High cholesterol - symptoms, causes and levels

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High cholesterol explained

Cholesterol is a natural fatty substance in your blood. It’s produced in the liver and it's also in some of the foods we eat. Cholesterol is important to keep the cells in our bodies healthy.

High cholesterol means that you have too much cholesterol in your blood. There are many things that can cause this. If you do not take steps to lower high cholesterol, it can increase your risk of heart attack and stroke. 

• Find out more about the types of cholesterol. 

Why you might have high cholesterol 

Anyone can get high cholesterol. It can be caused by many different things, some you can control and others you cannot.

Things you can control

• Eating too much saturated fat – this reduces the liver’s ability to remove cholesterol, so it builds up in the blood.
• Being physically inactive – being active raises the level of ‘good’ cholesterol and reduces the level of ‘bad’ cholesterol.
• Smoking - this can lead to high cholesterol levels and it causes tar to build up in your arteries, making it easier for cholesterol to stick to your artery walls.
• If you live with excess weight, especially around your middle.

Things you cannot control

• Getting older – having higher cholesterol is more likely as we age.
• Being a man – increases your risk of having higher cholesterol from a younger age.
• The menopause – during and after the menopause women's risk of high cholesterol goes up.
• Your family history – you may inherit a condition that causes high cholesterol from your parents. 

If you are transgender you may have a higher risk of heart disease and high cholesterol. Speak to your doctor to understand your risk of high cholesterol. 

Other conditions and high cholesterol

You may be more likely to have high cholesterol if you have: 

• kidney disease
• liver disease
• type 2 diabetes
• having an underactive thyroid (hypothyroidism)
• growth hormone deficiency. 

Inherited conditions and high cholesterol 

Genes carry the information that determine your features or characteristics that are passed on to you (inherited) from your parents.

Familial hypercholesterolaemia (FH), is an inherited condition, meaning you were born with it. It's often passed down through families in faulty genes and can lead to very high levels of cholesterol, even if you do not have other risk factors.

Lipoprotein (a), or LP(a), is made in your liver and carries fats around the body. High LP(a) is a condition that can cause heart problems like heart attack and stroke. This is because LP(a) is ‘sticky’ and can build up in your arteries. It's usually an inherited condition but there are other causes. Find out more through Heart UK.

Types of cholesterol

Cholesterol is used by all the cells in your body to keep them healthy. It is carried around your body to the cells that need it by proteins in your blood. Proteins are substances in your body that do most of the work in your cells and help keep your body’s tissues and organs working as they should.

When cholesterol and proteins combine, they're called lipoproteins. 

There are two main types of lipoproteins. One is good for your health; the other is bad.

High-density lipoproteins (good cholesterol)

High-density lipoproteins or HDL is known as ‘good’ cholesterol. It gets rid of the ‘bad’ cholesterol from your blood by taking cholesterol you do not need back to the liver, where it is broken down and removed from your body.

Non-high-density lipoproteins (bad cholesterol)

Non-high-density lipoproteins or non-HDL is known as 'bad' cholesterol. Too much non-HDL leads to a build up of fatty deposits inside the walls of the blood vessels (channels that carry blood throughout your body). This builds up and narrows blood vessels, increasing the risk of a heart attack or stroke. 

You may also have heard 'bad' cholesterol being called 'LDL' cholesterol. This used to be the main measure of harmful types of cholesterol, but we now know that other forms of non-HDL cholesterol can also affect your health.

Triglycerides

Our blood also contains a type of fat called triglycerides (found in fat cells), which can also contribute to narrowed arteries. Having excess weight, eating a lot of fatty and sugary foods or drinking too much alcohol can cause high triglyceride levels.

If you have had results from a lipid profile (a test that looks at all aspects of your cholesterol), you may see your triglycerides level – your doctor will be able to tell you if it's too high.

You can have a normal level of HDL and non-HDL cholesterol but still have a high triglyceride level. If you are found to have this, you may wish to speak to your GP to discuss what it means for you.

Symptoms of high cholesterol

There are usually no symptoms of high cholesterol. But if left untreated, it can lead to heart attack and stroke.

It's often a hidden risk factor which means it can happen without us knowing until it's too late. That is why it's so important to get your cholesterol level checked.

However, if you have familial hypercholesterolaemia, you may have visible signs of high cholesterol. These include:

• Tendon xanthomata. Swellings made from cholesterol on the knuckles of your hands, your knees or the Achilles tendon at the back of your ankle.

Getting a cholesterol test

You can ask your GP to check your cholesterol levels, which are measured using a simple blood test. It is sometimes referred to as a ‘lipid profile’.

You may be offered a finger-prick cholesterol test. This can be done in some pharmacies, or as part of the NHS Health Check in England.

Cholesterol levels 

Learn more about what a cholesterol test measures and what the names and numbers on the results mean.

Read more about cholesterol tests and what your levels should be

Primary and secondary prevention

You may hear ‘primary prevention’ and ‘secondary prevention’ mentioned when talking to your doctor about cholesterol.

Primary prevention means making changes to your life to stop you from getting a heart condition or from having something like a heart attack or stroke. The changes are normally focused on lifestyle, including things like doing more exercise and eating better. Sometimes medications like statins will be prescribed to you.

Secondary prevention means making changes to your life when you already have a heart condition to stop you from getting worse or from having another event like a heart attack. This may include lifestyle changes like eating better and exercising, as well as taking medications such as statins.

Other medications may be prescribed by your doctor to help lower your cholesterol. This is more likely to happen if your cholesterol is still high after taking statins for a while. It may also happen even if your cholesterol levels are currently well-managed.

Treating high cholesterol

There is lots you can do to help lower your cholesterol:

• try ways of getting more active, which will help lower your cholesterol but also help you sleep better and feel more energetic
• cut down on alcohol and stop smoking
• enjoy trying recipes that are good for your heart and eat less of foods that can increase your cholesterol.

If lifestyle changes are not enough to lower your high cholesterol, your doctor may suggest medication. If you are diagnosed with high cholesterol, your GP should invite you for a blood test every year to check your levels and adjust your treatment if necessary.

Statins are the main type of medicine used to reduce cholesterol. But there are other treatments available. Your doctor will let you know if you need to take any other drugs which help control your cholesterol levels. They may also refer you to a specialist called a lipidologist. 

If you have questions about your medicines, speak with your doctor or contact our Heart Helpline. You can also look at our publications for more information.

How do I lower my cholesterol? Your top 5 questions answered

Heart Helpline and other support

If you live in England and are aged 40-74 you can ask for an NHS health check. Your doctor should write to you every five years about this.

If you have high cholesterol, it's important to know that you're not alone. Find support from healthcare professionals and the people around you.

• speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm)
• contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have
• sign up to our Heart Matters magazine for online information packed with health and lifestyle advice
• join our HealthUnlocked community.