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High cholesterol are when cholesterol levels are higher than expected in the blood. There are different types of cholesterol particles, with the three most commonly reported types being:
When one or more of these is at higher levels than expected, this is known as high cholesterol.
Typically, high cholesterol does not cause any symptoms directly and is usually diagnosed on blood tests. However, the consequences of untreated high cholesterol are coronary artery disease, which can then lead to chest pain and other symptoms of heart disease and stroke. Occasionally, high cholesterol can show up as changes to your skin, such as yellow marks around the eyelids.
High cholesterol can be due to a combination of genetic, medical or lifestyle factors. A common genetic condition known as familial hypercholesterolaemia leads to very high cholesterol and a familial history of early heart disease or stroke. Identifying this condition is essential to prevent these illnesses from occurring.
Certain medical problems such as diabetes, kidney disease, liver disease, thyroid disease, and even some medications can lead to high cholesterol. Managing these will usually improve your cholesterol levels.
Finally, lifestyle factors such as particular diets or increased weight gain and alcohol consumption can also be linked to high cholesterol.
High levels of LDL cholesterol can increase the likelihood of coronary artery disease, with plaque or “furring” building up in your arteries. If severe, this could lead to a heart attack, angina, stroke, or peripheral arterial disease. Very high triglyceride levels carry a different risk of a life-threatening condition called acute pancreatitis.
High cholesterol is typically diagnosed by a simple blood test. The test does not have to be performed while fasting, but it is helpful to fast for 8 hours prior to the test if there are any concerns about high triglyceride levels. The decision to treat high cholesterol is dependent on other factors like overall heart or stroke risk, and whether any other conditions have been treated or modified first.
Treatment of high cholesterol among otherwise healthy people typically involves looking for and then addressing any underlying causes that could be contributing to these levels. Thereafter, lifestyle changes may be tried for around 3 months, during which time dietary modifications, exercise, alcohol reduction and weight management treatments are all pursued. Some supplements such as plant stanols and sterols can also help lower cholesterol by a modest amount.
Importantly, if someone already has heart disease or stroke, then cholesterol-lowering medications are usually advised without delay to offer the best protection against further heart attacks or strokes.
Where medications are needed, options typically include:
Statins: These are widely prescribed medications that lower cholesterol and heart disease risk at the same time. They are safe and effective and widely recommended in national guidelines for prevention of heart disease or to stop the progression of existing heart disease. Typically, a statin will reduce LDL-cholesterol levels by 30-50%.
Ezetimibe: This is a non-statin medication that is used when statins alone are not enough to lower cholesterol levels, or where statins are not tolerated. They are less potent than statins, but still effective and lower LDL cholesterol by around 20%.
Bempedoic Acid: A recently developed medication, bempedoic acid is used for people unable to take a statin due to side effects. It can be used on its own or be combined with ezetimibe, and comes as a combination pill.
PCSK9 inhibitors: These injectable treatments target a protein produced by the liver, which is designated PCSK9. This procedure leads to dramatically lowered LDL cholesterol levels. They are very potent and can lower cholesterol by as much as 60% by themselves. They are usually used in those unable to take statins or cannot tolerate them. There are two types of PCSK9 inhibitors and both are available through Welbeck Heart Health after consultation with one of our specialists:
Monoclonal antibodies: These are self-administered every two or four weeks.
Inclisiran: This is a treatment that is given as an injection by a nurse every six months.
Omacor and Vaskepa: These are high-strength fish oils that can help lower triglyceride levels. Vaskepa is a new drug that has been shown to have benefits for patients who have high triglycerides and heart disease.
Fibrates: These are relatively older drugs that are mainly used to treat high triglyceride levels, often taken in combination with statins.
If you are concerned about your cholesterol levels, or you would like to explore some of our other cholesterol-lowering treatments, please get in touch for a consultation with one of our specialists.
At Welbeck, our cardiologists are experts in their field and are dedicated to providing world-class care to every patient.
With access to colleagues across other specialities, our consultants are also able to refer within the Welbeck ecosystem if needed to ensure you receive the best possible treatment as quickly as possible, all under one roof.
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Stress doesn't directly raise cholesterol, but, in many cases, it contributes to unhealthy habits or coping mechanisms like overeating, lack of exercise, poor sleep, or smoking, all of which can lead to high cholesterol.
Your cholesterol profile typically contains values including:
Total cholesterol
LDL (low-density lipoprotein) cholesterol - recognised as a strong risk factor for atherosclerosis (the lower your LDL, the better)
HDL (high-density lipoprotein) cholesterol - recognised as a protective factor for atherosclerosis (in general, the higher your HDL, the better)
Non-HDL cholesterol (total cholesterol - HDL) - a risk factor for atherosclerosis (the lower your non-HDL cholesterol, the better)
In general, a cardiologist looks mainly at the values of your LDL and HDL cholesterol. Typically, they would advise keeping your LDL cholesterol as low as practically possible. Ideally, less than 2.5mmol/L if you have no other risk factors, but if you’ve had a previous heart attack or diabetes and hypertension, a much lower target may be suggested (ideally <1.4mmol/L).
There are emerging sensitive markers of premature atherosclerosis. One such marker is “lipoprotein little a”, also written as Lp(a). This is essentially a protein which is similar to LDL, but with an extra protein attached, called apolipoprotein (a). This makes Lp(a) more prone to causing inflammation in the arteries, leading to premature atherosclerosis.
Although there’s no current treatment to reduce Lp(a), elevated levels mean you might need to double down on reducing other risk factors for premature atherosclerosis – keeping your blood pressure, sugar metabolism, and LDL cholesterol in the optimal ranges, with a lower threshold to starting cholesterol treatment.
Elevated cholesterol alone may not be enough to trigger a process of atherosclerosis in all patients (although for some patients, this is the only identifiable risk factor). Oftentimes, other factors which promote inflammation have to be present (such as diabetes or pre-diabetes, hypertension, stress, kidney disease), which, together with elevated LDL cholesterol, trigger the cascade of inflammation within arteries, which promotes atherosclerosis.
The decision of whether or not to take statins is ultimately yours, but it should be made with the specialist advice from a cardiologist, who will be able to explain the nuanced pros and cons. Some have a view that it’s not if, but when, patients will develop coronary artery disease, and as far as cardiovascular longevity is concerned, your extended risk (beyond the typical 10-year risk calculators such as Q-risk) of developing atherosclerosis over a lifetime should be considered.
This is mostly a myth. In most people, with the best exercise and diet, total LDL levels reduce by 20-30%. However, this doesn’t mean you shouldn’t strive to have the healthiest lifestyle you can.
If your LDL is substantially above 4, and certainly above 5, then you should be aware and monitor your LDL after 3 to 6 months of implementing lifestyle changes. If you find this is insufficient in reducing your LDL value to ideal targets, then please consider seeing a cardiologist to discuss this further.
Ultimately, cholesterol and LDL values are a mixture of genetics and environment, and the degree to which environmental factors influence your cholesterol depends on your personal profile.
Our specialist cardiologists are here to guide you through the best lifestyle measures that are sustainable in the long term. If this does not reduce your cholesterol or overall risk sufficiently, there are evidence-based drugs which can be helpful in reducing your cardiovascular risk of developing a heart attack and stroke.
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The consultants at OneWelbeck Heart Health have been assembled based on their hard-earned international reputations and expertise. Together, they cover the major London teaching hospitals and leading cardiac services, making up the largest independent cardiology group in the UK.