What is cholesterol, why is it important and how would it impact my life? In England, high cholesterol leads to over 7% of all deaths and affects up to 60% of adults in 2023.¹ 

You might hear people talking about their cholesterol levels and wish you knew more about this. Here is a quick but comprehensive review of cholesterol for you (or your family and friends) to learn more about the relationship between cholesterol levels and life quality. 

Cholesterol 101

Cholesterol is a natural and essential fatty substance in our blood. However, an excessive amount of cholesterol can be bad for your health. 

Cholesterol is a fat-like, waxy substance, produced in the liver and is also found in some of the foods of animal origin. Its main function is to keep the cells in our body functioning by maintaining cell repair and synthesising some essential substances, such as hormones and vitamin D. Cholesterol is needed across your whole body and is carried in your bloodstream as particles called lipoproteins.

The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

Good cholesterol and bad cholesterol

Let’s have a closer look at different types of cholesterol.

Common risk factors that increase bad cholesterol levels

Other factors influence your cholesterol levels that are outside of your control, for example, established medical condition (type 2 diabetes, liver disease, etc), family history, ageing, being male by birth, and menopause.⁶

How to lower cholesterol level

Adopt a heart-healthy diet by reducing saturated fat

Saturated fats (saturates) are found in animal products, including meat and dairy, as well as in some plant foods like palm oil and coconut oil. Foods are considered high in saturated fat if they contain more than 5g of it per 100g. Some foods marketed as low in fat are often high in sugar, and excessive sugar intake from refined carbohydrates can lower good cholesterol (HDL) levels.⁷

When you consume saturated fat, the liver converts it into blood cholesterol, and it also slows down the body's ability to remove cholesterol. Reducing saturated fat in your diet and replacing it with unsaturated fats is an effective way to lower blood cholesterol levels. As a general guideline, the NHS recommends limiting saturated fat intake to between 20g and 30g per day.⁷

Here are some tips to help you decrease saturated fat in your diet:⁷

• Use tomato or vegetable-based sauces instead of cream or cheese sauces
• Lean cuts of meat and mince
• Use lower-fat dairy foods, such as 1% milk/skimmed milk, reduced-fat cheddar, and low-fat yoghurt
• Omega 3 fats are also considered a heart-healthy supplement, which can be found in oily fish and green leafy vegetables, some nuts, and some seeds (such as walnuts and pumpkin)⁸

Regular physical activity

Worldwide, physical inactivity causes 9% of premature mortality and 6% of coronary heart disease.⁹ Being physically active can reduce the risk of developing heart and circulatory diseases by as much as 35%.¹⁰

Being physically active is a major part of looking after your cholesterol levels, it can:

• Remove fat from your blood more efficiently by raising your HDL cholesterol levels
• Lower your bad (LDL) cholesterol
• Lower your blood pressure, and 
• Prevent obesity

How much physical activity should I do to lower cholesterol?

According to NHS recommendations, adults should aim for at least 150 minutes of moderate-intensity activity each week. Moderate-intensity exercise means your heart rate increases, and you're breathing harder, but not to the point of being out of breath. Walking, jogging, swimming, cycling, and dancing are all great options.¹¹

Maintain a healthy weight

In the UK, around 1 in 6 heart and vessel disease deaths are associated with a high body-mass index (BMI).¹⁰ Diets high in saturated and trans fats can raise cholesterol levels and contribute to being overweight. Obesity is often linked to insulin resistance, a condition where the body's cells do not respond effectively to insulin, leading to imbalances in cholesterol levels and an increased risk of heart disease.

Additionally, fat cell abnormalities are associated with chronic low-grade inflammation in the body and organs. This inflammation can cause increased production of LDL cholesterol and reduced clearance of LDL from the bloodstream.

Quit smoking

In the UK, 7.6 million people are living with heart and vascular diseases, contributing to around 170,000 deaths each year. It's estimated that about 15,000 of these deaths – or 1 in 11 – can be attributed to smoking.¹⁰

The chemicals in cigarettes interfere with the normal function of HDL cholesterol by altering the structure of its protein. This damage contributes to plaque buildup and reduces HDL’s ability to remove cholesterol from blood vessels and the heart. Quitting smoking can increase HDL levels by up to 10%, provided there is no significant weight gain.¹²

Research also suggests that smoking promotes inflammation and leads to the production of free radicals, causing oxidative stress in the body. Oxidative stress can damage cells, making them more susceptible to heart and vascular diseases.¹³

• Within weeks of quitting, your blood will become less sticky, and the risk of heart attacks will start to decrease¹⁴
• Within months of quitting, blood flow will improve, you’ll feel more energetic, and exercise will become easier¹⁴

Moderate alcohol consumption

When you drink alcohol, it is broken down in the liver, forming triglycerides and cholesterol, which raises the level of fat in your blood. If triglyceride levels become too high, they can accumulate in the liver, leading to liver damage and fatty liver disease.

