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.
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 be because of your age, weight or another condition you have (like high blood pressure or diabetes).
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
If you’re over 40, you may have a test during your Health Check. You can also get this check at a pharmacy.
This is a check-up that can help spot early signs of problems like heart disease and diabetes.
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.
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
triglycerides – a fatty substance similar to bad cholesterol
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, triglycerides, and your total cholesterol to HDL ratio. Ask your doctor or nurse.
| Type of cholesterol | Anyone 19 or younger | Men aged 20 or over | Women aged 20 or over |
| total cholesterol | less than 170 mg/dl | 125–200 mg/dl | 125–200 mg/dl |
| non-HDL | less than 120 mg/dl | less than 130 mg/dl | less than 130 mg/dl |
| LDL | less than 100 mg/dl | less than 100 mg/dl | less than 100 mg/dl |
| HDL | more than 45 mg/dl | 40 mg/dl or higher | 50 mg/dl or higher |
Check what your cholesterol levels should be
This is just a guide. The levels you should aim for might be different. Ask your doctor or nurse what your levels should be.
Healthy levels for different types of cholesterol.
Result Healthy level (mmol/L)
Total cholesterol 5 or below
HDL (good cholesterol) 1 or above
Non-HDL (bad cholesterol) 4 or below
Total cholesterol to HDL cholesterol ratio 6 or below
Fasting triglycerides (when you’re asked not to eat for several hours before the test) 1.7 or below
Non-fasting triglycerides (when you eat as normal before the test) 2.3 or below
Ways 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, wholegrain bread and wholewheat 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
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.
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, bile acid sequestrants (also called resins) and bempedoic acid
injections – such as alirocumab, evolocumab and inclisiran
Source NHS UK