Martin Cowie is Professor of Cardiology (Health Services Research) and is an Honorary Consultant Cardiologist at the Royal Brompton and Harefield NHS Foundation Trust.

The modern western diet means nearly all of us have higher blood cholesterol than we should. The result? We put on weight, we become less fit, and our arteries start to fur up. For good heart health, your cholesterol level should be below 5mmol/L (that’s millimoles per litre, or 200mg/dl) and, in general, the lower your level, the better for your long-term heart health. Here’s what you need to know…

Levels may be higher after christmas

The trouble with Christmas is that it’s not just about overindulging on the day itself. First there’s the weeks-long run-up, then the week of festivities, not to mention using up the leftovers afterwards. The excess can go on well into January.   The odd meal or day where you eat a bit more than usual (including too much saturated fat) won’t make a difference in the long run, but a prolonged period like this could have an impact on your weight and cholesterol levels. Whether you make a resolution or not, now’s the time to reinstate healthy eating habits and become more active, before that overindulgence becomes a habit that’s hard to break. Watching portions, eating plenty of fruit and veg, limiting unhealthy snacks and working more activity into your day will help you lose excess weight and get cholesterol levels down again.

Long-term high cholesterol is bad for the heart

Along with smoking and high blood pressure, high cholesterol levels increase your risk of cardiovascular disease, the most common cause of death in the UK. Coronary heart disease causes blood vessels in the heart to narrow or become blocked by the build-up of fat in the artery wall. This can result in a heart attack, or chest pain when you exercise or become stressed (also known as angina). A similar process occurs with arteries that supply the brain, where a blockage can cause a stroke. Other forms of cardiovascular disease include a mini-stroke or TIA (transient ischaemic attack), which carry a high risk of a future stroke; and peripheral arterial disease (a narrowing of the arteries, usually in the legs, with pain in the calves when you walk).


Your health risks change with age

As we get older and our waistlines expand, our cholesterol levels tend to rise. The risk of heart attack or stroke also goes up steadily with age. So don’t be surprised if your doctor changes his or her advice as you get older.

You can confirm your figures in a matter of minutes

Various finger-prick blood test kits are available from pharmacies that will give you results in a few minutes. These tests only provide you with your ‘total’ cholesterol reading, however. If you have a cholesterol test at your GP surgery, they’ll be measuring your total cholesterol, your HDL and your non-HDL cholesterol levels, and factor this into their discussions with you about your heart health and the need for any treatment

You can reduce cholesterol through diet

When raised, your levels of ‘bad’ cholesterol can be brought down by eating a healthier diet. Blood levels are strongly linked to how much saturated fat you eat, rather than the cholesterol in your diet, however. By eating more healthily, some people drop their levels a lot while others will see a smaller effect. The Portfolio Diet, which includes a collection of foods that work together, has been proved to help lower cholesterol – find out more and get a typical day’s diet by searching ‘Portfolio’ at If you’re overweight, losing just 5–10% of your weight can have an effect on your cholesterol levels and blood pressure (your GP or nurse can tell you whether you have a body mass index above 25, or use the calculator at In general, any improvement in your diet should lead to a drop in bad cholesterol.



It can be inherited

Around one in 250 people inherit a gene that makes them produce far too much cholesterol, even if they follow a strict diet. Their total cholesterol is often over 7.5mmol/L. This is known as familial hypercholesterolaemia. The NHS has recently become much more focused on identifying families with this condition, so that statin treatment can be considered from a young age to help prevent or delay the heart attacks or strokes that often occur in these families. If you have a family history of early heart attack or stroke, you should ask your GP to perform a cholesterol check. If it’s very high, the GP can refer you to a specialist for genetic testing for you and your close relatives, as well as appropriate treatment.

Your 10-year risk can be assessed

Your GP will use a computer tool known as QRISK2 to more accurately estimate your risk of developing heart disease or stroke in the next 10 years. This tool uses data based on information from hundreds of thousands of people living in the UK. It takes into account your age, sex, height and weight as well as your blood pressure, your cholesterol level, whether you have diabetes or smoke. Your GP will also take into account your family history and ethnic origin. If your risk is determined to be more than 10%, your GP is likely to offer you a statin as well as recommending you make improvements to your diet. Your GP won’t use the QRISK2 if you have already had a heart attack or stroke, if you have more than mild chronic kidney disease or if you have had diabetes since you were a child (type 1 diabetes). This is because the NHS advice in these circumstances is that you should always consider taking a statin.



 Medication will depend on your personal situation

There has been a lot of controversy about the pros and cons of taking drugs such as statins to lower cholesterol. Your doctor should discuss these with you, tailoring their advice to your circumstances. Currently, the NHS is advised to use a high-dose statin (such as 80mg atorvastatin once a day) for those who already have cardiovascular disease and a lower-dose (20mg) for those who haven’t had a previous heart attack or stroke, but have a 10-year risk of 10% or more. All medicines can cause side effects, which are listed in the patient information leaflet. It’s important to tell your doctor if you’re taking supplements or other over-the-counter medications and to avoid grapefruit juice, as these may interfere with your statin. If you think your statin is giving you problems, your GP may ask you to stop taking it for a while, reduce the dose or change you to a different one. Serious problems with statins are rare. If you get pain, tenderness or weakness in your muscles while taking a statin, let your GP or nurse know.

Taking Dietary supplements isn’t a magic bullet…

Many people take omega-3 fish oils, but there’s no clear evidence that this makes a difference to your risk of cardiovascular disease. Spreads and drinks that are enriched with plant stanols are popular, but the current NHS advice is that these don’t reduce the risk of heart attack or stroke, either. More important is to take advice from your GP on those lifestyle changes that are backed up by very good evidence, such as stopping smoking, losing weight, drinking only moderately, and taking a statin if your risk of cardiovascular disease suggests you would benefit from it.

It can improve quite quickly

If you change your diet, exercise a bit more and make sure you’re not drinking more than recommended, you should see changes quite quickly. Usually your GP will wait two to three months before repeating the cholesterol check, but changes may start before then. The key message is that it’s never too late to start taking care of your cholesterol – but don’t see it as a quick fix for just a few weeks in January – it should be a healthy choice for life.