My cholesterol is high on a blood test – what should I do next
Zohaib Iqbal
8/15/20269 min read
My cholesterol is high on a blood test – what should I do next?
Being told that your cholesterol is high can be worrying, particularly if you feel well, eat reasonably healthily and were not expecting an abnormal result.
The first thing to know is that a high cholesterol result does not automatically mean that you have heart disease, nor does it necessarily mean that you need medication. However, it is worth understanding properly rather than simply looking at whether your result has been marked in red on a blood test.
High cholesterol usually causes no symptoms. Its importance lies in the fact that, over many years, certain cholesterol-containing particles can contribute to the build-up of fatty deposits within arteries and increase the risk of cardiovascular disease, including heart attack and stroke.
What matters is not simply whether your total cholesterol is high. We need to understand which components of your cholesterol profile are raised, how high they are, why they are raised, and what they mean in the context of your overall cardiovascular risk.
So, if you have recently received an abnormal cholesterol result, here is how I would approach it.
1. Don't panic – but don't ignore it
For most people, an unexpectedly high cholesterol result is not an emergency.
Cholesterol-related cardiovascular disease develops over many years, which means there is usually time to assess the result properly and decide what, if anything, needs to be done.
At the same time, it is worth taking an abnormal result seriously. The higher your levels are, and the longer you are exposed to elevated levels of cholesterol-containing particles, the more important it becomes to understand the reason for them and whether treatment is appropriate.
This is particularly important if you have other cardiovascular risk factors, established heart or vascular disease, or a family history of heart attacks or strokes occurring at a young age.
2. What does “high cholesterol” actually mean?
A standard cholesterol blood test usually contains several measurements.
Total cholesterol
This is the overall amount of cholesterol measured within your blood.
The NHS gives a general guide of below 5 mmol/L for total cholesterol in healthy adults.
However, total cholesterol on its own is a relatively crude measurement. Two people can have exactly the same total cholesterol but quite different cardiovascular risk.
LDL cholesterol
LDL stands for low-density lipoprotein.
LDL particles transport cholesterol around the circulation. When concentrations of LDL particles are persistently elevated, more cholesterol can enter the arterial wall and contribute to atherosclerosis.
For this reason, LDL cholesterol is often referred to as “bad cholesterol”, although in specialist practice it is more useful to think of LDL as one of several atherogenic, or artery-damaging, particles.
HDL cholesterol
HDL stands for high-density lipoprotein and is commonly described as “good cholesterol”.
A relatively high HDL level can contribute substantially to your total cholesterol measurement, which is one reason that interpreting total cholesterol alone can be misleading.
Non-HDL cholesterol
Non-HDL cholesterol is calculated by subtracting HDL cholesterol from your total cholesterol.
It therefore captures cholesterol contained within several potentially atherogenic particles, not just LDL.
The NHS gives a general healthy reference level of below 4 mmol/L for non-HDL cholesterol.
Triglycerides
Triglycerides are another type of fat carried within the bloodstream.
They can be increased for different reasons from LDL cholesterol, including excess weight, insulin resistance, poorly controlled diabetes, alcohol intake and some genetic conditions.
This distinction matters.
A person with a total cholesterol of 6.5 mmol/L and a high HDL level may have a very different lipid profile from somebody with the same total cholesterol but markedly elevated LDL cholesterol.
The laboratory flag beside your cholesterol result is therefore only the beginning of the interpretation, not the end of it.
3. My cholesterol is 6, 7 or 8 mmol/L – should I be worried?
This is one of the most common questions people ask after seeing their results.
Unfortunately, total cholesterol alone cannot answer it.
A total cholesterol of 6 mmol/L does not carry exactly the same significance in everybody, and a cholesterol of 7 or 8 mmol/L needs to be interpreted alongside:
LDL cholesterol
HDL cholesterol
non-HDL cholesterol
triglycerides
your age
blood pressure
smoking status
diabetes and kidney disease
previous cardiovascular disease
your family history
and sometimes additional measurements such as apolipoprotein B and lipoprotein(a).
As cholesterol levels become more markedly elevated, however, the possibility of an underlying genetic cause becomes increasingly important.
4. Could my high cholesterol be inherited?
Yes.
One of the most important causes of markedly elevated LDL cholesterol is familial hypercholesterolaemia, usually abbreviated to FH.
FH is an inherited condition in which LDL cholesterol is elevated from a young age. Because cardiovascular risk relates partly to cumulative exposure to LDL cholesterol over a lifetime, identifying FH is important both for the individual and potentially for other family members.
An LDL cholesterol above 4.9 mmol/L in an adult forms part of the Simon Broome diagnostic criteria used when assessing for familial hypercholesterolaemia. However, a single LDL result above this level does not, by itself, prove that somebody has FH; family history and other clinical information also matter.
Features that should particularly raise the possibility of inherited high cholesterol include:
very high LDL cholesterol
high cholesterol from a relatively young age
a parent, brother or sister with very high cholesterol
heart attacks or coronary disease occurring unusually young within the family
several family members requiring cholesterol treatment.
If FH is diagnosed, assessment of relatives can also become important. NICE guidance specifically includes family tracing, known as cascade testing, as part of the management of familial hypercholesterolaemia.
5. I eat healthily – so why is my cholesterol high?
This is another common source of frustration.
Diet certainly influences cholesterol, but cholesterol levels are not determined by diet alone.
Your liver plays a major role in cholesterol metabolism, and genetics can have a substantial influence on your LDL level. Some people can therefore lead very healthy lifestyles and still have significantly elevated cholesterol.
There are also medical conditions that can alter the lipid profile.
Depending on the pattern of the abnormality, it may be appropriate to consider causes such as:
an underactive thyroid
diabetes or insulin resistance
kidney disease
certain liver or biliary conditions
excess alcohol consumption
obesity or metabolic syndrome
and certain medications.
This is one reason I prefer to approach an abnormal cholesterol result by asking “Why is this person's cholesterol high?”, rather than immediately moving to the question of which medication to prescribe.
Sometimes there is an important underlying explanation that needs addressing.
6. Do I need another blood test?
Sometimes.
Whether the cholesterol profile should be repeated depends on the circumstances in which it was measured and how abnormal it was.
Most people do not need to fast before a routine cholesterol blood test, although fasting measurements can occasionally be useful, particularly where triglycerides are significantly elevated.
Depending upon your individual circumstances, further blood tests might include:
a repeat lipid profile
thyroid function
HbA1c or glucose to look for diabetes
liver function
kidney function
apolipoprotein B
lipoprotein(a).
Not everybody requires every test.
The point is to investigate selectively according to the pattern of the lipid abnormality and the person's overall clinical picture.
7. What is apolipoprotein B, and do I need it measured?
Apolipoprotein B, usually abbreviated to ApoB, is a protein found on the surface of the major atherogenic particles circulating in the blood.
In simple terms, ApoB can provide information about the number of potentially harmful cholesterol-containing particles, rather than simply measuring how much cholesterol they happen to contain.
For many people, a conventional lipid profile provides enough information to make sensible treatment decisions.
However, ApoB can sometimes be particularly helpful when the lipid profile is more complex, for example where triglycerides are elevated or there is metabolic disease.
8. Should I have my lipoprotein(a) checked?
This is increasingly important.
Lipoprotein(a), or Lp(a), is an inherited cardiovascular risk factor that is not measured as part of a standard cholesterol profile.
This means that you can have a relatively ordinary-looking cholesterol result but still have a markedly elevated Lp(a).
Conversely, somebody undergoing investigation for high cholesterol may benefit from knowing whether raised Lp(a) is contributing additional cardiovascular risk.
Lp(a) levels are largely genetically determined, and high levels are associated with increased cardiovascular risk.
Because it is mostly determined by your genes and generally remains relatively stable throughout adult life, Lp(a) does not usually need to be measured repeatedly.
For people with markedly raised cholesterol, premature cardiovascular disease, a strong family history or otherwise unexplained cardiovascular risk, knowing the Lp(a) level can be particularly informative.
9. Does high cholesterol mean I need to take a statin?
Not necessarily.
This is where cholesterol management becomes more individualised.
For somebody who has never had cardiovascular disease, the decision to use medication is generally based on more than the cholesterol result alone. UK guidance recommends assessing overall cardiovascular risk alongside lipid levels and other clinical factors when considering lipid-lowering treatment for primary prevention.
The discussion can be quite different if you:
have already suffered a heart attack or stroke
have coronary or other arterial disease
have diabetes or significant chronic kidney disease
have familial hypercholesterolaemia
or have particularly severe hypercholesterolaemia.
In these circumstances, lowering LDL cholesterol may be particularly important.
The right question is therefore not simply:
“Is my cholesterol above the normal range?”
It is:
“How much is lowering my cholesterol likely to reduce my personal cardiovascular risk?”
That is a much more useful basis for deciding whether treatment is worthwhile.
10. What if I don't want to take a statin?
It is reasonable to want to understand why a medication is being recommended before deciding whether to take it.
