Half of UK adults have high cholesterol. Are you one of them?

What is cholesterol?

Cholesterol is a waxy, fat-like substance that your body relies on, but it's important that it stays at a healthy level.

Your body uses cholesterol to help build cells and make hormones (chemical messengers), bile salts (used to digest fats) and vitamin D. Your liver makes most of the cholesterol your body needs, but some also comes from animal foods (1).

Cholesterol travels through your blood in tiny particles made of fat and protein called lipoproteins (2). Two main types are:

LDL (low-density lipoprotein): often called 'bad' cholesterol. LDL carries cholesterol to your cells, but excess can build up in the walls of your blood vessels (2).

HDL (high-density lipoprotein): often called 'good' cholesterol. HDL carries excess cholesterol away from your blood and back to your liver, where it can be removed (2).

What is a healthy cholesterol level?

Cholesterol is measured in millimoles per litre (mmol/L). As a general guide, healthy levels for adults are:

• Total cholesterol (good and bad cholesterol together): below 5 mmol/L
• LDL cholesterol: below 3 mmol/L
• HDL cholesterol: above 1.0 mmol/L for men and 1.2 mmol/L for women

These numbers aren't fixed targets, and what's considered healthy for you may vary depending on your health and risk of heart disease (3).

Why does raised cholesterol matter?

Having too much of certain types of cholesterol (LDL) in your blood is a problem because it can lead to a build-up of fatty deposits called plaques. These can narrow your blood vessels, restricting blood flow. If a plaque breaks open, it can cause a blood clot, raising your risk of a heart attack or stroke (2).

Almost half of UK adults have raised cholesterol. High cholesterol usually has no symptoms, so you'll need a blood test to know what your levles are (1).

What can affect your cholesterol levels?

Several factors can play a part, including:

• Age: cholesterol levels can change as we get older. Raised cholesterol affects around 1 in 3 adults aged 16–34 in England, rising to around 7 in 10 among those aged 55–64 (4).
• Gender: men can develop raised cholesterol at a younger age (2).
• Menopause (5)
• Family history and genetics (1)
• Diet: particularly if it's high in saturated fat (1).
• Not being active enough (1)
• Smoking (1)
• Excess weight: particularly around your tummy (1).

Menopause and cholesterol

Oestrogen (a female sex hormone) helps protect heart health by regulating cholesterol and reducing the risk of fatty build-up in your arteries (a type of blood vessel). As oestrogen falls after menopause, cholesterol levels rise (5).

In England, around 6 in 10 women (aged 45–54) and two-thirds of women (aged 55–64) have raised total cholesterol (6).

If you've reached menopause, it's important to monitor your cholesterol, even if it's previously been at healthy levels.

What can I eat to help lower my cholesterol?

You don't need a special diet to help lower your cholesterol. A few simple swaps can make a signficiant difference.

1. Pick healthier fats: The type of fat you eat matters for your cholesterol, so try replacing some saturated fats with unsaturated fats. Here's how they compare (1,7):

All our meals are low in saturated fat, and we only use olive oil when cooking.

1. Get more soluble fibre to help lower LDL cholesterol. Oats, barley, fruit and vegetables are good sources. Try porridge for breakfast or add beans or lentils to soups, curries and salads (8). Looking to add more fibre? Check out our highest-fibre meals here.
2. Choose wholegrains. Brown rice, wholewheat pasta and wholegrain bread contain more fibre than refined versions (8).
3. Try swapping some red or processed meat for plant proteins, such as chickpeas, tofu or other soya foods during the week (1). Find more plant-based options in our veggie meals here.

Do I need to avoid foods that contain cholesterol?

For most people, this isn't necessary. That's because we tend to eat relatively little dietary cholesterol compared with saturated fat, which has a bigger impact on LDL cholesterol (9).

Some foods, such as prawns and eggs, are high in cholesterol but relatively low in saturated fat. Others, such as sausages, full-fat cheese, and butter, are high in both, so these are better eaten less often (9).

UK guidance does not set a specific limit on dietary cholesterol for most people. However, people with familial hypercholesterolaemia (FH) may be advised to limit dietary cholesterol(9). Your healthcare team can advise you further.

Are cholesterol-lowering products worth trying?

You may have seen spreads, milk and yogurt drinks with added plant sterols or stanols. These plant compounds reduce how much cholesterol is absorbed from your gut, helping to lower LDL cholesterol (10).

Research shows that having 1.5–3 g a day can lower LDL cholesterol by around 7–12.5%, with benefits seen within two to three weeks. For the best effect, have them with a main meal every day (10).

While the evidence for lowering LDL cholesterol is strong, we don't yet know whether these products reduce the risk of heart attack or stroke (11).

What other changes can help?

What you eat is only part of the picture, so here's some other lifestyle changes that can support healthy cholesterol levels:

• Stay active: Each week, aim for at least 150 minutes of moderate activity, such as brisk walking or cycling, or 75 minutes of more vigorous activity (7). A mix of aerobic and strength-based exercise can help improve your cholesterol profile (12).
• If you smoke, try to quit: Alongside raised cholesterol, smoking increases your risk of heart disease (2). For support with quitting smoking: NHS Quit Smoking
• Watch your alcohol intake: Drinking too much can raise triglycerides (another type of fat in your blood) (1). If you do drink, stay within low risk guidelines: no more than 14 units a week (around 6 x pints of average (4%)-strength beer or 6 x medium (175ml) glasses of average strength wine (13%) (7).

Lifestyle changes aren't always enough though. Depending on your cholesterol levels and other risk factors, your GP may recommend cholesterol-lowering medication (2).

Your next step: get your cholesterol checked

While you can't change factors such as your age or family history, your everyday choices still matter - and knowing your numbers is the first step.

How often you should get tested depends on your age:

• Ages 20–39: get checked every 4 to 6 years if you have low risk
• Ages 40–74: get checked every 5 years, such as through an NHS Health Check

If you're unsure when you last had a cholesterol test, it's worth speaking to your GP to request one.