High blood cholesterol is one of the most common health issues I encounter as an NHS GP. Millions in the UK have elevated cholesterol, raising their risk of heart attacks and strokes. The good news is that a simple blood test can detect it, and most people can manage it effectively with lifestyle changes and medication.
What is Cholesterol?
Cholesterol is a natural substance in the body, essential for building cells and producing hormones. However, when blood levels become too high, it can lead to health problems.
High cholesterol typically has no symptoms. Most people feel fine and are unaware of their levels. Over time, cholesterol can build up in arteries, narrowing and stiffening them, which reduces blood flow and increases the risk of heart attacks and strokes. It can also cause poor circulation in the legs. The risk is especially high when combined with smoking, high blood pressure, or diabetes.
How to Get Your Cholesterol Checked
The only way to know your cholesterol level is through a blood test. In England, adults aged 40 to 74 without cardiovascular disease can have an NHS Health Check every five years, which includes a cholesterol test. Those with long-term conditions like diabetes, heart disease, chronic kidney disease, or a previous stroke usually have annual checks.
Some people have familial hypercholesterolaemia, an inherited condition causing very high cholesterol from an early age. It significantly increases heart disease risk and often runs in families, so identifying one person can help detect and treat relatives.
Target Cholesterol Levels
Cholesterol results are measured in millimoles per litre (mmol/L). For many adults, a total cholesterol below 5 mmol/L is desirable, but targets vary. Doctors consider overall risk rather than just the number. Those who have had a heart attack or stroke, or have conditions like diabetes, are advised to aim for lower levels due to higher risk.
Lifestyle Changes to Lower Cholesterol
Diet is crucial. Reduce foods high in saturated fat, such as fatty meats, processed foods, and cakes. Increase intake of vegetables, fruit, wholegrains, beans, nuts, and fish. Maintaining a healthy weight is also important, as obesity raises cholesterol and cardiovascular risk. Regular physical activity helps; adults should aim for at least 150 minutes of moderate-intensity exercise weekly, like brisk walking, cycling, or swimming.
Not smoking is key, as smoking damages blood vessels and worsens cholesterol's effects. Limiting alcohol and managing diabetes and high blood pressure also help.
Cholesterol-Lowering Medicines
For many, lifestyle changes alone aren't enough. Statins are the most common cholesterol-lowering drugs, highly effective at reducing heart attack and stroke risk. Millions in the UK take them without problems. Other options include ezetimibe, which reduces cholesterol absorption from the bowel, and newer treatments like inclisiran, a twice-yearly injection for high-risk patients. Some need a combination to reach targets and maximise protection.
Protecting Your Health
High cholesterol is common, symptomless, and raises the risk of serious health issues. Through healthy lifestyle choices and medication, controlling cholesterol is one of the best ways to reduce heart attack and stroke risk. If you don't know your level, speak to your GP or attend an NHS Health Check. A simple blood test, along with the right lifestyle measures and drug treatment, will protect your health for years.
Dr Azeem Majeed has been a GP for over 30 years and is a professor of primary care and public health at Imperial College London.
