Why is high cholesterol a problem?
Cholesterol is essential for good health and is found in every cell in the body.
However, a high cholesterol level in the blood (hyper-cholesterolemia) is
associated with an increased risk of heart disease and stroke. Seven out of
10 people over 45 have high cholesterol. The main risks associated with high
cholesterol are caused by fatty deposits (plaques) forming in blood vessels
causing narrowing or complete blockage. Large patches of plaque are called
atheroma, atherosclerosis, or “hardening of the arteries”. This can result in
heart attacks, strokes and problems in the arterial supply to any organ, e.g.
Types of cholesterol
Cholesterol is transported around the body in the blood attached to a protein.
This combination of fat and protein is called a lipoprotein. Lipoproteins can be
high density (HDL), low density (LDL) or very low density (VLDL), depending
on how much protein there is in relation to fat.
LDL (low density lipoprotein) - Most of the body’s cholesterol is transported
as LDL. This is mostly made up of fat and a small amount of protein. Too
much LDL in the blood can cause cholesterol deposits to build up in the
arteries, making it harder for the blood to flow through these blood vessels.
High levels of LDL in the blood are associated with an increased risk of
cardio-vascular disease (CVD). So LDL is sometimes referred to as “ bad
HDL (high density lipoprotein) - A small amount of cholesterol is transported
as HDL, which is mostly made up of protein and a small amount of fat.
HDL actually helps prevent cholesterol deposits building up in the arteries.
Low levels of HDL (compared with LDL) in the blood is associated with
an increased risk of CVD. So HDL is sometimes referred to as “good
cholesterol”. Women tend to have higher levels of HDL cholesterol than men.
A high total cholesterol (TC) level is one risk factor for health problems.
However, it’s important to consider the relative amounts of HDL and LDL (the”
good and the bad”). This is often referred to as the TC:HDL ratio. A high level
of HDL to a low level of LDL (so a low TC:HDL ratio) is important.
Triglycerides - Triglycerides are a different type of fat, which mostly come from
fats in your food. Energy that is eaten and not used immediately is converted
into triglycerides and transported to fat cells for storage. This is an important
Although most triglycerides are stored in fat tissue, low levels are also found
in the blood. They are carried in the blood as very low density lipoproteins
A raised level of blood triglycerides together with high LDL can increase the
risk of heart disease, particularly in people with diabetes.
What factors affect the level of cholesterol in the blood?
There are many factors that may contribute to high blood cholesterol, it is not
• a diet that’s high in saturated fat and, less important, high in cholesterol
• lack of exercise may increase LDL (“bad”) cholesterol and decrease HDL
• family history, this is a genetic problem affecting how cholesterol is made
• being overweight, which may increase LDL (“bad”) cholesterol and
• age and sex - cholesterol generally rises slightly with increasing age, and
men are more likely to be affected than women
• drinking more than the recommended amount of alcohol (ie more than
three to four units per day for men and two to three units per day for
• ethnic group(e.g. people from the Indian sub continent).
Rarely, high cholesterol can be caused by a condition that runs in the family
called a lipid disorder (familial hypercholesterolaemia). About one in 500
Other health conditions such as poorly controlled diabetes, certain kidney and
liver diseases and an underactive thyroid gland may also cause cholesterol
levels to rise. Some medicines such as beta-blockers, steroids or thiazides (a
type of diuretic) may also affect blood lipid levels.
Only a small amount of cholesterol comes directly from your diet - the majority
is produced by your liver. However, if your diet is high in saturated fats and
cholesterol this can cause your liver to produce more LDL (“bad”) cholesterol.
The amount that diet influences cholesterol levels varies from person to
Current UK guidelines state that it is desirable to have a total cholesterol level
under 5mmol/l, and an LDL level under 3mmol/l.
In order to estimate your risk of getting CVD, the best indicator of risk is your
TC:HDL ratio. A lower ratio is desirable, because this indicates that you have
Measuring cholesterol involves a simple blood test.
Home-testing kits for cholesterol are not always accurate. Also, cholesterol
is just one of the risk factors for heart disease. It should ideally be measured
under medical supervision so that other important issues, such as blood
pressure, age and whether or not you smoke, are taken into account. Speak
to your pharmacist about your result if you do choose a home testing kit.
• Anyone who has any cardiovascular disease, such as coronary heart
disease, peripheral vascular disease (disease in the blood vessels that
• Anyone, even children, with a family history of familial
• Anyone aged 35 or over should consider having their cholesterol measured
if they have one or more of the following risk factors for CVD: family history
of early heart disease, diabetes, high blood pressure, or if they smoke.
Why have a test, I feel well?
A high cholesterol level does not cause symptoms. Most people find out they
have high cholesterol when they have their blood cholesterol measured as
part of a medical check-up or, it may be identified after other health problems,
such as heart disease, have been diagnosed. Prevention of heart disease is
much better than treatment once the disease is established
What treatments are available?
The main aim of lowering cholesterol is to reduce the risk of heart disease.
The type of treatment depends on the overall risk of heart disease and the
The first option is with simple lifestyle changes including changing diet,
managing weight and increasing exercise. Excess alcohol should also be
reduced and smoking stopped. The second is to combine lifestyle changes
with cholesterol-lowering medicines.
Cholesterol lowering diet
Healthy eating can reduce cholesterol. Your diet should be low in saturated
fats in particular, and low in fat overall. Biscuits, cakes, pastries, red meat,
hard cheese, butter and foods containing coconut or palm oil all tend to be
high in saturated fats these foods should all be reduced.
Large amounts of cholesterol are found in a few foods, including eggs, offal
such as liver and kidneys, and prawns. However, if you’re already eating a
balanced diet, you don’t need to cut down on these foods unless your GP or
Fibre reduces cholesterol and is important. It’s found in fruits and vegetables,
beans and oats .Ideally a minimum of at least five portions of fruit and
vegetables should be eaten each day.
Cholesterol lowering medications.
These are prescribed for people at high risk of heart disease or who already
have heart disease. The main group of medicines for lowering cholesterol
are statins e.g. simvastatin . They work by reducing the production of
cholesterol in the liver. Occasionally these drugs have side-effects such as
indigestion and muscle pains. Other types of drugs to reduce cholesterol are
called fibrates, nicotinic acids and cholesterol absorption inhibitors such as
ezetimibe (Ezetrol) but these are generally less effective or have more side-
effects. Your doctor will tell you more about these medicines.
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