment

Your doctor will take a small sample of blood from your arm. The test takes only a few minutes. Your results will show your cholesterol numbers in millimoles per litre (mmol/L). Your doctor will explain what each number means and compare them to healthy targets. This is a great time to ask questions like: 'What is my LDL and HDL? What should my target be? What can I do to improve my numbers? Do I need medicine? How often should I be tested?'

Treatment

Treatment for high cholesterol focuses on lowering your risk of heart attack and stroke. The first step is always lifestyle changes – eating better, moving more, and losing weight if needed. If your cholesterol is still high after a few months, or if you have a very high risk, your doctor may recommend medicines that help lower cholesterol. Several types of medicines are available, and your doctor will choose the one that is safest and most effective for you.

Self-care at home

• Eat a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins. Cut down on saturated fats (found in red meat, butter, cheese, and fried foods) and avoid trans fats (often in processed snacks and baked goods).
• Get at least 150 minutes of moderate activity each week, like brisk walking, cycling, or swimming.
• Maintain a healthy weight – losing even 5-10% of your body weight can help lower cholesterol.
• If you smoke, get help to quit. Smoking damages blood vessels and makes cholesterol stick more easily.
• Limit alcohol – no more than 14 units per week for both men and women, with several alcohol-free days.

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe a medicine to lower cholesterol. The most common type is a statin, which helps your liver produce less cholesterol. Other medicines include those that block cholesterol absorption in the gut or help remove cholesterol from your blood. Your doctor will decide the best option based on your cholesterol levels, age, other health conditions, and risk of side effects. Do not stop or change any medicine without talking to your doctor first.

When is surgery considered?

Surgery is not usually needed for high cholesterol itself. In very rare cases of extremely high cholesterol that does not respond to treatment, a procedure called apheresis (like dialysis for cholesterol) might be used. This is only done in specialised centres for people with a rare genetic condition.

Living with this condition

Living with high cholesterol means making everyday choices that protect your heart. You will become more aware of what you eat and how active you are. Many people find it helpful to track their food intake, plan meals, and set small goals. Over time, these habits become second nature. You will also need to have regular blood tests to check your progress.

Lifestyle tips

• Cook at home more often using healthier fats like olive or rapeseed oil.
• Choose wholemeal bread, brown rice, and oats instead of white refined options.
• Snack on fruit, nuts (without salt), or yoghurt rather than biscuits or crisps.
• Go for a walk after meals or take the stairs when you can.
• Find an activity you enjoy – dancing, gardening, swimming – so you stick with it.

Diet and exercise

A heart-healthy diet and regular exercise are the cornerstones of managing high cholesterol. Aim to eat at least 5 portions of fruits and vegetables daily. Include oily fish like salmon or mackerel twice a week. Choose skinless poultry and lean cuts of meat. Swap butter for spreads made from unsaturated oils. For exercise, try to raise your heart rate for 30 minutes most days. Even breaking it up into 10-minute chunks works.

Mental health and emotional wellbeing

Being told you have high cholesterol can feel worrying, especially because it increases your risk of heart disease. You might feel anxious or stressed about making changes. Remember that high cholesterol is very common and very treatable. Focus on the positives – every healthy choice you make lowers your risk. If you feel overwhelmed, talk to your doctor or a counsellor. You can also contact a mental health helpline if you need immediate support.

Prevention

High cholesterol can often be prevented or delayed by maintaining a healthy lifestyle from a young age. Eat a balanced diet low in saturated and trans fats, stay physically active, keep a healthy weight, avoid smoking, and limit alcohol. Even if you have a family history, these steps can make a big difference. Regular cholesterol checks help catch it early.

Vaccines

There are no vaccines to prevent high cholesterol. However, staying up to date with vaccines like flu and pneumonia can help prevent illnesses that put extra strain on your heart.

Screening programmes

Screening is recommended for all adults starting around age 40. If you have a family history of very high cholesterol or early heart disease (before age 60 in a close relative), ask your doctor about earlier testing. Children may be tested if there is a known genetic condition.

Complications

If left untreated

• Narrowing of the arteries (atherosclerosis), which can reduce blood flow to vital organs
• Heart attack (myocardial infarction) – when a blocked artery cuts off blood to part of the heart
• Stroke (cerebrovascular accident) – when a blocked or burst artery cuts off blood to part of the brain
• Peripheral artery disease – reduced blood flow to the legs, causing pain and difficulty walking
• Angina – chest pain due to reduced blood flow to the heart

Long-term outlook

The outlook for people with high cholesterol is very good if you take steps to manage it. With lifestyle changes and, if needed, medicine, you can lower your cholesterol and significantly reduce your risk of heart attack and stroke. Many people live long, healthy lives by keeping their numbers in a healthy range. The key is to start today and stay consistent. Your doctor will support you every step of the way.

Find support

Local organisations

• British Heart Foundation · UK
• Heart UK · UK

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