As the liver’s function becomes impaired and it struggles to remove cholesterol from the blood, cholesterol levels can rise even further. Additionally, alcohol contributes to weight gain and increases blood pressure, both of which are major risk factors for heart and vascular diseases.

How much alcohol is safe to drink?

To maintain good health and prevent illness, the government advises drinking no more than 14 units of alcohol per week, which is roughly:^15,16

• 6 pints of average-strength beer or ale (ABV 4%)
• 6x 175 ml glasses of wine (ABV 13%)
• 14x 25 ml single measures of spirits (ABV 40%)

You can use the NHS-recommended Alcohol Change UK's unit calculator to check how many units of alcohol you normally consume.

Here are some tips to help you reduce you alcohol comsumption:¹⁵

• Check the percentage of alcohol and swap to lower-strength options
• Make your drinks last longer by adding ice or water
• Try drinking more slowly
• Spread your units out across the week 
• Try some alcohol-free challenges
• Avoid binge drinking – that’s more than 8 units in a single session for men, and more than six units for women¹⁷

Regular check-ups and monitoring for high-riskers

According to the NHS, individuals over 40, those who are overweight, or those with a family history of high cholesterol or heart problems are more likely to have high cholesterol.¹⁸ High cholesterol usually does not cause obvious symptoms and can only be detected through a blood test. Your GP should invite you for an NHS health check every five years if you are between 40 and 74 years old. The NHS health check is designed to spot early signs of diseases, including heart disease.

If you are undergoing treatment, monitoring may be more frequent. Initially, blood tests may be required every 2-3 months to assess the treatment’s effectiveness.¹⁹ As your body adjusts to the treatment, the check-ups will become less frequent.

Consider treatment if necessary

Medical treatment for high cholesterol often involves the use of medications, particularly when lifestyle changes alone are insufficient to control cholesterol levels or when individuals are at higher risk of developing heart disease.¹⁹ Medical treatments are individualized, and healthcare professionals consider factors such as overall health, cholesterol levels, and potential side effects. The most commonly prescribed medication is statins, which work by inhibiting cholesterol production in the liver, thereby reducing LDL cholesterol levels.¹⁹ 

If prescribed medication, it is crucial to take it as directed by your healthcare provider. Regular follow-up appointments will be scheduled to monitor your response to the medication. Open communication with your healthcare team is essential for optimizing the effectiveness of the treatment.

Summary

Cholesterol is a natural and essential fatty substance found in the blood. While necessary for certain bodily functions, excessive cholesterol levels can negatively impact your health, particularly your heart. To lower your cholesterol levels you should:

Know the cholesterol basics

• Cholesterol exists in two main forms: LDL (bad cholesterol) and HDL (good cholesterol)
• High levels of LDL cholesterol can lead to the buildup of plaque in the arteries, increasing the risk of heart disease
• Excess cholesterol can form plaque, a thick and hard substance that clogs and narrows blood vessels
• Plaque buildup restricts blood flow, which can lead to serious cardiovascular conditions like coronary heart disease, heart attacks, and strokes

Consider lifestyle modifications to lower cholesterol levels

• Choose foods low in saturated fats and high in fibre for a heart-healthy diet
• Engage in at least 150 minutes of moderate exercise per week
• Maintain a healthy weight to lower cholesterol and reduce heart disease risk
• Quit smoking to improve HDL (good cholesterol) levels and reduce inflammation
• Limit alcohol intake to no more than 14 units per week

Schedule regular check-ups and monitoring with your GP

• Regular cholesterol tests are recommended for individuals over 40, those who are overweight, or with a family history of heart disease
• The NHS offers health checks every five years for individuals aged 40 to 74 to monitor cholesterol and overall heart health

Consider medical treatment, if necessary

• If lifestyle modifications alone aren’t enough, medical treatment may be recommended
• Follow your healthcare provider’s guidance, which may include medications to control cholesterol levels
• Attend regular follow-ups to ensure medication effectiveness and overall heart health

By understanding cholesterol and implementing lifestyle changes, along with regular monitoring and, if necessary, medical treatment, you can significantly reduce your risk of heart disease and improve your overall health.