Fact CheckHeart Health
Misleading

High cholesterol always means you need statins

Cholesterol levels are just one factor. Doctors assess overall cardiovascular risk before recommending statins.

Last reviewed: 15 January 2026

The Full Story

This statement is misleading because it oversimplifies a complex medical decision. Having high cholesterol doesn't automatically mean you need medication - and conversely, some people with "normal" cholesterol may benefit from statins.

Doctors use a tool called QRISK3 to assess your 10-year risk of cardiovascular disease. This considers many factors beyond just cholesterol: your age, sex, smoking status, blood pressure, family history, ethnicity, and other health conditions.

For example, a 30-year-old with high cholesterol but no other risk factors might have a low overall cardiovascular risk, and lifestyle changes alone might be appropriate. Meanwhile, a 60-year-old with diabetes and high blood pressure might benefit from statins even with moderately elevated cholesterol.

The Facts

  • Total cholesterol alone is not diagnostic
  • HDL/LDL ratio is more important than total cholesterol
  • QRISK3 assessment determines overall cardiovascular risk
  • Lifestyle changes are usually tried first
  • Statins are offered when 10-year risk is 10% or higher
  • Some people with normal cholesterol benefit from statins

What the Evidence Says

Risk-based approach

NICE guidelines recommend using cardiovascular risk calculators rather than cholesterol levels alone to guide treatment decisions.

Lifestyle first

For most people, dietary changes, exercise, and weight loss are tried before medication, unless cardiovascular risk is very high.

Individual decision

The decision to start statins should involve shared decision-making between patient and doctor, considering benefits, risks, and preferences.

Your Health Matters to Us

The information on this website is designed to support, not replace, the relationship between you and your healthcare providers. Always seek the advice of your GP or other qualified health provider with any questions about your health.

If you think you may have a medical emergency, call your doctor, visit A&E, or call 999 immediately. We're here to help you stay informed on your health journey.