Heart & CholesterolAround 6 in 10 adults in England have raised cholesterol

High Cholesterol

Also known as: Hypercholesterolaemia, Hyperlipidaemia, Dyslipidaemia

High cholesterol means you have too much cholesterol in your blood, which can increase your risk of heart disease and stroke. It has no symptoms, so many people don't know they have it.

Last reviewed: 15 January 2026

What is High Cholesterol?

Cholesterol is a fatty substance essential for building cells and making hormones. However, too much LDL ('bad') cholesterol or too little HDL ('good') cholesterol can cause fatty deposits to build up in your arteries, increasing cardiovascular risk.

Who is affected?

Anyone can have high cholesterol. Risk increases with age, unhealthy diet, lack of exercise, being overweight, and family history.

Symptoms of High Cholesterol

Common Symptoms

  • High cholesterol has NO symptoms
  • Only detected through a blood test

Less Common Symptoms

  • Fatty deposits around the eyes (xanthelasma) - in severe cases
  • Fatty lumps on tendons (tendon xanthomata) - in familial hypercholesterolaemia

When to Seek Urgent Help

  • Symptoms only appear when complications develop
  • Chest pain (if coronary arteries affected)
  • Leg pain when walking (peripheral arterial disease)

Causes & Risk Factors

Causes

  • Eating too much saturated fat
  • Not exercising enough
  • Being overweight
  • Smoking
  • Drinking too much alcohol
  • Genetic factors (familial hypercholesterolaemia)
  • Other conditions (diabetes, liver disease, kidney disease)

Risk Factors

  • Diet high in saturated fat
  • Being overweight or obese
  • Lack of physical activity
  • Smoking
  • Family history of high cholesterol or heart disease
  • Age (cholesterol rises as we get older)
  • Ethnicity (South Asian have higher rates)
  • Diabetes

Possible Complications if Untreated

  • Coronary heart disease
  • Heart attack
  • Stroke
  • Transient ischaemic attack (TIA/mini-stroke)
  • Peripheral arterial disease

Diagnosis & Blood Tests

High cholesterol is diagnosed through a blood test called a lipid profile, which measures different types of cholesterol and fats.

Total Cholesterol

The overall amount of cholesterol in your blood.

What to look for: Should be 5 mmol/L or less for healthy adults.

LDL Cholesterol

'Bad' cholesterol that can build up in artery walls.

What to look for: Should be 3 mmol/L or less (lower if high risk).

HDL Cholesterol

'Good' cholesterol that removes other cholesterol from the bloodstream.

What to look for: Should be above 1 mmol/L (higher is better).

Triglycerides

Another type of fat in your blood.

What to look for: Should be less than 2.3 mmol/L when fasting.

Non-HDL Cholesterol

Total cholesterol minus HDL - increasingly used as main measure.

What to look for: Should be 4 mmol/L or less.

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Treatment Options

Treatment starts with lifestyle changes and may include medication (statins) depending on your overall cardiovascular risk.

  • Healthy diet - reduce saturated fat, increase fibre
  • Regular exercise
  • Weight loss if overweight
  • Stop smoking
  • Statins (if lifestyle changes aren't enough or high risk)
  • Other medications (ezetimibe, PCSK9 inhibitors)

Living with High Cholesterol

  • Swap saturated fats (butter, fatty meat) for unsaturated fats (olive oil, nuts)
  • Eat more fibre, especially soluble fibre (oats, beans, lentils)
  • Include plant stanols/sterols (in some yoghurt drinks)
  • Eat oily fish twice a week
  • Limit processed foods and takeaways
  • If prescribed statins, take them consistently

Frequently Asked Questions

Do I need to fast before a cholesterol test?

For most people, fasting isn't necessary. Non-fasting tests are accurate for total and HDL cholesterol. Your doctor may request a fasting test if they need accurate triglyceride levels.

At what level do I need statins?

The decision isn't based on cholesterol alone. Doctors use a QRISK score assessing your 10-year cardiovascular risk. Statins are usually offered if your risk is 10% or higher.

Can I stop taking statins if my cholesterol drops?

No, don't stop without consulting your doctor. Cholesterol will rise again if you stop. Statins reduce cardiovascular risk beyond just lowering cholesterol.

Are eggs bad for cholesterol?

Current evidence suggests eggs can be part of a healthy diet. Saturated fat has a bigger impact on cholesterol than dietary cholesterol. The NHS doesn't recommend a specific limit on eggs.

When to See Your GP

  • You haven't had a cholesterol check in 5 years and you're over 40
  • You have risk factors for heart disease
  • You have a family history of high cholesterol or early heart disease
  • You're struggling to lower cholesterol with lifestyle changes
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