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  • What is a healthy Cholesterol level?

    You should be aiming for:

    • Total cholesterol level of less than 5 (mmol/L)
    • LDL cholesterol level of less than 3 (mmol/L)
    • HDL cholesterol level of greater than 1 (mmol/L)

    The most important measurement is the 'bad' LDL cholesterol. You should always aim to keep this below 3 mmol/L, even if your total cholesterol is above the recommended limits.

    It is often useful to keep a track of your cholesterol levels every time they are tested so you can see the progress you are making. 


  • What Cholesterol levels are considered to be high?

    Blood cholesterol is measured in units of millimoles per litre of blood (mmol/L). In healthy adults, the total cholesterol level should be 5 mmol/L or less. For those at high risk of developing arterial disease, a total cholesterol level of 4 mmol/L or less is recommended.


    As a general guideline, a healthy adult should have an LDL level of no more than 3 mmol/L, while those at high risk should keep their LDL level to 2 mmol/L or less.


    An ideal HDL level is recommended to be above 1 mmol/L. If the HDL level is any lower than that, then there could be an increase in the risk of heart disease.


    You can also calculate the ratio of total cholesterol to HDL by dividing your total cholesterol level by your HDL level. Generally, this ratio should be below four, as a higher ratio means increased risk for heart disease.

  • What are HDL and LDL?

    Cholesterol is a fat-like substance that travels in your bloodstream. They are carried by little particles called lipoproteins that are made up of fats and protein. There are two types of lipoprotein: HDL and LDL.


    • High-density lipoprotein (HDL) removes harmful cholesterol from the cells and transports it to the liver for processing. From there, the cholesterol gets removed from the body by either getting broken down or passed out as a waste product. For this reason, HDL is often called "good cholesterol" and higher levels are better.


    • Low-density lipoprotein (LDL) transport cholesterol from the liver to the cells where it is needed. If there is too much LDL in the blood, there will be excess cholesterol and it can build up in the arteries. This could then lead to arterial disease. For this reason, LDL is often called the "bad cholesterol".


    HDL and LDL levels can both be measured with a blood test. The recommended cholesterol levels in the blood vary depending on whether the person is at high risk of developing arterial disease.

  • Why treat high Cholesterol?

    Research has proven that people with high cholesterol are at higher risk for an array of medical conditions, including:

    • Heart attack 
    • Stroke 
    • The narrowing or furring of the arteries, medically known as atherosclerosis
    • Peripheral arterial disease
    • Stroke

    Cholesterol can build up in the artery wall. Too much build-up will eventually restrict blood flow to the brain, heart, and the rest of your body. This increases the chances of a blood clot developing in the body.

    The risk of developing coronary heart disease also increases with higher cholesterol levels. This can cause pain in your chest or arm (known as angina) during physical activity or when stressed.

  • What risk factors increase the chance of having high Cholesterol?

    Your lifestyle choices play a big role in whether you become at risk for developing high blood cholesterol, including:

    • An unhealthy diet: We have all heard that some foods (such as eggs, liver, and kidneys) contain cholesterol and need to be eaten in moderation. But these kinds of dietary cholesterol actually make little impact on blood cholesterol levels. Instead, it is more important to control the total amount of saturated fat in your diet.
    • Obesity:Those who are overweight are more likely to have higher levels of LDL cholesterol and triglycerides, and lower levels of HDL, or “good cholesterol”.
    • Lack of physical activity or exercise:Living a sedentary lifestyle can increase your level of LDL or "bad cholesterol". 
    • Smoking: Cigarettes contain a chemical called Acrolein that prevents the HDL from taking cholesterol to the liver for removal out of the body. This causes the arteries to narrow, a condition known as atherosclerosis, which leads to heart disease.
    • Excessive alcohol usage: Regular and extreme alcohol consumption can increase your cholesterol and triglyceride levels.

    People with high blood pressure (hypertension) and diabetes often have high cholesterol as well. Other medical conditions that can also cause cholesterol levels to increase include liver disease, kidney disease, and an underactive thyroid gland (hypothyroidism).

    There are also a number of “fixed factors” associated with high cholesterol that increases your likelihood of having a heart attack or stroke. These are factors that cannot be changed. They include: 

    • A family history of early coronary heart disease (CHD) or stroke: If you have a close male relative (father or brother) under 55 or a female relative (mother or sister) under 65 who has had CHD or a stroke, you are also more likely to have high cholesterol.
    • A family history of a cholesterol-related condition: A genetic disorder called familial hypercholesterolaemia causes high levels of LDL cholesterol even in someone who leads a healthy lifestyle. If you have a parent or sibling with this condition, you are also more at risk.
    • Age: There is an increased risk of atherosclerosis (the narrowing of arteries) as we get older.
    • Gender: Statistics have shown that men are more likely to develop heart disease than women.
    • Ethnicity: People of Indian, Pakistani, Sri Lankan and Bangladeshi descent are at higher risk for heart attack.

    If any (or maybe several) of the above-fixed risk factors apply to you, it is even more important to assess your lifestyle and evaluate any underlying conditions you may have.

  • How do you choose the right medication for you?

    High cholesterol can only be correctly diagnosed through a blood test. Upon a diagnosis, your doctor will be able to determine an appropriate medication depending on your personal circumstances. If at any time, you feel that the medication is not right for you, it is important to discuss it with your doctor so he can prescribe a more suitable treatment.

