High cholesterol and cardiovascular risk

What is high cholesterol?

Cholesterol is a type of fat in your blood. While your body needs some cholesterol, too much "bad" cholesterol (LDL) can build up in the walls of your arteries, forming plaques that narrow the blood vessels. Over time, this leads to coronary artery disease, heart attacks, and strokes.

Your overall cardiovascular risk depends not just on cholesterol but on a combination of factors including blood pressure, smoking, diabetes, family history, and age.

Common symptoms

High cholesterol causes no symptoms. It is detected through a blood test. By the time symptoms develop (such as chest pain or a heart attack), significant artery damage has already occurred.

How is it diagnosed?

• Fasting lipid profile: a blood test measuring total cholesterol, LDL, HDL, and triglycerides
• Cardiovascular risk assessment: using tools such as QRISK to estimate your 10-year risk of heart attack or stroke
• CT coronary calcium score: in some cases, to check for calcium deposits in the arteries
• Additional blood tests: to rule out secondary causes such as thyroid or liver problems

How is it treated?

• Lifestyle changes: a heart-healthy diet (such as the Mediterranean diet), regular physical activity, stopping smoking, and reducing alcohol
• Statins: the most commonly prescribed cholesterol-lowering medication, with strong evidence for reducing heart attacks and strokes
• Additional medications: such as ezetimibe or PCSK9 inhibitors, if statins alone are not sufficient
• Ongoing monitoring: repeat blood tests to check cholesterol levels and adjust treatment

How should you prepare?

For any appointment it helps to bring: a list of your current medications and doses; copies or details of any previous heart tests (ECGs, scans, or angiogram reports); a note of your symptoms, when they happen, and what brings them on; and your questions. If you have results from another hospital, ask that clinic to send them ahead of your visit.

When to seek urgent help

If you develop sudden chest pain, arm pain, or difficulty speaking, call 999 or 112 immediately. These could be signs of a heart attack or stroke.