Private high cholesterol & heart risk clinic in London, same-day cardiology.

What the numbers mean

• LDL cholesterol — the one that deposits in artery walls. Lower is better; there is no threshold below which benefit stops.
• Non-HDL cholesterol — total minus HDL. Now the preferred measure in the UK, as it captures all the harmful particles.
• HDL cholesterol — carries cholesterol away. Higher is generally better, though raising it with drugs has not proved beneficial.
• Triglycerides — raised by alcohol, sugar, excess weight and poorly controlled diabetes. Very high levels can cause pancreatitis.
• Total:HDL ratio — used in risk calculation.

What lowers it

Statins, honestly

• They substantially reduce heart attacks and strokes, and the benefit is greatest in those at highest risk.
• Muscle aches occur in a minority. Blinded trials show most people who report them get the same symptoms on placebo — which does not mean the pain is imagined, but does mean a trial off and on, or a switch of statin or dose, is worth doing before abandoning treatment altogether.
• Serious muscle damage is rare. Severe widespread muscle pain with dark urine needs stopping the statin and same-day assessment.
• Liver tests are checked before starting and at three and twelve months.
• They slightly increase the chance of developing diabetes, and reduce cardiovascular risk by considerably more.
• Alternatives exist — ezetimibe, and injectable treatments for those who cannot take statins or need more.

Two things often missed

• Familial hypercholesterolaemia — an inherited condition affecting roughly 1 in 250 people, causing very high cholesterol from birth and early heart disease. Suspect it with total cholesterol above 7.5, a family history of heart attack under 60, or tendon deposits. It is substantially under-diagnosed, and identifying one person means testing the whole family.
• Lipoprotein(a) — an inherited independent risk factor, measured once in a lifetime, and not affected by diet or statins. Worth knowing if you have a strong family history without an obvious explanation.