Overview

What is high cholesterol?

• high cholesterol is when you have too much of a fatty substance called cholesterol in your blood
• it's mainly caused by eating fatty food, not exercising enough, being overweight, smoking and drinking alcohol. It can also run in families
• you can lower your cholesterol by eating healthily and getting more exercise. Some people also need to take medicine
• too much cholesterol can block your blood vessels. It makes you more likely to have heart problems or a stroke
• high cholesterol does not cause symptoms. You can only find out if you have it from a blood test

Heart UK has separate information about inherited high cholesterol that starts at a young age (familial hypercholesterolaemia).

Find out more about amilial hypercholesterolaemia on the Heart UK website

Getting tested

Check if you have high cholesterol

High cholesterol does not cause symptoms. You can only find out if you have it from a blood test.

Your GP might suggest having a test if they think your cholesterol level could be high.

This may because of your age, weight or another condition you have (like high blood pressure or diabetes).

Ask your GP surgery for a cholesterol test if:

• you have not had a test before and you're over 40, overweight, or high cholesterol or heart problems run in your family

You're more likely to have high cholesterol.

Having a cholesterol test

There are 2 ways of having a cholesterol test.

Taking blood from your arm

Some blood will usually be taken from your arm with a needle.

This is sent to a lab to check your cholesterol level. You should get the result in a few days.

You might be asked not to eat anything for up to 12 hours before the test. But this is not always needed.

Finger-prick test

The test can be done by pricking your finger. A drop of blood is put on a strip of paper. This is put into a machine that checks your cholesterol in a few minutes.

What happens next

If you have high cholesterol, a doctor or nurse will talk to you about how you can lower it.

This might include things like changing your diet or taking medicine.

They may also work out your risk of having a heart attack or stroke in the next 10 years.

They can do this using your:

• cholesterol levels
• blood pressure
• height and weight
• age, sex and ethnicity

Lowering your cholesterol can help lower your risk of having a heart attack or stroke

Cholesterol levels

About your cholesterol result

A cholesterol test can measure:

• total cholesterol – the overall amount of cholesterol in your blood, including both "good" and "bad" cholesterol
• total cholesterol to HDL cholesterol ratio (TC:HDL) - the level of good cholesterol in your blood compared to your overall cholesterol level
• good cholesterol (called HDL) – this makes you less likely to have heart problems or a stroke
• bad cholesterol (called LDL and non-HDL) – this makes you more likely to have heart problems or a stroke

When you get your result, you may just be told your total cholesterol.

You might be able to get separate results for your good and bad cholesterol and your total cholesterol to HDL ratio. Ask your doctor or nurse.

Check what your cholesterol levels should be

These levels are just a guide.

Cholesterol levels are used alongside other factors, such as lifestyle and medical conditions, to estimate your risk of cardiovascular disease.

The levels you should aim for might be different depending on things like your age, and whether you have conditions such as diabetes or cardiovascular disease.

Ask your doctor or nurse what your levels should be.

Result                                                Healthy level
Total cholesterol                                 5mmol/L or below
Total cholesterol to HDL                                                                        cholesterol ratio                                  below 6                                               HDL (good cholesterol)                     1mmol/L or above for men or                                                                           1.2mmol/L or above for women              Non-HDL (bad cholesterol)              4mmol/L or below

Find out more about cholesterol levels on the Heart UK website.

How to lower your cholesterol

Eat less fatty food

To reduce your cholesterol, try to cut down on fatty food, especially food that contains a type of fat called saturated fat.

You can still have foods that contain a healthier type of fat called unsaturated fat.

Check labels on food to see what type of fat it has in it.

Try to eat more:

• oily fish, like mackerel and salmon
• brown rice, bread and pasta
• nuts and seeds
• fruits and vegetables

Try to eat less:

• meat pies, sausages and fatty meat
• butter, lard and ghee
• cream and hard cheese, like cheddar
• cakes and biscuits
• food that contains coconut oil or palm oil

Exercise more

Aim to do at least 150 minutes (2.5 hours) of exercise a week.

Some good things to try when starting out include:

• walking – try to walk fast enough so your heart starts beating faster
• swimming
• cycling

Try a few different exercises to find something you like doing. You're more likely to keep doing it if you enjoy it.

Stop smoking

Smoking can raise your cholesterol and make you more likely to have serious problems like heart attacks, strokes and cancer.

If you want to stop smoking, you can get help and support from:

• your GP
• Help me Quit (Wales)

They can give you useful tips and advice about ways to stop cravings.

Cut down on alcohol

Try to:

• avoid drinking more than 14 units of alcohol a week
• have several drink-free days each week
• avoid drinking lots of alcohol in a short time (binge drinking)

Ask your GP for help and advice if you're struggling to cut down.

Medicines for high cholesterol

Medicine to lower your cholesterol

You might need medicine to lower your cholesterol if:

• your cholesterol level has not gone down after changing your diet and lifestyle
• you're at a high risk of having a heart attack or stroke

Ask your doctor about the medicines you can take.

Statins

Statins are the most common medicine for high cholesterol.

They reduce the amount of cholesterol your body makes.

You take a tablet once a day. You usually need to take them for life.

Other medicines for high cholesterol

Other medicines may be used if statins do not work or you do not want to take statins.

These include:

• other tablets – such as ezetimibe, fibrates and bile acid sequestrants (also called resins) and bempedoic acid
• injections – such as alirocumab, evolocumab and inclisiran

Find out more

Heart UK: treatment for high cholesterol