Cholesterol is a soft, waxy substance, similar to fat, that is found in the body’s cells and bloodstream. It is part of a group of compounds called lipids, which also includes fats.
Cholesterol is essential for many functions – from building cell membranes, producing certain vitamins and hormones, to supporting the digestion of fatty foods. Your liver produces cholesterol naturally, but you also get some from animal-based products such as meat, dairy or eggs.
While cholesterol itself is not bad, having high levels of LDL-C — a type of cholesterol — can increase your risk of cardiovascular disease (CVD), including heart attack and stroke.
Over 50% of adults in Europe have high cholesterol, the highest rate in the world.
LDL (low-density lipoprotein) cholesterol, or LDL-C – makes up most of your body’s cholesterol. LDL-C is often referred to as “bad” cholesterol, because high levels can raise your risk of heart disease and stroke. Usually, doctors monitor closely these levels, as it is very important when determining your treatment plan.
HDL (high-density lipoprotein) cholesterol, or “good” cholesterol, helps remove excess LDL-C from the bloodstream by carrying it to the liver for breakdown and elimination. Although it only transports a small amount of cholesterol, higher HDL-C levels can support better heart health.
Atherosclerosis is a serious condition in which cholesterol, fats, and other substances gradually build up in the inner walls of the arteries, forming deposits known as plaque. Over time, this buildup can narrow the arteries and reduce blood flow to the heart, brain, and other parts of the body.
Atherosclerosis can lead to life-threatening complications: if a plaque ruptures, it can cause a blood clot that may block an artery entirely — potentially triggering a heart attack or stroke.
Coronary arteries are the blood vessels that supply your heart muscle with the oxygen-rich blood it needs to function. Just like other parts of your body, your heart needs a steady supply of oxygen and nutrients to pump blood effectively.
Familial Hypercholesterolemia or FH, is a genetic disorder where LDL-C levels are very high in a person’s body from birth. People with FH can have LDL-C levels that are 2 to 6 times higher than normal.
FH is inherited and passed down through families from either one or both parents. This means if a parent has FH, there is a 50% chance their children will have it too.
When a person is diagnosed with FH, it is important that all family members are screened.
Lipids are a group of natural fats and fat-like substances that are important for your body’s health. They include fats, oils, waxes, certain vitamins (like A, D, E, and K), hormones, and components of cell membranes.
The main types of lipids important to human health include:
Lp(a), also known as lipoprotein(a), is a cholesterol-like substance produced in the liver and found in the blood. It is made up of two smaller lipoproteins joined together.
Everyone has some Lp(a) in their body – but when levels are too high, it can be harmful. Elevated Lp(a) may interfere with the body’s natural ability to break down blood clots, making clots harder to dissolve. Over time, this can cause inflammation in the arteries and lead to the buildup of plaques inside their walls. As a result, high Lp(a) increases the risk of heart disease and stroke, even in people with otherwise normal cholesterol levels.
Triglycerides are not a type of cholesterol, but they are the most common type of fat in your body. They can be found in certain foods you eat, and the body can produce them from extra carbohydrates you consume. Triglycerides provide energy – and when not needed right away, they are stored in fat cells and later released between meals. High levels are often associated with overweight or obesity, increasing your risk of heart disease.
High levels of LDL-C and triglycerides are both considered risk factors for atherosclerosis, the buildup of substances in artery walls called plaque.
LDL-C is the primary substance in plaque. Triglycerides are not part of the plaque, but they can cause inflammation of artery walls, which can initiate the plaque process.
Plaques limit the blood flow through the affected artery, or they can rupture, and block blood flow altogether, causing a heart attack or stroke.
High LDL cholesterol can be inherited (such as familial hypercholesterolemia), it can be the result of making unhealthy lifestyle choices, or both. While 1 in 250 to 300 people in Europe have hereditary high cholesterol, most people have high LDL cholesterol because of unhealthy lifestyle choices.
The most common causes of non-inherited high LDL cholesterol are:
High LDL cholesterol typically presents no visible signs or symptoms, which is why many people are unaware they have it. However, the cardiovascular events it can lead to — such as heart attacks or strokes — often do have warning signs.
An exception is individuals with FH, who may develop visible physical signs, such as:
Because high LDL cholesterol usually does not cause any symptoms, the only way to know your cholesterol levels is through a blood test.
This test — called a fasting lipoprotein profile or lipid panel — measures the different types of cholesterol in your blood and helps you understand your numbers.
About the test:
You will be asked to fast (avoid eating or drinking anything except water) for a set period before the test.
It is a simple blood test that measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides.
The results give an overall picture of the levels of fats (lipids) in your bloodstream.
The test is quick and typically takes only a few minutes.
There are different ways to treat high LDL-C depending on your lipid profile lab results and other factors your healthcare provider will consider. In many cases, elevated LDL-C can be managed through a combination of lifestyle changes and medications. Your healthcare provider will help determine the approach that best suits your needs and overall cardiovascular risk.
Some individuals, especially those with a family history of high LDL-C, may need medication in addition to lifestyle changes. The decision on which medicines to use, and the specific type and dose, should be made on a case-by-case basis by a healthcare professional, based on your individual risk factors and any other medical conditions.
Some medications used to treat elevated LDL are:
Adopting healthy habits – such as eating a balanced diet low in saturated fats and high in fibre, engaging in regular physical activity, reducing stress and maintaining a healthy weight – can help lower your LDL-C levels and reduce your risk of heart disease and stroke.
Whether you have recently been diagnosed with high LDL-C, are already living with cardiovascular disease, or have experienced a heart attack or stroke, taking charge of your health can make a real difference. Proactive management can help prevent a first or recurrent heart attack, stroke, or further disease progression.
Here are some key actions you can take to manage high cholesterol and support heart health:
Many people find it helpful to reflect on their daily habits — like eating, activity, stress, and sleep — when thinking about making healthy changes.
Asking a few simple questions (e.g., Do I eat balanced meals? Am I active enough? How well am I sleeping?) can be a good starting point for conversations with your doctor about how to improve your heart health.
Follow your treatment plan exactly as you were told. Taking medications as instructed is vital for feeling better and enhancing your longevity. If you have any uncertainties, don’t hesitate to reach out to your doctor.
Eating well is always beneficial — especially for those with high LDL cholesterol. A balanced diet can help lower cholesterol levels, boost energy, reduce fatigue, and support overall health. What you eat plays a key role in how you feel and how your body functions.
Physical activity is just as important as eating well for your heart health. Becoming more active, even a little bit at a time, is good for the body and mind.
Diet and physical activity are important, but there may be other things you can do to get and stay healthier too. Some changes you can make are:
Know your family history. If heart disease or high cholesterol runs in your family, especially at a young age, share this information with your doctor.
Get screened regularly. Routine checks help detect risk factors early. Talk to your doctor about the tests you need.
Manage stress. Chronic stress can increase your risk of heart problems. Try techniques like deep breathing, exercise, or mindfulness to help you cope.
Prioritise sleep. Poor sleep affects heart health. Aim for regular, quality rest and healthy sleep habits.
Boost your confidence in self-care by learning more about your heart disease. Use reliable sources to gather information and make informed decisions regarding your health. Knowledge is a powerful tool on your journey.
Maintain connections with supportive individuals in your life and seek out peers who share similar experiences. Building an emotional support network is crucial for staying motivated and focused on your health goals. Share your journey, seek advice, and offer support to others in your community.
Early diagnosis and treatment can delay or prevent cardiovascular events, such as heart attacks.
As you begin managing high LDL-C, it is essential to have open and detailed discussions with your healthcare provider. Consider these questions for a collaborative and informed approach to your care:
