Risk factors for high cholesterol

Despite these essential functions, we’re told that too much of a certain type of cholesterol may put us at increased risk of heart attack and stroke. For decades, total cholesterol was believed to be the enemy when it came to heart health, but more recent research suggests this is not the whole story.

Find out all you need to know about high cholesterol. Then check out our cholesterol-friendly recipes, heart-healthy recipes and low-fat meals.

What is high cholesterol?

Your GP will check your cholesterol levels by using a simple blood test. The test will involve a blood draw from your arm or a simple finger prick test. You may be eligible for an NHS cholesterol test if you are over 40 and have not been tested before, are overweight, have a genetic predisposition to high cholesterol or a heart condition. For those over 40, a midlife health check, that includes a cholesterol review is available on the NHS every 5 years.

In the UK cholesterol is measured as millimoles per litre of blood (mmol/L) with current recommendations as follows:

• Total cholesterol – below 5mmol/L
• HDL – above 1.00mmol/L for men and above 1.2mmol/L for women
• Non-HDL- below 4.00mmol/L (this figure is your total cholesterol less your HDL, it’s largely made up of LDL plus other less favourable forms)
• LDL –below 3.00mmol/L (this is an estimation).

You may be told you have high cholesterol (hyperlipidemia) if there is too much total cholesterol in your blood, however, always ask your GP to explain the break-down of the other numbers reported. This is important to fully understand the implications of your cholesterol results.

Read what do my cholesterol numbers mean?

Who is affected by high cholesterol?

There are numerous factors that may influence your cholesterol levels, making many of us likely to be affected, these include:

• What you eat – foods rich in saturated fat like processed meat and fast foods that may contain trans fats, as well as highly processed and refined carbs
• Your body weight – being overweight or obese, and having high levels of visceral / abdominal fat
• If you smoke – this potentially makes the balance of the different types of cholesterol less favourable
• Excess alcohol – elevates cholesterol and other blood fats
• Medical conditions – such as diabetes, chronic kidney disease and HIV
• Certain prescribed medication – including some blood pressure pills and HIV medicines
• Your age – as we get older our levels rise
• Your gender – after menopause women experience an increase in levels
• If you have just had a baby, your levels may be higher than the norm for you
• Your genes – if your blood relatives have high cholesterol levels, you may too
• The time of year that your test is taken – with the colder months resulting in higher readings

What are the symptoms of high cholesterol?

High cholesterol is usually symptomless, although there are signs that you may be at risk. These include being overweight or obese, smoking, heavy alcohol consumption, poor sleep, as well as high levels of stress. Other indicators that suggest high cholesterol include a diet high in saturated fat, as well as ultra processed foods, refined carbs and processed meats.

Your family history may also have an impact, especially if there is a condition known as familial hypercholesterolemia. Over time, you may have symptoms such as fatty deposits in the skin or on the eyelids, yellowish areas around the eye or a pale ring on the iris. Other symptoms include swollen tendons or bumps around joints, like the knuckles.

What are the health implications of high cholesterol?

Cholesterol levels are important because they help us understand our heart disease risk. This is because cholesterol is one of a number of factors that together may suggest an increased risk of heart attack or stroke. Other factors include high blood pressure, diabetes, smoking and being inactive. The reason cholesterol is implicated is because cholesterol particles can get retained in the artery wall and this may lead to atherosclerosis (hardening of the arteries). So, although you may feel cholesterol is not the single most relevant factor for you, it is considered to be an important piece of the heart disease puzzle and this is why we are encouraged not to ignore it.

Elevated levels are especially relevant if they remain high over an extended period of time, but, fluctuating total cholesterol levels and triglycerides during mid-life (after the age of 60) may also be important because they may be associated with an increased risk of dementia and Alzheimer’s later in life. Although, more studies are needed to clarify this.

High levels of blood fats and cholesterol may also be a risk factor for non-alcoholic fatty liver disease as well as obesity and diabetes and the eye condition, glaucoma.

A high cholesterol may also suggest an underlying health condition, for example, an underactive thyroid may lead to elevated blood fats including cholesterol. Once treated your cholesterol levels should return to normal. Other health conditions that may lead to elevated cholesterol include growth hormone deficiency, kidney disease and gout.

Is high cholesterol linked to diet?

We previously believed eggs were to blame for high cholesterol levels. We now know this is incorrect – only a small amount of the fat we eat is in the form of cholesterol which suggests you’d need to eat a lot of these offending foods to put yourself at risk. However, when we eat a lot of foods that are rich sources of saturated and/or trans fats then levels of cholesterol are likely to increase.

Furthermore, high levels of refined carbs such as pastry, cakes and biscuits made with white flour, that have a high glycaemic effect (causing blood sugar and insulin levels to rise) may lead to unfavourable changes to blood fats, including cholesterol production.

Ways to lower high cholesterol

Making changes to your diet can be useful and may help you manage your levels, these include:

• Cut down on saturated and trans fats (red meat, butter and coconut oil, as well as fast foods and takeaways)
• Minimise refined and processed foods (pastry, bread and biscuits)
• Focus on mono and poly-unsaturated fats such as those in oily fish, nuts and seeds as well as olive oil
• Increase the plant foods in your diet, like beans and pulses
• Eat more foods rich in fibre, especially soluble forms of fibre such as that found in oats and flaxseeds – these help the body remove excess cholesterol
• Certain foods, like avocado, are rich in compounds called plant stanols and sterols, these foods help inhibit the absorption of cholesterol in the gut
• Eat an abundant variety of vegetables and fruit – these may help protect blood vessels from damage and from the inflammation that may promote plaque formation in the arteries
• Be more active
• If you smoke or vape, stop
• If you enjoy an alcoholic tipple be sure to keep within guidelines
• Achieve and maintain a healthy weight for your height, age and gender

For more tips check out 10 ways to lower cholesterol guide.

Do I need to know my cholesterol numbers?

Although we’ve grown to fear cholesterol, it is fundamental to life, nevertheless, knowing your cholesterol numbers is valuable because it’s an important piece of the heart disease puzzle. Furthermore, elevated levels of cholesterol and other blood fats may be suggestive of other underlying health conditions, and for these reasons we’re encouraged not to ignore it.

Enjoyed this? Now read

Food and drink to avoid for gout
Are you at risk of fatty liver disease?
Healthy diet for diabetes
What to eat to beat common health problems
What is high blood pressure?

Kerry Torrens BSc. (Hons) PgCert MBANT is a Registered Nutritionist with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including Good Food. Find her on Instagram at @kerry_torrens_nutrition_

All health content on goodfood.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other healthcare professional. If you have any concerns about your general health, you should contact your local healthcare provider. See our website terms and conditions for more information.