High cholesterol 

Introduction 

Preventing high cholesterol (BSL version)

Too much cholesterol in the body causes coronary diseases such as angina, heart attack and stroke. Dr Jonathan Morrell explains who is at risk and the treatments that are available.

Media last reviewed: 30/09/2013

Next review due: 30/09/2015

Lower your cholesterol

Foods you can eat and those you should avoid to help lower your cholesterol

Cholesterol is a fatty substance known as a lipid and is vital for the normal functioning of the body. It is mainly made by the liver but can also be found in some foods.

Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health. High cholesterol itself does not cause any symptoms, but it increases your risk of serious health conditions.

About cholesterol

Cholesterol is carried in your blood by proteins, and when the two combine they are called lipoproteins. There are harmful and protective lipoproteins known as LDL and HDL, or 'bad' and 'good' cholesterol.

  • Low-density lipoprotein (LDL): LDL carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as "bad cholesterol".
  • High-density lipoprotein (HDL): HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed out of the body as a waste product. For this reason, it is referred to as "good cholesterol" and higher levels are better.

The amount of cholesterol in the blood (both LDL and HDL) can be measured with a blood test. The recommended cholesterol levels in the blood vary between those with a higher or lower risk of developing arterial disease.

Why should I lower my cholesterol?

Evidence strongly indicates that high cholesterol can increase the risk of:

This is because cholesterol can build up in the artery wall, restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing somewhere.

Your risk of coronary heart disease (when your heart's blood supply is blocked or disrupted) also rises as your blood's cholesterol level increases and this can cause pain in the front of the chest or arm (angina) during stress or physical activity.

What causes high cholesterol?

There are many factors that can increase your chance of having heart problems or stroke if you have high cholesterol, including the following:

  • an unhealthy diet: some foods already contain cholesterol (known as dietary cholesterol) but it is the amount of saturated fat in your diet which is more important
  • smoking: a chemical found in cigarettes called acrolein stops HDL transporting fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis)
  • having diabetes or high blood pressure (hypertension)
  • having a family history of stroke or heart disease

There is also an inherited condition known as familial hypercholesterolaemia (FH). This can cause high cholesterol even in someone who eats healthily.

Read more about the causes of high cholesterol.

When should I test my cholesterol levels?

Your GP may recommend that you have your blood cholesterol levels tested if you:

  • have been diagnosed with coronary heart disease, stroke or mini-stroke (TIA) or peripheral arterial disease (PAD)
  • have a family history of early cardiovascular disease
  • have a close family member who has a cholesterol-related condition
  • are overweight
  • have high blood pressure, diabetes or a health condition that can increase cholesterol levels

Read more about how high cholesterol is tested.

How can I lower my cholesterol levels?

The first step in reducing cholesterol is to maintain a healthy, balanced diet. It is important to keep your diet low in fatty food. Try to swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help to prevent high cholesterol from returning.

Other lifestyle changes can also make a big difference. It will help to lower your cholesterol if you:

If these measures don't reduce your cholesterol and you continue to be at a high risk of heart disease, your GP may prescribe a cholesterol-lowering medication such as statins. Your GP will take into account the risk of any side effects from statins and the benefit of lowering your cholesterol must outweigh any risks.

Read more about how high cholesterol is treated.




Page last reviewed: 16/08/2013

Next review due: 16/08/2015

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Comments

The 17 comments posted are personal views. Any information they give has not been checked and may not be accurate.

SueinWales said on 30 April 2014

I had an 8.4 cholesterol count when I became vegetarian and used cheese as a main ingredient of my diet. I have begun a healthier lifestyle, more exercise and no cheese :) down to 6.1 now and hopefully will return to a much better count in the next few months. I tried statins but it made me feel really ill and my joints ached dreadfully.

