Cholesterol is a fatty substance your body needs, but too much of the wrong type builds up in artery walls and raises the risk of heart attack and stroke. High cholesterol causes no symptoms whatsoever — it is found on a blood test, not by how you feel.
What do LDL and HDL mean?
- LDL ("bad") carries cholesterol into artery walls. Lower is better — this is the main treatment target.
- HDL ("good") carries cholesterol away from arteries. Higher is generally better.
- Triglycerides are another blood fat, raised by alcohol, sugar and excess weight.
- Total cholesterol alone is a poor guide — the breakdown matters more.
Target numbers are not the same for everyone. Someone who has already had a heart attack or has diabetes needs a substantially lower LDL than someone at low overall risk.
Who should be tested?
Testing is generally advised for adults over 40, and earlier for anyone with diabetes, high blood pressure, obesity, a family history of early heart disease, or a family history of inherited high cholesterol. Familial hypercholesterolaemia is a genetic condition causing very high levels from a young age, and it runs in families — if a close relative had a heart attack before 55 (men) or 65 (women), mention it to your doctor.
What lowers cholesterol?
- Replace saturated fat — fatty meat, butter, ghee, cream, palm oil — with olive oil, nuts and fish
- Eat more soluble fibre — oats, barley, lentils, beans, apples
- Avoid trans fats in some commercial baked goods and fried foods
- Move regularly — activity raises HDL and lowers triglycerides
- Lose excess weight and stop smoking; smoking lowers HDL and damages artery walls directly
Do I need a statin?
That depends on your overall cardiovascular risk, not on the cholesterol number alone. Doctors weigh age, blood pressure, smoking, diabetes and family history together. Statins meaningfully reduce heart attack and stroke risk in people at raised risk. Muscle aches are the most commonly reported side effect; serious problems are uncommon. Do not stop a statin without discussing it — cholesterol returns to its previous level within weeks.
When should I see a doctor?
See a doctor to have cholesterol checked if you have never been tested and are over 40 or have any risk factor above. Seek emergency care for chest pain or pressure, pain spreading to the arm, neck or jaw, or sudden breathlessness — these are symptoms of the disease high cholesterol contributes to.
