This deadly condition is almost symptomless – here's how to find out if you have it

While high cholesterol is often thought of as a condition associated with an unhealthy lifestyle, lack of exercise and one too many pizza and Prosecco nights, you might not be as unlikely to have it as you think.

It’s perhaps one of the most common, rarely considered and highly dangerous of health conditions, yet it has no symptoms and could creep up on you without a word of warning.

You might be an outdoorsy, exercise-loving type, with the physique to show for it, who feasts on a wholefood diet sprinkled with nourishing seeds, always eating something resembling a rainbow on a plate, and hardly ever touching a drop of alcohol, safe in the belief you’re as healthy as humanly possible. And while all this effort does put you in a better position, it doesn’t mean you should ignore the possibility you might be living with a ticking time bomb.

While you may think you’re doing all you can to keep your body in tip-top condition, high cholesterol can affect anyone, including young children and seemingly healthy people.

So, what is cholesterol exactly?  A quick Google says it’s a waxy-like substance produced by the liver, and our bodies need it to produce hormones, build cells and process our exposure to sunlight into a good dose of vitamin D.  But there’s a bit more to it than that.

HDL (high density lipoproteins) cholesterol is known as ‘good’ cholesterol. But as it so often turns out, where there’s good, there’s bad. This comes in the form of LDL (low density lipoproteins) cholesterol. Both are found in food and drink, and it’s our over consumption of too much ‘bad’ cholesterol which causes plaque to build up in our arteries.

‘Good’ cholesterol’s job is to be the knight in shining armour, battling to counteract and reduce the amount of bad cholesterol, which can build up in our artery walls, heightening the risk of heart disease, heart attacks and strokes.

But despite the dangers, Dr Jeff Foster, an NHS and private GP, says concerns about levels of high cholesterol is often the reason many patients make appointments for.

He says: “People are not coming in with a primary concern of high cholesterol, it’s usually that they come in for a well man or well woman check, diabetes reviews or blood pressure reviews, and we’re picking up more cases of high cholesterol.

“You won’t have any symptoms as such, you won’t feel unwell, but there are some signs you could have it.”

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Silent killer

Xanthomas, which are cholesterol deposits, appear along tendons in the body and are usually tan or yellow in colour. Xanthelasmas, which you can see really easily, are similar little yellow spots around your eyelids, which are associated with congenital, or hereditary, high cholesterol.

In rare cases you can get Corneal arcus, a white ring around your iris, which Dr Foster says is another sign you have high cholesterol, and that you were probably born with it. You wouldn’t get those signs from just eating poorly though.

Hereditary high cholesterol, known as hypercholesterolemia (FH), it rarely shows up in children, and is usually discovered in adulthood, when it’s already started to build up.

In the UK, there are around 270,000 people who are living with FH, which translates to around one in every 250 people who have been born with an abnormal gene, potentially putting them at risk of suffering a heart attack at a young age. The longer you have high cholesterol, the worse it will be.

The trouble is, whether it’s caused by hereditary factors or by poor diet and lack of exercise, most people don’t even know they have it. Dr Foster says: “If it’s not congenital, it’s down to not enough physical activity, what you’re putting in your body and your body weight.

“You could argue that really it comes down to what you’re doing to yourself, that your diet is too high in LDL containing foods, or too low in HDL containing foods.

“Cakes, crisps, dairy, cheese, processed meat, and red meat all contain high levels of it, while we know that alcohol also increases your cholesterol.

“It’s not to say you can’t ever have those things, but you have to get your ratio right, so have lots of HDL foods like nuts, oily fish, like salmon, mackerel or sardines, avocados, peanuts, almonds, walnuts and that kind of thing, to try and get your levels up. Wholegrains and beans are important as well, but it’s not an exhaustive list.”

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Overhaul your diet

The British Heart Foundation lists fatty meats, full fat dairy like butter, cream and ghee, palm and coconut oil and processed foods like cakes, biscuits and pastries among the top foods to avoid.

Once you’ve overhauled your diet and emptied the fridge, it’s time to consider whether to swap your Netflix and chill for a spot of exercise. “Exercise is so, so important because you need cholesterol to make hormones like testosterone,” according to Dr Foster. “The more exercise you do, the more testosterone you make to burn up, so you can reduce your cholesterol just by moving more.

“For women to produce muscle mass they need testosterone as well as men, they just don’t need as much of it as men.

“Walking is fine and will help burn calories, but if you’re trying to put on muscle mass and use up cholesterol, you need to be exercising in a way that the intensity means you either get short of breath or get sweaty or hot, which is a sign your metabolism has had to speed up, which is what burns the cholesterol.

“This could be cardiovascular or weightlifting. It just has to be intense exercise for 45 minutes three times a week.”

