We couldn't live without cholesterol. It's in every cell in our
body, helps us digest fats, keeps our nerves healthy and helps us
make vital hormones. Yet for all its life-supporting
properties, cholesterol can be a threat. High levels of cholesterol
in our blood increase our risk of heart and circulatory
Have you got your cholesterol under
- What is cholesterol?
- How high is too high?
- What causes high cholesterol?
- What are the symptoms?
- Why does it matter?
- Who should have a cholesterol blood test?
- What's the treatment for high cholesterol?
What is cholesterol?
Cholesterol is a type of fat, a soft, waxy substance (lipid),
most of which is made in the liver, from the fat that we eat. It's
also found in foods such as eggs, meat and dairy products and
especially in saturated fats.
Your body produces all the cholesterol it needs. So eating a
diet that is high in cholesterol increases the amount in your
blood, and can lead to health problems.
Cholesterol is transported around our bodies in the blood
stream, attached to proteins. Together they're known as
There are two main types of lipoproteins:
- Low-density lipoproteins (LDL) are often also known as 'bad'
cholesterol. LDL transports cholesterol from the liver to cells. If
there is too much LDL, it can result in a build-up of deposits in
the blood vessels, narrowing them and reducing the space through
which blood can flow.
- High-density lipoproteins (HDL) are often also known as 'good'
cholesterol. These are the ones you want more of, as they remove
the LDL from your blood stream and take it back to your liver. Once
there, the LDL leaves your body as a waste product (through your
bowels), or is broken down so it is no longer harmful.
High levels of HDL can give some protection against heart
Other substances that are linked to cholesterol are
triglycerides. These are also a type of fat found in the blood.
They are made in your liver, and in meat, cooking oils and dairy
foods such as cream and cheese.
When you take in more calories than you actually need (alcohol
or sugar, for example) your liver produces triglycerides, which are
carried in the bloodstream to your body tissues and stored as
How high is too high?
Cholesterol levels vary from person to person. The important
fact to remember is that the higher your cholesterol levels are,
the more at risk you are of developing heart conditions.
Current guidelines say that our total cholesterol levels should
be less than 5 mmol/l (millimols per litre), and that our LDL
cholesterol levels should be less than 3 mmol/l. However, figures
from Heart UK, the cholesterol charity, show that
the average total cholesterol level in the UK is 5.7.
If you have been told by your GP that you are at higher risk of
a heart attack or other heart conditions, your total cholesterol
level should be less than 4 mmol/l and your LDL cholesterol
should be less than 2 mmol/l. These levels were recommended by the
Joint British Societies, which include the British
Cardiovascular Society, British Hypertension Society, Diabetes UK,
HEART UK, Primary Care Cardiovascular Society and the Stroke Association.
The balance of LDL and HDL is an important factor when deciding
whether your levels are too high. The greatest risk comes from
having low levels of HDL and high levels of LDL and
What causes high cholesterol?
The way we live can put us at risk of high cholesterol, but the
positive part of this is that in many cases you can take steps to
reduce your risk.
Diet is an important factor in avoiding high cholesterol levels.
If you eat foods that contain high levels of saturated fat, you'll
be increasing your risk, as your liver turns saturated fat into
Processed meat such as sausages and pies, red meat, baked food
such as biscuits and cakes, hard cheese, butter, lard, and cream
all contain saturated fat.
Other risk factors that you can control
Being overweight or obese - you're more likely to have a lower
level of HDL and a higher level of LDL
Low levels of physical activity or exercise - this can
decrease your HDL level and increase your LDL level
Drinking too much. NHS guidelines
recommend three to four units a
day for men and two to three units a day for women
There are also medical conditions that can increase your blood
Conditions that push up cholesterol levels:
High blood pressure (hypertension)
High triglyceride blood levels
Some kidney and liver diseases
Under-active thyroid gland
There are some risk factors you may not be able to
You have a family history of heart disease or stroke under 55
in a close male relative or under 65 in a close female
You have familial hypercholesterolaemia, an inherited
condition which means that those people who are affected have high
You are a man over 45
You are a woman over 55
You are a woman who had an early menopause
What are the symptoms?
High cholesterol doesn't usually produce any symptoms on its
own, however, you may have symptoms from a medical condition caused
by high levels of cholesterol.
Symptoms to watch out for:
when exercising due to build up of
cholesterol deposits in the arteries (atherosclerosis)
(chest pain) again due to
Yellow patches on the skin (xanthomas
) formed by cholesterol. Often
associated with familial hypercholesterolaemia
Why does it matter?
Having high cholesterol means that your arteries are more likely
to narrow as cholesterol in the form of plaques build up on the
inside surface of the arteries.
