October marks National Cholesterol Month, with HEART UK running its 2026 campaign under the message 'Cholesterol Matters. Every Swap Counts', encouraging people to understand their cholesterol and make practical changes to protect their heart health.
Dr Francesco Lo Monaco, a preventative cardiologist and founder of The National Heart Clinic on London's Harley Street, has explained why feeling healthy doesn't necessarily mean your heart is protected. He is also the author of Heart Saviour, a new book designed to show how small, consistent changes can make life-changing differences to health and longevity.
Know your cholesterol number
Dr Lo Monaco said: “One of the challenges with high cholesterol is that people can feel completely well and assume everything is fine. But cholesterol doesn’t usually cause symptoms you can feel, so you cannot judge your cardiovascular health simply by how healthy you feel. Knowing your cholesterol levels gives you useful information, but the important thing is understanding what those numbers mean for your individual risk.”
High cholesterol often causes no symptoms, meaning the only way to know your levels is through a blood test. For healthy adults, a total cholesterol level below 5mmol/L and non-HDL cholesterol at or below 4mmol/L are commonly used as general UK guide levels. However, these figures are not a complete assessment of someone's cardiovascular risk, and individual targets may differ.
What do your cholesterol numbers actually mean?
A cholesterol test, often called a lipid profile, measures different fats in your blood. Results may include total cholesterol, HDL cholesterol, non-HDL cholesterol and triglycerides. HDL is often described as 'good' cholesterol because it helps transport cholesterol back to the liver. Non-HDL cholesterol includes the cholesterol carried by particles that can contribute to fatty build-up in artery walls.
Dr Lo Monaco said: “It’s important not to focus on just one number in isolation. Your clinician will consider your cholesterol results alongside factors such as your blood pressure, age, smoking status, diabetes, medical history and whether you have a family history of cardiovascular disease. That wider picture helps determine what action, if any, is needed.”
Why cholesterol is essential
Cholesterol is essential for the body, helping to build cells and produce hormones, including oestrogen, testosterone and cortisol. “Cholesterol itself isn’t bad,” Dr Lo Monaco said. “The concern is when certain cholesterol-carrying particles become too high, increasing cardiovascular risk.”
He highlighted two additional markers that may help clinicians assess cardiovascular risk in appropriate patients: ApoB and Lp(a). He said: “ApoB measures potentially harmful cholesterol-carrying particles, while Lp(a) is largely genetically determined and can increase heart disease risk even when standard cholesterol levels appear normal.” Whether these tests are appropriate depends on an individual's circumstances and should be discussed with a healthcare professional.
Five ways to support healthier cholesterol levels
Practical steps can help support cardiovascular health. Swapping foods high in saturated fat for sources of unsaturated fat, such as olive oil, nuts, seeds and oily fish, can help improve cholesterol levels. Eating more fibre-rich foods - beans, lentils, fruit and vegetables - while oats and other foods containing soluble fibre can help lower LDL cholesterol.
Regular physical activity supports cardiovascular health and can help improve some blood-fat measurements; walking, cycling, swimming and other activities you enjoy can all contribute. Smoking damages blood vessels and increases cardiovascular risk, so stopping smoking is one of the most important steps people can take. Healthy habits can make a meaningful difference, but genetics and other medical factors also influence cholesterol - some people will need medication, such as statins, alongside lifestyle changes to reduce their risk.
Dr Lo Monaco said: “There is no single food, supplement or lifestyle change that can guarantee protection from heart disease. The most effective approach is to understand your own risk, make sustainable changes and seek medical advice when needed. If you have high cholesterol, don’t assume that improving your diet alone will always be sufficient - treatment decisions should be based on your overall cardiovascular risk.”
People who haven't had their cholesterol checked, or who are unsure what their results mean, can speak to their GP or healthcare professional about testing and their individual cardiovascular risk. For Dr Lo Monaco, this focus on prevention is central to both his work at The National Heart Clinic and the message behind Heart Saviour: that small, consistent changes can make a meaningful difference to long-term health. “Prevention is about identifying risks before they develop into serious problems,” he said. "You don’t need to wait until you feel unwell to start taking your heart health seriously."