  • I’ve read a lot of negative articles about Statins in the news, are they as bad as they are made out to be?

    Statins are one of the most widely reported medicines in the news and have acquired fairly bad reputation with the public.

    Statins are one of the most widely used groups of medicines in the UK. It is generally considered that the risk of side effects is far outweighed by the benefits they offer in reducing cholesterol levels and therefore the risk of heart and circulatory problems. 

    As with any medicine, there will always be a minority of people who have a bad reaction or side effects from statins. It is important to read your information leaflet carefully when you start your treatment and be aware of any effects that may need to be reported to your doctor. It is important to have blood tests 6-12 monthly whilst taking statins to test their effectiveness and for any adverse effects.

  • What are Statins?

    Statins are a type of medication prescribed to high cholesterol patients. Statins work by blocking the enzyme in your liver that helps produce cholesterol. Eventually, this will lower the total blood cholesterol level. The most common statin prescribed is Atorvastatin. Other statins include Simvastatin and Rosuvastatin.

    Statins are safe to use, however, some people will find that they have an intolerance to this medication, which will then produce some side effects. Common side effects include muscle pain, headaches, and a range of stomach issues, from indigestion to constipation and/or diarrhea.

    Statins need to be taken for life, so they will only be prescribed to people who are at extremely high risk of heart disease. As soon as a patient stops taking a statin, cholesterol levels will start to increase again.

  • How will I know if my Statins are working?

    With cholesterol-lowering medications, you won’t feel any different, so it is even more important to remember to take it every day and routinely follow up with your doctor or nurse. You will need to have a blood test to measure your cholesterol levels to check if your treatment is effective or not.

  • Will I need to take Statins for the rest of my life?

    You will likely need to take statins on a long-term basis. If you stop taking your cholesterol medication, it’s likely your cholesterol level will rise.

    There is a chance that you will be able to come off statins, or at least reduce your dose, if you make significant lifestyles changes to help reduce your cholesterol naturally.

  • How long will Statins take to work?

    It takes several weeks of taking a statin before your doctor can see a change in your cholesterol levels. Your doctor will monitor your cholesterol (to see if your treatment is effective) and your liver function (to make sure your aren’t experiencing any unnoticed side effects). You will not notice any difference as your cholesterol lowers; it is important to continue to take your medicine and take steps to lower cholesterol anyway.

  • How often do I need to take Statins?

    Typically, you take one statin tablet per day as directed by your doctor.

    The body manufactures more cholesterol at night than during the day, taking statins in the evening meal or at night is usually allows them to be most effective. Lipitor (atorvastatin), Crestor (rosuvastatin) and Lipostat (pravastatin) are longer acting statins and can be taken at anytime of the day.

  • What should I do if I miss a dose of my Statin?

    If a dose is missed, you can take it as soon as your remember if it is on the same day. Don't double up the next day; just take your usual dose as normal.

    If you do miss a dose of your statin, there is no need to worry. Cholesterol levels are a long-term measure and will not drastically change with an occasional missed dose. That said, you should try to take your treatment regularly to keep your condition well managed and give you the best chance possible of achieving a healthy cholesterol level.

  • What’s the difference between the different types of Statins?

    Currently, five statins are available in the UK. Listed below are the five different types, with their brand names in brackets.

    All these statins can be taken during any time of day, with the exception of Simvastatin, which is only recommended to be taken at night right before sleeping.

  • What is Ezetimibe?

    Ezetimibe is another medication commonly prescribed for the treatment of high cholesterol. Usually, the cholesterol present in your intestines (from food and bile juices) will get absorbed into your blood. Ezetimibe works by blocking this absorption of cholesterol. Generally, it is not as effective as statins, but it is less likely to cause side effects.

    Ezetimibe can be safely taken at the same time you typically take your statin if you find that the statin alone does not keep your cholesterol at the desired low level. When taken in this combination, the side effects are generally the same as if taking statin on its own (stomach problems and muscle pain).

    Some people are unable to take a statin for whatever reason (maybe you experience side effects, are using other medications that conflict with a statin, or are diagnosed with a different medical condition), so in that case, ezetimibe is another option and can be taken on its own. Ezetimibe taken by itself rarely causes any undesirable side effects.

  • Can I have grapefruit or grapefruit juice with my Cholesterol tablets?

    Do not drink grapefruit juice if you are taking simvastatin. Grapefruit juice increases the level of simvastatin in your blood and makes side effects more likely.

    Atorvastatin interacts with grapefruit juice if you drink large quantities, but an occasional glass is thought to be safe.

    It is safe to drink grapefruit juice and eat grapefruit if you're taking other types of statins.

Authored By:

A photo of Dr Donald Grant

Dr Donald Grant

MB ChB DRCOG MRCGP Dip.orth.med

Published on: 29-05-2019

Last modified on: 29-05-2019

Dr Don Grant is a GP with over 30 years experience and is the Clinical Advisor at The Independent Pharmacy

Reviewed By:

A photo of  Andy Boysan

Andy Boysan


Reviewed on: 29-05-2019

Next review date: 29-05-2021

Andy is a co-founder, the superintendent pharmacist and director at The Independent Pharmacy.

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