Raised cholesterol is one of the most common things we find at a health check, and one of the least likely to be noticed any other way. It causes no symptoms at all. Most people only find out when a blood test is done for another reason, or after a heart attack or stroke. The good news is that it is also one of the most changeable risk factors there is.

What cholesterol actually is

Cholesterol is a fatty substance your body needs to build cells and make hormones. It travels in the blood attached to proteins, and the type of carrier matters:

• LDL cholesterol (“bad” cholesterol) can build up in the walls of arteries, narrowing them over many years.
• HDL cholesterol (“good” cholesterol) helps carry cholesterol away to the liver.
• Non-HDL cholesterol is your total cholesterol minus HDL. It captures all the potentially harmful types, and UK guidance increasingly uses it to judge risk and track progress.
• Triglycerides are another type of blood fat, strongly affected by diet, alcohol and weight.

Why a number on its own is not enough

A cholesterol result means little without the rest of the picture. UK doctors use a risk calculator called QRISK3, which combines your cholesterol with your age, sex, blood pressure, smoking, weight, family history, ethnicity and other conditions to estimate your chance of a heart attack or stroke over the next ten years. Two people with identical cholesterol can have very different risks.

That is why a doctor-led health check is more useful than a cholesterol test in isolation. We take your blood pressure, weight and full history in the same appointment, so your result can be put straight into context.

Why people with raised cholesterol often don’t know

Raised cholesterol is very common in the UK, and it does not make you feel unwell. It often runs in families, and in some people it is caused by an inherited condition called familial hypercholesterolaemia, which can cause very high levels from a young age. It can also rise with age, weight gain, an underactive thyroid, diabetes, some kidney and liver conditions, and some medicines. Being slim and active does not rule it out.

In our own audit of health checks, raised cholesterol was by far the most common new finding among the more than half of patients who had a modifiable risk factor.

What you can change

Lifestyle changes make a real difference, and they help your heart in other ways too:

• Swap saturated fats (fatty meat, butter, cheese, cream, pastries) for unsaturated fats such as olive oil, nuts, seeds and oily fish.
• Eat more fibre, especially oats, beans, lentils, vegetables and fruit.
• Move more. Aim for at least 150 minutes of moderate activity a week.
• Stop smoking, which damages artery walls and lowers HDL cholesterol.
• Keep alcohol within 14 units a week, spread over several days.
• Lose weight if you need to. Even a modest loss can improve your blood fats.

For some people, particularly those with a higher overall risk or very high levels, lifestyle changes are not enough on their own and cholesterol-lowering medicine is recommended. That is a decision to make with your doctor, based on your overall risk rather than a single number.

When to get your cholesterol checked

It is worth having your cholesterol checked if you are over 40 and have not had it done recently, if heart disease or stroke runs in your family (especially before 60), or if you have high blood pressure, diabetes or are carrying extra weight. A repeat test after a few months of lifestyle changes shows whether they are working.

Both of our health checks include a full cholesterol profile and HbA1c (a blood sugar test), alongside blood pressure, weight and a doctor’s review. You do not need to fast for the Core Health Check. The Advanced Health Check adds apolipoproteins, which give a further measure of the particles that carry cholesterol.