I do think that prescribing statins straight away is a bad way to create a healthier body, taking measures to prevent the problem in the first place should be the first goal.
Replacing bad practices should be the resolution to try before we fill ourselves full of chemicals.
I'll keep hammering away at the diet and the exercise and as long as a reduction keeps taking place then I feel content to carry on, without statins

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The sceptic said on 09 December 2013

I agree with the views of Azzy13. Jonny Bowden has also written a book on this topic and I trust his views. The cholesterol-lowering drug industry is worth $31-billion a year. With these enormous profits the industry has the muscle to tell governments and doctors what to do and uses its power to increase sales of statins. For most people there is no benefit in reducing cholesterol and there is the risk of very nasty side-effects

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Dicardia said on 29 August 2013

I was prescribed statins 3 months ago and told to get on with life rather than worrying about my diet. I didn't want to follow this advice as I had got my levels slowly down from an overall reading of 6.7 to 6.1 over a long period, but my LDL level was nearly 3 times my HDL so not good. No I wasn't going to take these tablets without further attempts to lower my cholesterol levels myself.

I really wanted to try really lowering my fat intake still further (no cheese etc) and then try plant sterols, porridge for breakfast, soy milk and soya mince/Quorn instead of red meats. and almonds. Plus more walking etc. All things I had read that could help me.

3 months later I am over the moon as II have just been told my overall reading is now 4.7 and my LDL's are now 1.4 - so a good ratio now.

I shall carry on with this healthier lifestyle and hopefully lower it still further. It can work doing it yourself so people give it a try. Good luck with your efforts.

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v anya said on 26 August 2013

I eat prawns with advocado every day //// is the prawns bad for cholesterol.

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Strobak said on 17 August 2013

I had a stroke 18 months ago as a result of trauma to my neck. I had a carotid artery dissection throwing off a clot which lodged in my brain. I have never had any of the risk factors for stroke and good diet and exercise profile. However, on arrival at hospital by ambulance following a fallen left side of my face and left hand weakness, the first thing I was prescribed was a statin - even before establishing that a stroke was what I had suffered. My cholesterol level was 7, mostly HDL, low triglycerides and very low risk factor. Eventually the diagnosis was confirmed by a neurologist, who did not push statins and encouraged my GP to prescribe them only if my overall medical condition required it, not from the stroke perspective, which he classed as an accident.

My GP is still keen to prescribe statins and I was entered into a trial for a new treatment for preventing stroke, which necessitated taking a statin. I withdrew.

I worry about the knee jerk attitude to prescribe statins purely on the basis of total cholesterol level, regardless of the detail or other medical issues. I am sure this is useful treatment for some people, but the blanket approach I have been subjected to has made me very wary of accepting that it is a good choice for me.

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Rod5454 said on 22 July 2013

I had high cholesterol diagnosed some 3 years ago. I was offered statins be declined because of the side effects such as inhibiting ubiquinone (Co-enzyme Q10). I decided to give plant sterols a chance. After 18 months my cholesterol was reduced to the "safe level". Why is this simple treatment not offered by GPs? It may not work for everyone but surely a simple herbal remedy should be an option. One doesn't have to spend a fortune on fancy margarine or health drinks. Just take a tablet!

I also had problems trying to get the actual breakdown of the test data. It seems that all the GP is interested in is the average rather than the actual amount of LDL and HDL. Surely what we need to have is a low LDL. Does the level of HDL matter? I'm not medically qualified; just a patient trying to make sense of what the medics say.

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Azzy13 said on 02 July 2013

Some interesting views being expressed on here. As it states clearly at the top, posts here are personal views only. So asking for the list to be moderated smacks of big brother and removes freedom of speech. I hope that doesn't happen.

I started to research cholesterol and statins some six months ago when I suspected my doctor would want to put me on statins after my latest blood test which showed my cholesterol still high 7.2 IIRC. She did offer and I refused.

Too many GP's in the UK are kept in the dark about the damage statins cause when prescribed simply to lower cholesterol. Cholesterol is not directly responsible for heart disease (CHD) or clogged arteries (atherosclerosis)

Curtailing cholesterol biosynthesis using statins inevitably inhibits the production of other vital products that the body needs, primary among them are ubiquinone (Co-enzyme Q10) and dolichols. These are essential for the body to function properly.