Depending on your individual case, you may even be prescribed statins, medication which can lower your risks. It works by blocking the enzyme the liver needs to produce cholesterol, resulting in the liver doing the opposite and removing cholesterol from the blood.

According to the National Institute for Health and Care Research (NIHC) there are 7-8 million people in the UK who take statins, though Dr Foster thinks the UK is not aggressive enough when it comes to protecting people with the condition by prescribing the medication.

Research has showed people aged 70 and older who take statins live longer in good health than those who do not, regardless of whether they have cardiovascular disease, which can only be a good thing.

Those behind the study hope their findings will encourage clinicians to recommend statins for the 5 million or so older people in the UK who are not currently taking the once-daily prescription pill.

The good news is, finding out if you have high cholesterol could not be simpler, and you don’t even have to leave the comfort of your own home. Home test kits can be ordered online for less than £15, and local pharmacies can also carry them out. If you want more advice, you could opt for a doctor’s appointment.

In most cases it’s a simple finger-prick test, and results are available almost immediately. Slightly more complex, is if you do get bad news, what can you do about it?

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Benefits of statins

Dr Foster explains that a measurement of LDL levels above 3 or total cholesterol above 5, would be classed as high cholesterol, so clinicians work out a ‘QS’ score, deciding what the risk is, over a ten year period, of having a heart attack or stroke.

He says: “This would indicate whether we need to prescribe a statin, but the counter-argument is that if you have a total cholesterol of 7, and you’re relatively young, you eat really healthily and you do all the stuff you can to stay healthy and there’s nothing more you can do, we know your cholesterol is high and it’s going to be causing damage to your heart.

“There’s a better argument to say we should be treating the 25-year-old, before the 65-year-old, because cholesterol is cumulative and the longer you have it, the more damage it will do, so it’s not a cut off number, it’s supposed to be based on an algorithm of what your overall risk is.

“In reality, I think we should be far more aggressive in treating it than we are at the minute. Cardiovascular disease and heart attacks are the leading cause of death in men, and we still have this absolute aversion to giving patients statins, even though they work.

“Diabetes UK agrees, the British Heart Foundation also says we should be tackling cholesterol more aggressively, and we don’t because a few articles years ago said taking statins had side effects which made you feel unwell. But the new evidence is actually that they’re pretty well tolerated.”

Although it’s not something you might even consider if you’re a fit and healthy 20-something with no medical history whatsoever, you should still go and get checked or test yourself once every five years. After 35 if you have no other medical conditions, you should check every two to three years, and after the age of 40 he advises a check every year.

This also applies if you have a co-morbid problem like diabetes, which in theory means you should have a yearly check with the doctor, as diabetes, especially Type 2, is an independent factor for heart disease because sugars are not as well-regulated as a non-diabetic.

As well as statins, the UK has begun treating some NHS patients with a new injection which only has to be given twice a year. Inclisiran was approved for use in 2021 and is proven to cut levels of bad cholesterol by 50 per cent. NHS England says inclisiran, whose brand name is Leqvio, could prevent 55,000 heart attacks and strokes, with the potential to save 30,000 lives by 2031.

But as it currently stands only patients who are referred for medical reasons are likely to have access to the injections as it has a price tag of £1,700 per injection, compared to £1 for a month’s supply of the tablets.

• Dr Jeff Foster is an NHS and director of health at men’s health specialist Manual

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Follow this NHS advice for lowering your cholesterol

Eat less fatty food

To reduce your cholesterol, try to cut down on fatty food, especially food that contains a type of fat called saturated fat. You can still have foods that contain a healthier type of fat called unsaturated fat. Check labels on food to see what type of fat it has in it.

Try to eat more:

• oily fish, like mackerel and salmon
• olive oil, rapeseed oil and spreads made from these oils
• brown rice, wholegrain bread and wholewheat pasta
• nuts and seeds
• fruits and vegetables

Try to eat less:

• meat pies, sausages and fatty meat
• butter, lard and ghee
• cream and hard cheese, like cheddar
• cakes and biscuits
• food that contains coconut oil or palm oil

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Exercise more

Aim to do at least 150 minutes (2.5 hours) of exercise a week.

Some good things to try when starting out include:

• walking – try to walk fast enough so your heart starts beating faster
• swimming
• cycling

Try a few different exercises to find something you like doing. You're more likely to keep doing it if you enjoy it.

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Stop smoking

Smoking can raise your cholesterol and make you more likely to have serious problems like heart attacks, strokes and cancer.

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Cut down on alcohol

• avoid drinking more than 14 units of alcohol a week
• have several drink-free days each week
• avoid drinking lots of alcohol in a short time (binge drinking)

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Perhaps it's time to go plant based

If you're looking to change your diet to combat cholesterol, it might be time to ask yourself – could a plant-based diet really be the best way to stay healthy?