The arteries can become increasingly furred up with deposits
(plaques), allowing less space for blood to pass through. It's
known as atheroma or atherosclerosis (or "hardening of the
arteries"), and can restrict blood flow through your arteries.
When your coronary (heart) arteries are narrowed by plaque it
can cause angina.
Blood clots are more likely to develop when you have
atherosclerosis and they can block the flow of blood. If this
happens and stops blood flow to your heart, it can cause a heart
attack. If a clot blocks blood flow to your brain, it can cause a
Who should have a cholesterol blood test?
Current guidelines in the UK recommend that
anyone who is over 40, has a family history of heart disease at a
young age, or an inherited condition that affects their cholesterol
levels should have their cardiovascular health risk assessed.
The cholesterol blood test is usually carried out at your GP's
surgery. You may be asked not to eat for 12 hours before the test,
so your results aren't affected by any food you've eaten; most GPs
do the test in the morning.
Your GP will also ask whether you smoke, whether there's a
history of cardiovascular disease in the family and will check your
blood pressure and your weight. This will all help to assess
whether you have a high, moderate or low risk of developing
What's the treatment for high cholesterol?
Your GP will recommend the most suitable treatment for you,
depending on the results of your assessment. If you do have high
cholesterol, your GP will probably start by looking at your diet.
If you have a high risk of heart disease, your GP will combine
lifestyle and diet changes with drug treatment with a statin drug,
Move over to a healthy diet
One of the first steps you can take to improve your cholesterol
levels is to change to a low fat diet. Cut back on the total amount
of fat in your diet and reduce the amount of saturated fats you
Replace saturated fats with moderate amounts
Monounsaturated fats, found in olive oil, walnut oil, rapeseed
oil, avocado and some margarines and spreads
Polyunsaturated fats, found in cornflower oil, sunflower oil,
fish oil and some margarines and spreads
Omega-3 fats, which can help prevent blood clotting and help
lower triglyceride levels. These are found in oily fish such as
herring, kippers, pilchards, mackerel, sardines, salmon and fresh
Eating a high-fibre diet may also help lower how much
cholesterol is absorbed into your blood stream. Soluble fibre is an
especially good choice. It's found in oats, beans, peas, lentils,
chickpeas, fruit and vegetables.
Eating at least five different portions of fruit and vegetables a
day will help reduce your risk of heart disease.
You should also have a good balance of carbohydrates, from wholegrain
bread, rice, pasta and potatoes, and protein from lean meat, such
as chicken and oily fish.
Research has found that walnuts, which contain polyunsaturated fatty
acids, can reduce blood cholesterol and keep blood vessels
Regular exercise is vital to keep your heart, and the rest of
you, healthy. Yet far too few of us achieve the recommended amount
- 30 minutes of moderate intensity exercise on five days of the
Health data from the British Heart Foundation is very persuasive.
Inactive people have twice the risk of developing coronary heart
disease as active people.
Exercise makes your heart stronger and more efficient, so it
pumps more blood every time it beats. The more exercise you do, the
stronger your heart becomes.
Regular exercise slows down the rate at which the arteries to
the heart and brain narrow as we age. And physical activity
increases the level of 'good' HDL, giving you more protection
against 'bad' LDL.
If you don't take regular exercise, start slowly and build up
gradually. Walking is ideal to start with and will help build up
your endurance and strength.
Cycling, dancing, gardening, swimming, housework, Pilates,
climbing stairs, and yoga are all good ways of exercising.
Choose something you enjoy, do it with a friend and keep it up.
Regular moderate exercise is better for you than occasional bursts
There are a number of different types of medication that can
bring down your cholesterol levels. Your GP will talk to you about
whether you need to take cholesterol-lowering drugs, and which type
is best for you.
Statins are often prescribed to bring down levels of LDL and
increase levels of HDL). They work by blocking the liver from
making cholesterol. Statins can reduce LDL cholesterol levels by
between 15 to 20 per cent
per cent. Statins can cause side
effects, including constipation, diarrhoea, headaches and muscle
pain. Low-dose statins are available at pharmacies over-the-counter
(OTC) without a prescription
Aspirin can prevent blood clots forming, so reducing the risk
of heart attacks and stroke
Fibrates are usually prescribed to reduce high levels of
triglycerides, but they also reduce cholesterol. They are most
often prescribed for people with an inherited lipid disorder, or
who have high levels of triglycerides and cholesterol
Bile acid binding drugs, also known as resins, help your body
to use more LDL, so reducing the amount in your blood stream
Your GP may recommend using a combination of approaches, such as
taking statins and making changes to your lifestyle.
Even if your risk is moderate, and you don't need to take
action, you don't need to take a test to know that eating more
healthily and taking more exercise is a smart move for your heart
and your health.
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