Forget all you have heard about cholesterol being the bad bad thing that will give you heart attacks and strokes. It's been proven not true. Some suggested reading is:

Statin Drugs - Side Effects and the Misguided War on Cholesterol by Dr Duane Graveline

The Great Cholesterol Con by Dr Malcolm Kendrick

Ignore the Awkward - How the Cholesterol Myths are Kept Alive by Dr Uffe Ravnskov

The Statin Damage Crisis by Dr Duane Graveline

The books are well researched and will blow your mind on statins and the damage they do and the £$billions being made by big Pharma who keep quiet about the side effects.

If you are on statins or know a friend or relative on them simply to lower cholesterol, then please read at least one of the books above. It would be wise for many GP's to read them too if they are not up to date on statin/cholesterol research.

Regards

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mark40odd said on 09 December 2012

y ddraig coch, good to see you are keeping fit, that should help your HDL numbers. My parents have slightly high cholesterol too (although not as bad as yours) and I have been overweight and unfit recently so I am looking into this problem myself.
I wouldn't go too far towards a veggie diet, meat and especially fish are important parts of the diet for health. (and eggs too) Try to eat oily fish regularly (or if not, take a fish oil supplement), that might help lower your triglycerides. You could try reducing your bread and sugar intake as well and see if that helps your numbers - I believe it may.

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y ddraig coch said on 24 January 2012

I am 65, female and fitter than most 16year olds. However I did have a cholesterol level of 7.6. A genetic condition. My GP agreed that it would be very difficult to improve my diet or my lifestyle. (I Recently walked up mountains for 9 miles on Lanzarote)

One statin caused very painful joints. The next was a slightly more expensive version and caused palpitations.

The last GP I saw insisted I stay on the statin because he is not concerned about now but the next 30 years! and would do liver function tests on my next visit. I do not think so.

I would happily live for another 30 years providing I have all my faculties and a reasonable quality of life.

I am now attempting to control the levels by adopting an almost vegetarian diet and fish and occasional meat.

I too despair of the NHS having given it almost 50 years of my working life, paid towards my pension etc. etc.. I refuse to go privately for any health treatment. The NHS should be run by health professionals i.e. doctors, nurses and experts in health management. PFI's were the worst thing ever for the National Health Service.

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Pravda said on 21 December 2011

If I fall over and graze my knee then a protective clot will form over the subsequent inflammation of the damaged skin. In order to hold the blood platelets together then the body deploys a substance called fibrin so forming "plaque like" scab over the wound. Cholesterol then gets on and repairs the damaged skin.

So if you analysed thousands and thousands of scabs from peoples knees what would you logically conclude.

Fibrin (and cholesterol) is highly associated with scabs.

Therefore grazed knees are caused by..............

If you are a Doctor or Pharmaceutical drug pusher (Think about it !) then the answer is obvious.

Coincidently it is a medical fact (feel free to check) that 50% of all heart attack victims have normal cholesterol levels and NO prior symptoms.

How about this for a good idea in these cash strapped times. Reduce the number of ambulance crew so as to cut the number of road traffic accidents. After all they are highly associated with them.

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PRL said on 27 November 2011

To be exact cholesterol is both an alcohol - it has an OH attached to an aliphatic carbon - and a fatty substance - as the molecule is predominantly non-polar.

Fairly clear article. Might be nice to know about OK ratio of LDL /HDL

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LindaJW said on 20 May 2011

Cholesterol is not an alcohol.

Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. Lesser amounts of cholesterol are also found in plant membranes.

Triglycerides come from the food we eat as well as from being produced by the body.Triglycerides are chemical compounds digested by the body to provide it with the energy for metabolism. Triglycerides are the most common form of fat that we digest, and are the main ingredient in vegetable oils and animal fats.

