Cholesterol and Heart Health: Your Numbers and How to Improve Them

What is cholesterol?

Cholesterol is a fatty substance your body needs to build cells and make hormones. It is carried in the blood by proteins. LDL and other non-HDL cholesterol can build up in artery walls, forming fatty plaques that narrow them and can lead to a heart attack or stroke. HDL cholesterol helps carry cholesterol away to the liver.

The British Heart Foundation estimates that around half of adults in the UK have cholesterol levels above the recommended range. Because it causes no symptoms, a blood test is the only way to know.

Understanding your results

Measurement	Healthy level for most adults
Total cholesterol	5 mmol/L or below
Non-HDL cholesterol	4 mmol/L or below
LDL cholesterol	3 mmol/L or below
HDL cholesterol	1.0 mmol/L or above (men), 1.2 mmol/L or above (women)
Triglycerides (fasting)	Below 1.7 mmol/L

These are general guides from the NHS. If you already have heart disease or diabetes, your targets will be lower.

Your overall cardiovascular risk

Cholesterol is only one part of the picture. Clinicians in the UK use the QRISK3 tool to estimate your chance of having a heart attack or stroke in the next 10 years. It takes into account your age, sex, ethnicity, postcode, cholesterol, blood pressure, smoking, BMI, family history and conditions such as diabetes or kidney disease.

When are statins recommended?

Under NICE guideline NG238 (2023):

• If you have not had a heart attack or stroke and your QRISK3 score is 10% or more, you should be offered a statin, usually atorvastatin 20 mg, after lifestyle changes have been discussed.
• If your risk is below 10%, a statin can still be considered if you would prefer to take one.
• If you already have cardiovascular disease, you should be offered a higher-intensity statin, usually atorvastatin 80 mg.

Statins are among the most widely studied medicines. Muscle aches are the most commonly reported side effect, but large trials show most people tolerate them well. Speak to your pharmacist or GP rather than stopping on your own, as a different dose or statin may suit you better.

Lifestyle changes that help

• Replace saturated fats (butter, fatty meat, pastries) with unsaturated fats (olive oil, nuts, oily fish).
• Eat more fibre from oats, beans, lentils, fruit and vegetables.
• Aim for at least 150 minutes of moderate activity a week.
• Stop smoking, keep alcohol within 14 units a week and maintain a healthy weight.

Familial hypercholesterolaemia

About 1 in 250 people inherit a condition called familial hypercholesterolaemia (FH), which causes very high cholesterol from birth. If you have a very high cholesterol result, or a close relative had a heart attack at a young age, ask your GP about testing for FH.

Get checked

The NHS Health Check is offered free every five years to adults in England aged 40 to 74 without existing heart disease, diabetes or kidney disease. It includes a cholesterol test, blood pressure check and your cardiovascular risk score.