High cholesterol

High cholesterol means the level of cholesterol, a fatty substance, in your blood is higher than recommended, particularly LDL ("bad") cholesterol, which can build up in artery walls over time and increase the risk of heart attack and stroke. Like high blood pressure, it typically causes no symptoms itself and is identified through a blood test. Cholesterol levels are influenced by both genetics and lifestyle factors.

Causes include diet high in saturated fat, lack of physical activity, being overweight, smoking, and genetic factors, with some people having an inherited tendency towards high cholesterol (familial hypercholesterolaemia) regardless of lifestyle. Certain medical conditions, such as an underactive thyroid or diabetes, can also raise cholesterol levels. Often lifestyle and genetic factors combine to determine an individual’s cholesterol level.

High cholesterol typically causes no symptoms at all, which is why it is detected through a blood test rather than by how you feel. Very high levels, particularly with familial hypercholesterolaemia, can occasionally cause visible signs such as fatty deposits around the eyes or in tendons, though this is uncommon. This lack of symptoms in most cases is exactly why regular cholesterol checks, particularly for those with risk factors, matter.

Yes, sustained high cholesterol, particularly LDL cholesterol, contributes to the build-up of fatty deposits in artery walls over years, significantly increasing long-term risk of heart attack and stroke. This risk accumulates silently over time, which is why it is taken seriously and treated even without symptoms. Effective management, through lifestyle changes and, where needed, medication, substantially reduces this long-term cardiovascular risk.

Treatment typically starts with lifestyle changes, including a diet lower in saturated fat, regular exercise, weight management, and stopping smoking, with statin or other cholesterol-lowering medication added if lifestyle changes alone are not sufficient or if overall cardiovascular risk is high. The specific target cholesterol level and treatment approach depend on your individual overall cardiovascular risk, not cholesterol level alone. Regular monitoring helps track response to treatment and guide any needed adjustments.

For many people, particularly those with lifestyle-related high cholesterol, meaningful diet and exercise changes can significantly reduce cholesterol levels, sometimes into a healthy range without needing medication. For people with a genetic predisposition, such as familial hypercholesterolaemia, lifestyle changes alone are often not sufficient, and medication is generally needed for effective long-term control. Even with medication, continuing healthy lifestyle habits remains valuable for overall cardiovascular health.

Cholesterol and triglycerides are both types of fat measured in a standard lipid blood test, but they are different substances with somewhat different health implications: LDL cholesterol is particularly linked to artery-clogging plaque build-up, while high triglycerides are more specifically linked to lifestyle factors like diet, alcohol, and blood sugar control, and very high levels also carry a risk of pancreatitis. Both are relevant to overall cardiovascular risk and are usually assessed together as part of a full lipid profile. Your doctor will interpret your specific pattern of results together to guide the most appropriate management.

Most adults should have cholesterol checked at least once by age 40, and more regularly if risk factors such as family history, obesity, or diabetes are present. A private health assessment including a full cholesterol (lipid) profile can typically be arranged within about a week. If you have a strong family history of early heart disease or very high cholesterol, ask your doctor about testing for familial hypercholesterolaemia specifically, as this needs a somewhat different management approach.