The triglyceride molecule is a form of the chemical glycerol (tri=three molecules of fatty acid + glyceride=glycerol) that contains three fatty acids. To be absorbed, these parts are broken apart in the small intestine, and afterwards are reassembled with cholesterol to form chylomicrons. This is the source of energy for cells in the body. Fat cells and liver cells are used as storage sites and release chylomicrons when the body needs the energy.
Excess carbohydrate consumption and sugar spikes caused by carbohydrate consumption lead to the formation of triglycerides.
Triglycerides
Triglycerides, a type of lipid found in your blood, form when your body converts calories it does not want into fat for storage. When you body needs energy, it can use these triglycerides.

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User363 said on 19 November 2010

Thanks for all your comments. These pages will be fully reviewed in October 2011.

I can confirm that the patient information we have provided on these pages is clinically accurate.

Regards,
The Editor, Health A-Z

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Brother Francis said on 06 November 2010

Please can this page be reviewed promptly? Its next scheduled review is nearly a year away.

rodders995 made a comment, Hepsi8 supported it but koebner disagreed strongly. I have a view as to which is correct but I am not medically qualified so I will not express it; that won’t help. However someone with the proper knowledge needs to review and resolve this. I expect there will always be medical debate but surely cholesterol is understood better than the debate on this page suggests. If there is a level of uncertainty the page should express it openly. If there is no uncertainty the page should be definitive.

As for me, I could do with more information.

I was recently diagnosed as having a raised cholesterol level but below the level that would normally be treated medically, but I wanted to know more. The page gives the government’s recommended maximum level but then says the *average* in England is greater than this maximum. What if *average* traffic speed in a built-up area were greater than 30 mph?! OK, I know we’re dealing with different matters but you get the picture. There’s something not right – but, again, I’m not qualified to sort things out, but it would good if there were an answer. As a start I would like this page to show a recommended range (is it as simple as <5?) with a view as to how risks/concerns increase (and what they are) with increasing level.

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koebner said on 28 October 2010

to rodders995:
It's important to keep facts correct on this site since many people might be misguided by misguided and uninformed comments, for example your comments.
First, and perhaps least importantly for readers of this site, cholesterol is a sterol, hence the suffix 'sterol'. It is not an alcohol. Second, it is indeed a waxy substance on deposition. Third, triglycerides are indeed derived from our diet. They are converted to mono- or diglycerides by pancreatic lipase in the gut, absorbed in that form, then subsequently converted to triglycerides for distribution and storage in the body. Carbohydrates don't really come into the equation. Finally, and most importantly, you say we should not worry about cholesterol, implying that it plays no role in atherogenesis and cardiovascular disease. Your statement flies in the face of multiple large scale cross sectional surveys, case controlled trials, and randomised controlled trials. It is now clear that lowering cholesterol, for example by taking statins, significantly reduces mortality from cardiovascular disease and stroke. Interventional designs are the strongest support we have for a direct role of cholesterol in causing the pathology and disease. Sometimes drug companies do push drugs of questionable efficacy, but certainly not in this case. I only wish this site was moderated to remove reader's erroneous statements of fact potentially deleterious to the nation's health.

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Hepsi8 said on 22 October 2010

I agree entirely with the above comment.

Millions are now on statins. The public have been scared into taking them. GPs ar told it will keep their patients healthy and they go along with this. And the drug companies are laughing all the way to the bank.

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rodders995 said on 13 October 2010

I sincerely worry about the NHS when it can't get a basic fact correct.

Cholesterol is not a 'fatty substance' as the first line states. It is an alcohol, hence the 'ol' at the end.

The article then goes on to state, "Triglycerides are the fats you use for energy and come from the fatty foods you eat.". Again, this is wrong. Triglycerides come primarily from carbohydrate consumption.

And finally, there is very strong evidence that cholesterol is NOT something we should worry about. In older people, it appears to be protective.

I'm sorry, but 1/10 for this effort.

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