I’m a GP — here’s how to keep cholesterol under control

A high blood cholesterol level is one of the most common health problems I see in my work as an NHS GP. Millions of people in the UK have cholesterol levels that are higher than recommended, increasing their risk of serious conditions such as heart attacks and strokes. The good news is that a high cholesterol level can be detected through a simple blood test and, for most people, can be managed effectively through lifestyle changes along with medication.

What is cholesterol?

Cholesterol is found naturally in the body and has several important roles, including helping to build cells and produce hormones. Although cholesterol is essential for good health, problems can arise when the level in the blood is too high.

High cholesterol usually causes no symptoms. Most people feel perfectly well and are unaware that their cholesterol level is raised. Over time, cholesterol can accumulate inside arteries, causing them to become narrower and stiffer. This reduces blood flow and increases the risk of heart attacks and strokes.

High cholesterol can also lead to poor circulation of blood in the legs and other parts of the body. The risk is particularly high when raised cholesterol occurs alongside other risk factors such as smoking, high blood pressure or diabetes.

How can I get my cholesterol checked?

The only way to know your cholesterol level is through a blood test. In England, adults aged 40 to 74 years who do not already have cardiovascular disease can have an NHS Health Check every five years. This assesses a person’s risk of developing conditions such as heart disease, stroke, diabetes, and kidney disease and includes a cholesterol test.

People who already have long-term health conditions such as diabetes, heart disease, chronic kidney disease or a previous stroke will usually have their cholesterol checked every year as part of their ongoing care.

Some people have an inherited condition known as familial hypercholesterolaemia. This genetic disorder causes very high cholesterol levels from an early age and can significantly increase the risk of developing heart disease. Because the condition often runs in families, identifying one affected person can help doctors detect and treat other relatives who may also be at risk.

What cholesterol level should I aim for?

Cholesterol results are usually reported in millimoles per litre (mmol/L). For many adults, a total cholesterol level below 5 mmol/L is considered desirable. However, there is no single target that applies to everyone. Doctors focus on an individual’s overall risk rather than just the cholesterol level.

People who have already had a heart attack or stroke, or who have conditions such as diabetes, are advised to achieve lower cholesterol levels because they are at higher risk of future medical problems.

What can I do to lower my cholesterol?

Lifestyle changes are an essential part of cholesterol management and can also benefit many other aspects of health. A healthy diet is particularly important. Reducing foods that are high in saturated fat — such as fatty meats, processed foods and cakes — can help lower cholesterol levels. Try to also increase your intake of healthier alternatives such as vegetables, fruit, wholegrains, beans, nuts and fish.

Maintaining a healthy weight is also important. Being overweight or obese increases your risk of developing high cholesterol levels and also increases your cardiovascular risk.

Regular physical activity can help improve cholesterol levels and overall cardiovascular health. Adults should aim for at least 150 minutes of moderate-intensity physical activity each week, such as brisk walking, cycling or swimming.

Not smoking is another key step. Smoking damages blood vessels and increases the harmful effects of high cholesterol. Limiting alcohol intake and managing conditions such as diabetes and high blood pressure also helps.

Cholesterol-lowering medicines

For many people, lifestyle changes alone will not be enough to reduce cholesterol to recommended levels. In these situations, medicines play an important role. Statins are the most commonly prescribed cholesterol-lowering drugs. They are highly effective at reducing the risk of heart attacks and strokes. Millions of people in the UK are currently taking statins without experiencing any problems or side effects.

Other medicines are also available. Ezetimibe reduces the absorption of cholesterol from the bowel and is often used when statins alone do not provide sufficient cholesterol reduction.

Newer treatments, such as the twice-yearly injection inclisiran, can produce large reductions in cholesterol and may be offered to patients at high risk. Some people require a combination of medicines to achieve their cholesterol targets and maximise protection against cardiovascular disease.

Protecting your health

High cholesterol is common, usually causes no symptoms and increases the risk of serious health problems. Through healthy lifestyle choices and medication, keeping your cholesterol under control is one of the most effective ways to reduce the risk of heart attack and strokes.

If you do not know your cholesterol level, speak to your GP practice or attend for an NHS Health Check when invited. A simple blood test along with right lifestyle measures and drug treatment will help protect your health for many years to come.

• Dr Azeem has been a GP for over 30 years and is also a professor of primary care and public health at Imperial College London’s School of Public Health