Management of hypercholesterolaemia

Hypercholesterolaemia, or high cholesterol, is a common condition that increases the risk of heart disease, stroke and other cardiovascular problems. Because it often causes no symptoms, many people are unaware they have it until it is picked up during a routine blood test. Understanding how to manage cholesterol levels effectively can make a significant difference to long-term heart health.

What is hypercholesterolaemia?

Cholesterol is a fatty substance produced by the liver and obtained from food. It is essential for hormone production, vitamin D synthesis and building healthy cells. However, when cholesterol levels become too high, fatty deposits can build up inside blood vessels, leading to atherosclerosis (hardening and narrowing of the arteries).

A blood test measures two main types of cholesterol:

Low-density lipoprotein (LDL): Often called “bad” cholesterol because it contributes to plaque formation.
High-density lipoprotein (HDL): Known as “good” cholesterol, as it helps remove excess cholesterol from the bloodstream.

An imbalance, with too much LDL and too little HDL, increases cardiovascular risk.

What causes high cholesterol?

Hypercholesterolaemia may be due to:

Dietary habits: Eating too much saturated or trans fat
Lifestyle factors: Lack of exercise, smoking, excess alcohol or being overweight
Medical conditions: Diabetes, kidney or liver disease, and underactive thyroid
Genetics: Familial hypercholesterolaemia is an inherited form that causes very high LDL levels from birth

Identifying the cause helps guide treatment.

How can lifestyle changes help?

For many people, simple lifestyle adjustments can significantly improve cholesterol levels:

Eat a heart-healthy diet: Focus on fruit, vegetables, whole grains, lean protein, oily fish and healthy fats such as olive oil or nuts.
Reduce saturated fat: Cut back on fatty cuts of meat, butter, cream and processed foods.
Increase fibre: Foods like oats, beans and lentils help lower LDL cholesterol.
Exercise regularly: Aim for at least 150 minutes of moderate activity per week.
Maintain a healthy weight: Losing excess weight can improve lipid balance.
Stop smoking: Smoking lowers HDL and damages blood vessels.

What treatments are available?

When lifestyle measures are not enough, or if cholesterol levels are very high, medication may be recommended:

Statins: The most commonly prescribed drugs, which reduce the liver’s production of cholesterol.
Ezetimibe: Lowers absorption of cholesterol from food.
PCSK9 inhibitors: Injectable treatments for people with very high cholesterol or who cannot tolerate statins.
Bempedoic acid and fibrates: Other options for selected patients.

Treatment is tailored to individual risk factors, including family history and other medical conditions.

Why is regular monitoring important?

Managing cholesterol is a lifelong commitment. Regular blood tests help track progress and ensure treatment remains effective. By combining healthy lifestyle habits with medication where necessary, most people can keep their cholesterol at safe levels and significantly reduce their risk of cardiovascular disease.