Understanding and lowering elevated cholesterol

Cholesterol is not all bad. It’s a fat made by your liver that’s essential for healthy cells. It’s carried in your bloodstream by different kinds of lipoproteins. Low-density lipoproteins (LDL) are the 'bad' kind that tend to build up in the body’s blood vessels. High-density lipoproteins (HDL) are the 'good' kind that can actually remove bad cholesterol from your blood stream. It’s better to have high HDL levels than high LDL levels as the latter can put you at risk of heart disease. The NHS recommends aiming for a total blood cholesterol level of less than 5 mmol/l and an LDL level of under 3 mmol/l.

High cholesterol is often referred to as the 'silent killer'. You may be unaware you are at risk because it usually doesn’t cause symptoms. The first indication may be angina, pain in your legs, or a heart attack or stroke. See your GP for a test if you’re concerned, especially if you are over 40, when the risk of heart disease is higher.

An unhealthy lifestyle is one factor that can trigger high cholesterol levels. That may include:

• Not getting enough exercise
• Being overweight
• Having a lot of belly fat
• Eating too much saturated fat

Reduce trans fatty acids (partially hydrogenated oil) found in many packaged foods and choose lean meat rather than meat that’s high in saturated fats. Eating well and exercising can help you reduce excess weight generally, especially around your abdomen.

As many as 2 out of 3 adults in the UK have total cholesterol levels that are higher than the recommended 5 mmol/l. Making changes to your diet and being more active can help lower your cholesterol levels.

A fibre-rich diet has been shown to help lower cholesterol levels. Sterol or stanol-enriched foods, like spreads, have also been shown to help reduce LDL cholesterol levels as part of a healthy, balanced diet. You can also take a stanol or sterol-ester ‘shot’ drink once a day before or after your main meal.

Gallstones are hard lumps that can form in the gallbladder made of cholesterol. Avoiding food that is high in saturated fat is recommended to help reduce the risk of gallstones.

A healthy total cholesterol level for most people is less than 5 mmol/l, but 2 in 3 people in the UK have levels that are higher than this. However, even if your total score is lower, it’s important to know all your cholesterol numbers. You may still have high LDL cholesterol or low HDL cholesterol, which increases your risk of heart disease and stroke. Get your cholesterol checked and then follow your GP’s advice. Aiming for an LDL of less than 3 mmol/l is recommended for most people.

Both drinking alcohol and smoking can affect your cholesterol levels. Smoking can lower 'good' HDL cholesterol levels and prevent it from carrying cholesterol to the liver increasing the risk of high levels of ‘bad’ cholesterol. Smoking also irritates the wall of your blood vessels, making them more likely to fur up. Cholesterol and triglyceride levels are increased by drinking excessive amounts of alcohol.

You don’t have to be a certain age to get your cholesterol checked. However, your risk is higher after 40, so experts recommend you get checked every 5 years if you are between 40 and 75 – or more often if advised to do so. If you are in that age range you can get tested as part of an NHS Health Check. You may need to consider earlier checks if you have other risk factors like:

• A family history of heart disease
• A family history of inherited high cholesterol
• Being overweight
• Having high blood pressure.

You should be checked at least every 12 months if you are taking cholesterol-lowering medication.

To check your cholesterol levels, you’ll need a fasting lipid profile. This is a simple blood test done after you haven’t eaten for 9-12 hours. Some people choose to fast overnight and get tested in the morning. The results of the test break down your cholesterol into triglycerides, HDL, LDL and total cholesterol. The NHS says most people should aim for a total blood cholesterol level of less than 5 mmol/l, and an LDL level of under 3 mmol/l.

If you have a healthy diet in the first place, you may be able to prevent high cholesterol. However, if you have changed your diet under advice from your doctor, you should start seeing results as early as 3 months. That’s as long as you are following other healthy lifestyle measures such as being physically active, not smoking and maintaining a healthy weight. If your cholesterol remains high, despite these and other diet changes, your GP may recommend cholesterol-lowering medication. Quicker results may be possible with special diets or using stanols or sterol-containing products.

To optimise your workout and help lower cholesterol, the NHS recommends 150 minutes of moderate intensity exercise a week. Moderate intensity means you increase your heart rate and breathing, but you should still be able to talk as you work out. Examples include:

• Light jogging
• Brisk walking
• Cycling
• Swimming and water aerobics.

Regular moderate intensity exercise has been shown to raise good HDL cholesterol and may also lower bad LDL cholesterol and triglycerides.

One in 500 people are born with a condition known as familial hypercholesterolaemia (FH). It’s a common genetic disorder that disrupts your body’s ability to remove cholesterol from your blood. FH is inherited and affects people from birth. If you are born to a parent with FH, you have a 50% chance of inheriting this type of high cholesterol yourself.

Most experts say that lowering cholesterol does not pose health risks to adults.  However, in rare cases lowering LDL (low-density lipoprotein) 'bad' cholesterol has been associated with a higher chance of developing some health conditions - but the link has not been fully confirmed. Children and teenagers actually need more cholesterol as they grow, so they may be more closely monitored if they are prescribed cholesterol-lowering medication.

It’s perfectly normal to have high cholesterol during pregnancy. This is because your baby needs it for development. Breast milk also contains high cholesterol levels, but that’s nothing to worry about.

People aged 40-74, who don’t already have diagnosed heart disease, are invited for a free NHS Health Check. In addition to the above, you will be offered a blood test to measure your cholesterol levels, and will be asked about your personal health history to determine risk factors for heart disease, kidney disease, diabetes and stroke. You will be asked lifestyle questions, such as information about your diet, smoking and alcohol consumption. You may get the results of blood tests the same day or return to discuss them later.