Overview
is a waxy, fat-like substance the body needs to build cells and make hormones. Most is made in the liver, and the rest comes from food.
It travels in the blood attached to proteins. Low-density lipoprotein, or LDL, is the harmful type: when there is too much, the extra cholesterol settles in the artery walls as . High-density lipoprotein, or HDL, carries cholesterol back to the liver, so a higher HDL is helpful.
Symptoms
High causes no symptoms. People usually learn about it from a blood test, or after it has caused a problem such as , a heart attack or a stroke.
Very high inherited levels can show as yellowish fatty lumps in the skin around the eyes, elbows or knees, or a pale grey ring around the iris in a younger adult.
When to see a doctor
See a doctor within a few days if cholesterol has never been tested, if a close relative had a heart attack or stroke young, or if diabetes, high or kidney disease is not being followed up.
Causes
The level depends partly on how much the liver makes, which is set largely by inherited genes, and partly on the way a person eats and moves.
Saturated fat in the diet raises LDL cholesterol, as do excess weight, inactivity, smoking and heavy drinking. Diabetes, an underactive thyroid, kidney disease and some medicines can also push levels up. Familial hypercholesterolaemia is an inherited condition that causes a very high level from childhood.
Risk factors
- A family history of high or early heart disease
- South Asian or African ancestry
- A diet high in fried food, ghee, butter, palm oil and red meat
- Being overweight and inactive
- Smoking, chewing tobacco or heavy alcohol use
- Diabetes, high , thyroid or kidney disease
- Older age, and menopause in women
Complications
narrows and stiffens the arteries over many years, a process called atherosclerosis. It can lead to:
- and heart attack
- Stroke and mini-stroke
- Poor circulation in the legs, with cramping pain on walking
- Heart failure, when the heart muscle has been damaged
Very high triglycerides can also inflame the pancreas.
Prevention
- Using less ghee, butter, vanaspati, coconut and palm oil
- Eating more vegetables, fruit, pulses, whole grains and nuts
- Steaming, roasting or shallow frying instead of deep frying
- Cutting down sweets, sugary drinks and refined flour
- Being active for at least 150 minutes a week
- Keeping to a healthy weight and limiting alcohol
- Not smoking or chewing tobacco
Diagnosis
A blood test called a lipid profile measures total , LDL, HDL and triglycerides, another blood fat that rises with sugar, alcohol and excess weight. Some laboratories ask for a fast beforehand, so follow the instruction given.
The number alone does not decide treatment. The doctor weighs it with age, , blood sugar, smoking, weight and family history to judge the overall risk. Thyroid, kidney and liver tests may be added.
Treatment
Changes to food and activity come first, and for many people they are enough. Replacing saturated fat with vegetables, pulses, nuts and whole grains, losing weight, walking regularly and stopping tobacco all lower the harmful .
Cholesterol-lowering medicines, the best known being , are added when the risk of a heart attack or stroke is high, when the level is very high, or when there is already heart disease, a previous stroke or diabetes. Others can be used if statins are not tolerated.
Any other condition raising the level, such as an underactive thyroid, is treated too, and repeat blood tests check progress.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“I am thin and I eat simple home food, so my cholesterol cannot be high.”What is true?
Fact
Cholesterol levels depend on inherited genes as well as diet and weight. Slim people with a careful diet can still have a high level, and an inherited condition called familial hypercholesterolaemia raises it from a young age. Only a blood test shows the level.
Myth“Desi ghee and coconut oil are natural, so they do not raise cholesterol.”What is true?
Fact
Being traditional or unrefined does not change what a fat does in the body. Ghee, butter, coconut oil, palm oil and the fat in red meat are all high in saturated fat, which raises the harmful LDL cholesterol. They are best used in small amounts.
Myth“If my cholesterol is high I will feel weak, tired or heavy.”What is true?
Fact
High cholesterol produces no symptoms at all. It is silent until the narrowed arteries cause chest pain, a heart attack or a stroke, which is why testing matters even when a person feels completely well.
Myth“Statins are harmful and once started can never be stopped, so it is better to manage with home remedies alone.”What is true?
Fact
Statins are among the best studied medicines and are prescribed when the risk of a heart attack or stroke is high enough to justify them. Muscle aches and other side effects can happen and should be reported, because the dose or the medicine can often be changed. Diet and exercise help, but for some people they are not enough on their own.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Do I need to fast before a cholesterol test?
It depends on the test your doctor orders. Many laboratories now accept a non-fasting sample for a first check, while a fasting sample is often preferred when triglycerides matter or when treatment is being adjusted. Follow the instruction you are given when the test is booked.
Are eggs bad for cholesterol?
The cholesterol eaten in food has less effect on blood levels than the amount of saturated fat in the diet. Eggs can usually be part of a balanced diet for most people. How they are cooked matters, so an egg boiled or lightly cooked is a better choice than one fried in a lot of ghee or butter.
My cholesterol came down. Can I stop the medicine?
A good result usually means the treatment is working, not that it is no longer needed. Cholesterol tends to rise again if the medicine stops. If you want to reduce or stop it, ask the doctor who prescribed it so the decision is made with your latest results and your overall risk in view.
Should my children be tested?
Testing in childhood is not routine, but it is worth discussing if a parent or grandparent had very high cholesterol or a heart attack or stroke at a young age. That pattern can point to familial hypercholesterolaemia, which runs in families and is treatable.
