Patient information · Cardiovascular
Cholesterol and heart risk
the numbers, and what to do about them
Cholesterol causes no symptoms. It contributes to heart attacks and strokes silently over decades, which means the decision to treat is made on calculated risk rather than on how you feel. Understanding the numbers puts you in a position to make that decision properly.
Call 999 if you have
- central chest pain or tightness lasting more than 15 minutes
- chest discomfort spreading to jaw, neck, back or arm, with sweating or nausea
- sudden face droop, arm weakness or speech difficulty
- sudden severe breathlessness at rest
- calf pain, swelling and warmth with breathlessness
Cholesterol itself is not an emergency. These are. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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.
The number alone does not decide anything
Treatment decisions use QRISK, which combines cholesterol with age, sex, ethnicity, blood pressure, smoking, diabetes, family history, weight, kidney function and other conditions to estimate your ten-year risk of a heart attack or stroke. A cholesterol of 6.0 may need no treatment in one person and definite treatment in another. This is why a cholesterol result on its own, without the rest of the picture, tells you very little.
What lowers it
Genuinely effective
- Replacing saturated fat with unsaturated — olive oil, nuts, oily fish
- Soluble fibre: oats, beans, lentils, apples
- Plant stanols and sterols in fortified spreads and drinks
- 150 minutes of activity a week, which mainly raises HDL
- Losing excess weight, and stopping smoking
Limited or no effect
- Cutting dietary cholesterol alone — eggs matter far less than once thought
- Most supplements marketed for cholesterol
- Coconut oil, which raises LDL
- Exercise alone, without dietary change, for LDL specifically
- Waiting for symptoms before acting
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.
Why come to us. A lipid profile on its own is not much use. We combine it with blood pressure, HbA1c, kidney and liver function and an ECG — all performed in-house — calculate your actual cardiovascular risk with you, and explain the results face to face with a written plan. Echocardiography is available on site and consultant cardiology without a referral. We can test Lp(a) and screen for familial hypercholesterolaemia, including family members. Seven days a week, with published fees.
Your actual risk calculated, not just a number
Lipids, HbA1c, ECG and echo in-house. Cardiology without a referral.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.