Cholesterol: The Good, the Bad, and How to Control It

Cholesterol is a waxy, fat-like substance found in every cell in your body. Although cholesterol is often described as something harmful, your body needs it to function normally and your liver produces it naturally. Problems can arise when levels of certain cholesterol-carrying particles in the blood become too high, increasing the risk of fatty deposits building up inside the arteries.

Contents

• The Two Main Types of Cholesterol
• What Causes High Cholesterol?
• Dangers of High Cholesterol
• Symptoms and Testing
• How to Lower High Cholesterol
• Cholesterol-Lowering Medicines
• Take Control of Your Cholesterol

The Two Main Types of Cholesterol

Cholesterol travels through the bloodstream in particles called lipoproteins. Two of the best-known types are:

• Low-density lipoprotein (LDL): Often described as “bad” cholesterol because higher LDL levels can contribute to fatty deposits building up inside artery walls. This increases the risk of cardiovascular disease, including heart attacks and strokes.
• High-density lipoprotein (HDL): Often described as “good” cholesterol because HDL carries cholesterol away from the tissues and back to the liver. HDL forms part of the overall lipid profile used when assessing cardiovascular risk.

Doctors do not normally assess LDL or HDL in isolation. Your cholesterol results are considered alongside other factors such as your age, blood pressure, smoking status and existing health conditions when assessing your overall cardiovascular risk.

What Causes High Cholesterol?

Several lifestyle, medical and genetic factors can contribute to unhealthy cholesterol levels. These include:

• Eating a diet high in saturated fat
• Being physically inactive
• Being overweight or living with obesity
• Smoking
• Drinking too much alcohol
• Some health conditions, including diabetes and an underactive thyroid
• Getting older
• Your family history and genetics

Some people inherit a condition called familial hypercholesterolaemia, which can cause very high cholesterol levels from an early age. Someone can therefore have high cholesterol even if they otherwise follow a healthy lifestyle.

Dangers of High Cholesterol

Over time, high levels of LDL cholesterol can contribute to fatty deposits known as plaques building up inside artery walls. This process is called atherosclerosis.

Atherosclerosis can narrow the arteries and restrict blood flow. If a plaque ruptures and a blood clot forms, blood flow may become completely blocked. Depending on where this happens, it can result in conditions such as a heart attack or stroke.

Managing cholesterol is therefore an important part of reducing your overall cardiovascular risk.

Symptoms and Testing

High cholesterol usually causes no symptoms. You can feel completely well while having cholesterol levels that increase your risk of cardiovascular disease. A blood test is the only way to find out your cholesterol level.

You may be particularly likely to benefit from having your cholesterol checked if you:

• Are over 40 and have not previously had your cholesterol tested
• Have a family history of high cholesterol or early heart disease
• Have heart disease, diabetes or another condition that increases cardiovascular risk
• Are overweight or living with obesity
• Have high blood pressure
• Smoke

If you are aged 40 to 74 and live in England, you may also be eligible for an NHS Health Check, which is generally offered every five years to eligible adults without certain pre-existing conditions. Cholesterol testing forms part of the cardiovascular risk assessment.

If you are unsure whether you should be tested, speak to your GP surgery or pharmacist. Your individual testing needs depend on your age, medical history and overall cardiovascular risk.

How to Lower High Cholesterol

Lifestyle changes can help improve your cholesterol levels and reduce your overall risk of cardiovascular disease.

Eat a heart-healthy diet. Try to reduce foods high in saturated fat and replace some saturated fats with unsaturated fats. Include plenty of vegetables, fruit, wholegrain foods and other sources of fibre.

Stay physically active. Regular activity is good for your heart and can help improve several cardiovascular risk factors. UK guidance generally recommends at least 150 minutes of moderate-intensity activity each week, or an equivalent amount of vigorous activity, alongside muscle-strengthening activity where appropriate.

Stop smoking. Smoking substantially increases your cardiovascular risk. Stopping smoking is one of the most important steps you can take to protect your heart and blood vessels.

Maintain a healthy weight. If you are overweight, losing excess weight can improve several cardiovascular risk factors, including cholesterol and blood pressure.

Cut down on alcohol. Regularly drinking too much alcohol can affect cholesterol and triglyceride levels and increase blood pressure. If you drink alcohol, keep within the UK recommended limits.

Lifestyle changes are important whether or not you also need cholesterol-lowering medicine. Your doctor can assess your cholesterol alongside your other cardiovascular risk factors and advise you about the most appropriate approach.

Cholesterol-Lowering Medicines

Some people need medicine as well as lifestyle changes to lower their cholesterol and reduce their risk of heart attack or stroke. The decision depends on your cholesterol results, existing health conditions and your overall cardiovascular risk.

Statins are the most commonly prescribed medicines for high cholesterol. They reduce the amount of cholesterol produced by the liver.

If statins are unsuitable, are not tolerated or do not reduce cholesterol sufficiently, other treatments may be considered. Depending on your circumstances, these can include ezetimibe, bempedoic acid or injectable treatments such as alirocumab, evolocumab and inclisiran.

The most appropriate treatment varies from person to person. Do not stop taking prescribed cholesterol-lowering medicine without discussing it with your doctor or another healthcare professional.

Take Control of Your Cholesterol

Maintaining healthy cholesterol levels can help reduce your risk of heart disease and stroke. Cholesterol is only one part of the picture, however, and your results should be considered alongside factors such as your age, blood pressure, smoking status, family history and other health conditions.

A balanced diet, regular physical activity, maintaining a healthy weight, not smoking and keeping alcohol consumption within recommended limits can all contribute to better cardiovascular health.

Because high cholesterol usually has no symptoms, testing is the only reliable way to know your cholesterol level. If a test shows that your cholesterol is high, your GP or another healthcare professional can help assess your wider cardiovascular risk and discuss whether lifestyle changes, medication or both are appropriate.

---

You May Also Like