Cholesterol is a waxy, fat-like substance found in all cells of the body. While essential for making hormones, vitamin D, and bile acids for digestion, too much cholesterol in the blood increases the risk of cardiovascular disease. High cholesterol has no symptoms, making regular testing essential for early detection.
Types of Cholesterol
LDL (Low-Density Lipoprotein) - "Bad" Cholesterol
LDL carries cholesterol to the arteries, where it can accumulate in the vessel walls, forming plaques (atherosclerosis). Higher LDL levels are associated with greater cardiovascular risk.
HDL (High-Density Lipoprotein) - "Good" Cholesterol
HDL carries cholesterol away from the arteries back to the liver for removal. Higher HDL levels are associated with lower cardiovascular risk.
Triglycerides
A type of fat in the blood. High triglycerides, combined with high LDL or low HDL, increase cardiovascular risk. Often elevated in obesity, diabetes, and with high sugar and alcohol intake.
Total Cholesterol
The sum of all cholesterol types. A useful initial screening measure.
Cholesterol Targets
NICE guidelines focus on cardiovascular risk reduction rather than specific cholesterol targets for most people. However, general guidance includes:
- Total cholesterol: Below 5 mmol/L
- LDL cholesterol: Below 3 mmol/L (below 1.8 mmol/L for high-risk patients)
- HDL cholesterol: Above 1.0 mmol/L for men, above 1.2 mmol/L for women
- Triglycerides: Below 1.7 mmol/L
For those on statin therapy, a 40% or greater reduction in non-HDL cholesterol from baseline is the recommended target.
Risk Factors for High Cholesterol
- Diet: High in saturated fats (fatty meats, full-fat dairy, fried foods, coconut oil, butter)
- Obesity: Particularly abdominal obesity
- Physical inactivity
- Age: Cholesterol tends to rise with age
- Genetics: Familial hypercholesterolaemia (FH) is an inherited condition causing very high LDL from a young age. Affects approximately 1 in 250 people
- Diabetes and metabolic syndrome
- Smoking: Lowers HDL and damages blood vessels
- Hypothyroidism: Underactive thyroid raises cholesterol
- Kidney disease
Testing
A lipid panel (fasting or non-fasting) measures:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Triglycerides
- Non-HDL cholesterol (total minus HDL)
NICE recommends cardiovascular risk assessment using the QRISK3 tool for adults aged 40-84 without existing CVD. Screening is also recommended for those with:
- Family history of premature CVD or familial hypercholesterolaemia
- Diabetes
- Hypertension
- Chronic kidney disease
Lifestyle Changes
Diet
- Reduce saturated fat: Choose lean meats, low-fat dairy, use olive oil instead of butter
- Increase soluble fibre: Oats, barley, beans, lentils, fruits. Soluble fibre binds cholesterol in the gut
- Eat more omega-3 fatty acids: Oily fish (salmon, mackerel, sardines) twice per week
- Plant stanols and sterols: Found in fortified margarines and yoghurt drinks. Can lower LDL by 7-10%
- Soy protein: Evidence suggests modest LDL reduction
- Nuts: A handful daily (almonds, walnuts) can improve lipid profile
- Reduce refined carbohydrates and added sugars: These raise triglycerides
Exercise
Regular physical activity raises HDL and improves lipid profile:
- 150 minutes of moderate-intensity aerobic exercise per week
- Resistance training also beneficial
Weight Management
Losing 5-10% of body weight can significantly improve cholesterol levels.
Smoking Cessation
Quitting smoking raises HDL within weeks and improves overall cardiovascular risk profile.
Statins
Statins are the most prescribed and most evidence-based medications for reducing cardiovascular risk. They work by blocking an enzyme in the liver that produces cholesterol.
Who Should Take Statins?
NICE recommends statins for:
- 10-year cardiovascular risk of 10% or more (QRISK3)
- Existing cardiovascular disease (secondary prevention)
- Familial hypercholesterolaemia
- Type 1 diabetes (aged over 40 or with diabetes for more than 10 years)
- Chronic kidney disease
Common Concerns
- Muscle aches: Occur in 5-10% of patients. Usually mild and can be managed by changing statin type or dose
- Liver effects: Mild enzyme elevation is common but clinically significant liver damage is very rare
- Diabetes risk: Small increase in risk for those already predisposed, but the cardiovascular benefits significantly outweigh this risk
Other Lipid-Lowering Medications
- Ezetimibe (blocks cholesterol absorption)
- PCSK9 inhibitors (injectable, for those with very high risk or statin intolerance)
- Fibrates (primarily for high triglycerides)
- Bempedoic acid (for statin-intolerant patients)
At Jabal Sina Medical Centre, our general practitioners and cardiologists provide comprehensive cardiovascular risk assessment, lipid testing, and personalised management plans.
This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.