Cholesterol: do you know your numbers?

October 28, 2022

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This article was written by London-based GP – Dr Nirja Joshi

What is cholesterol?

Cholesterol is a waxy substance found in the body. It is not inherently bad, and some cholesterol is actually essential to build cells, make vitamins, and hormones. However, too much cholesterol can be problematic.

Cholesterol comes from two main sources, most of it is made by the liver and about 20% comes from the diet. The amount of cholesterol your body naturally makes can be inherited. In some instances this genetic component can cause certain diseases such as familial hyper-cholesterolemia, where there is excess cholesterol production that goes above healthy levels. That means that while a healthy diet and lifestyle certainly play a role in determining cholesterol levels, it’s not always the whole story. However for most people cholesterol levels can be controlled with a healthy lifestyle +/- medication (1).

What causes high cholesterol?

Having high cholesterol is mainly caused by:

eating foods high in saturated fat
low physical activity levels
smoking
overweight or obesity (especially central adiposity)
genetics

Other factors which determine our cholesterol levels that we can’t control include our age, sex, ethnicity and also certain medical conditions (like kidney or liver disease).

What are the numbers you should know?

There are two types of cholesterol, HDL (high density lipoprotein) and non-HDL or LDL (3). Non-HDL or LDL cholesterol is typically known as ‘bad cholesterol’ and this is the type of cholesterol which builds up on blood vessel walls and can cause ‘plaques’ to form. This can lead to narrowing of blood vessels and lead to issues such as angina (chest pain) or heart attacks. HDL is sometimes referred to as “good” cholesterol because it removes cholesterol from artery walls where it may be deposited. . When we look at cholesterol, we analyse both numbers and ratios, because it’s helpful to know what proportion of each cholesterol you have, ideally you should have more HDL than non-HDL cholesterol. Below is a table with results which you may receive from your doctor or nurse to help you to understand what the normal values are.

Fig 1 – NHS Healthy Cholesterol levels (4)

Getting tested

High cholesterol in itself does not generally cause symptoms which you would notice, so you would only know if you have high cholesterol if you had a test.

Your GP or nurse may suggest a blood test if you have risk factors such as a family history of high cholesterol, if you are overweight, smoke, have diabetes or other lifestyle factors which may indicate your cholesterol may be abnormal (5).

You would also be offered a cholesterol check at the age of 40 in your NHS health check.

The blood test will normally be suggested by your GP or practice nurse and done as a blood test from your arm, but sometimes can be done as a finger prick test. The finger prick test is less detailed but will give a result in a few minutes.

How to reduce your cholesterol

Follow a healthy diet: One thing which can help to reduce your cholesterol is to reduce your intake of saturated fats, such as processed meats, dairy such as cream and butter, palm oil, coconut oil and things such as cakes and biscuits (6). Find out more about what foods can help with reducing cholesterol levels here. There are some diets used clinically that are designed to lower cholesterol such as the Ultimate Cholesterol Lowering Diet (UCLP). The UCLP is centred around consuming more heart-healthy fats (less saturated fat), oil rich fish, getting your 5-a day fruit and veg, whole grains, and lots of water (13). You can read more about it here.

Exercise is very helpful in managing cholesterol, and it is recommended to do around 150 minutes of moderate intensity exercise each week (6). My tip is, if you do something that you enjoy doing, it will be much easier to incorporate this into your life, and exercise and physical activity will have a positive benefit on your mental health as well as your physical health.

It is also important to try and stop smoking if you smoke, and ensure that if you have alcohol that this is within the recommended limits for adults (14 units/week).

Statins

You may have heard of a type of medication known as statins. Statins are the most common medication prescribed to lower cholesterol (8). This is a medication which is taken at night time as this is when cholesterol is processed in the body, and is a medication that you would generally need to take lifelong. This is taken to reduce your 10 year risk for diseases such as heart attacks and strokes. The main adverse effect reported from taking statins is muscle aches. Statins are generally speaking, very well tolerated. Most patients who take them find a good reduction in their cholesterol and this is helpful to reduce their 10 year risk of heart attacks and strokes. If for whatever reason you do not get on with your statin, which can happen, it is possible to change the type of medication if side effects are concerning you.

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