High Cholesterol (Hypercholesterolaemia)
Cholesterol is a fatty substance produced naturally by the liver and obtained from certain foods. It is essential to the body — needed for building cell membranes, producing hormones, and making vitamin D — but when levels in the blood become elevated, it can silently accumulate in the walls of arteries, leading to atherosclerosis and significantly increasing the risk of heart attack and stroke.
Understanding cholesterol types
Cholesterol travels through the bloodstream bound to proteins, forming particles called lipoproteins. Low-density lipoprotein (LDL) — often called "bad" cholesterol — carries cholesterol to cells but can deposit it in artery walls if levels are too high. High-density lipoprotein (HDL) — "good" cholesterol — scavenges cholesterol from the arteries and returns it to the liver for disposal. Total cholesterol, LDL, HDL, and triglycerides are all measured in a standard lipid panel. Most guidelines focus particularly on LDL as the primary treatment target.
Causes
In the majority of people, raised cholesterol results from a diet high in saturated and trans fats, physical inactivity, obesity, and excessive alcohol consumption. In others, there is a significant genetic component. Familial hypercholesterolaemia (FH) is an inherited condition — affecting approximately 1 in 250 people — in which LDL cholesterol is substantially elevated from birth, leading to premature cardiovascular disease if untreated. Secondary causes include hypothyroidism, type 2 diabetes, kidney disease, and certain medications.
Symptoms and detection
High cholesterol itself causes no symptoms and is detected only through a blood test. In people with severe or longstanding hypercholesterolaemia, cholesterol deposits can form visible fatty lumps under the skin (xanthomas) or around the eyes (xanthelasma), or create a pale arc around the cornea (arcus cornealis) — but these signs are not universal.
Treatment
Lifestyle modification is the first-line approach for most people: reducing saturated fat intake, increasing soluble fibre (found in oats, pulses, and fruit), increasing physical activity, losing excess weight, and stopping smoking. When lifestyle changes are insufficient, statins — which inhibit the liver's production of cholesterol — are the most widely prescribed and extensively evidenced medication. Other options include ezetimibe, PCSK9 inhibitors, and fibrates depending on the individual's lipid profile and cardiovascular risk.
Choosing where to be treated
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