A discussion about cholesterol treatment should ideally consider:
your current cardiovascular risk
how much that risk might be reduced by treatment
how high your LDL or non-HDL cholesterol is
whether you have evidence of cardiovascular disease
your family history
your preferences
and the potential advantages and disadvantages of treatment.
For many people, statins are the first-line cholesterol-lowering treatment and have extensive evidence supporting their ability to reduce cardiovascular events.
But they are not the only cholesterol-lowering medicines available.
If somebody genuinely cannot tolerate an appropriate statin regimen, or does not achieve adequate cholesterol lowering despite treatment, other therapies can sometimes be considered.
The important thing is not simply to abandon treatment after experiencing symptoms with one statin without first reassessing what happened and what alternatives are available.
11. Can I lower my cholesterol naturally?
For many people, lifestyle measures form an important part of cholesterol management whether or not medication is also needed.
These include:
reducing saturated fat intake
replacing some saturated fats with unsaturated fats
maintaining a healthy weight
exercising regularly
avoiding smoking
moderating alcohol intake
improving diabetes control where relevant.
These measures can improve both cholesterol levels and cardiovascular health more broadly.
However, it is important not to assume that somebody with very high cholesterol has caused it through their lifestyle.
People with strongly genetically determined hypercholesterolaemia may have high LDL cholesterol despite an excellent diet, normal weight and high levels of physical activity.
Lifestyle and genetics are not competing explanations for high cholesterol. For many people, both contribute.
12. What cholesterol level should I aim for?
There is no single cholesterol target that is appropriate for everybody.
Someone who is young, otherwise healthy and at very low cardiovascular risk may be managed very differently from somebody who has already suffered a heart attack.
Similarly, somebody with familial hypercholesterolaemia may require a different approach from somebody whose cholesterol is mildly elevated as part of metabolic syndrome.
This is why laboratory “normal ranges” should not be mistaken for personalised treatment targets.
Your appropriate target depends upon your underlying level of cardiovascular risk and the reason that treatment is being considered.
13. When should I consider seeing a lipid specialist?
Many straightforward cholesterol abnormalities can be managed extremely well by your GP.
Specialist assessment can, however, be particularly helpful when the diagnosis or treatment is less straightforward.
You may benefit from a lipid specialist assessment if:
your LDL cholesterol is markedly elevated
you have been told that you may have familial hypercholesterolaemia
you have a strong family history of premature heart attack or stroke
your lipoprotein(a) is elevated
your cholesterol remains high despite treatment
you have experienced possible statin side effects
you have tried several cholesterol-lowering treatments without success
both your cholesterol and triglycerides are significantly elevated
you have developed cardiovascular disease despite apparently reasonable cholesterol levels
you are unsure whether you personally stand to benefit from medication
or you would simply like a more detailed assessment of your lipid profile and cardiovascular risk.
What should I do next?
If you have just discovered that your cholesterol is high, a sensible approach is:
First, look at the complete lipid profile rather than the total cholesterol alone.
Then consider whether there might be an explanation for the abnormality, including your family history, lifestyle, medications and relevant medical conditions.
Next, consider your overall cardiovascular risk rather than asking whether your cholesterol result is simply inside or outside a laboratory reference range.
Finally, decide whether lifestyle measures alone are appropriate or whether cholesterol-lowering treatment is likely to provide worthwhile additional protection.
For many people, this assessment is relatively straightforward.
For others — particularly those with very high LDL cholesterol, suspected familial hypercholesterolaemia, elevated lipoprotein(a), previous cardiovascular disease, complex lipid profiles or difficulties tolerating treatment — a more detailed specialist assessment can be useful.
Would you like a specialist review of your cholesterol results?
At The Lipid Clinic, we provide specialist online assessment for adults with high cholesterol and other lipid disorders.
Our approach is to look beyond an isolated cholesterol number and consider your complete lipid profile, medical history, family history and cardiovascular risk before making recommendations about further investigation or treatment.
The clinic commonly assesses people with:
high LDL cholesterol
possible or confirmed familial hypercholesterolaemia
elevated lipoprotein(a)
statin intolerance
cholesterol that remains elevated despite treatment
mixed cholesterol and triglyceride disorders
uncertainty about whether cholesterol-lowering treatment is appropriate.
Consultations are carried out online and, where appropriate, a detailed clinic letter and management plan can be provided for you and your GP.
This article provides general medical information and is not a substitute for individual medical advice. If you have symptoms such as new or severe chest pain, breathlessness or symptoms suggestive of a stroke, seek urgent medical attention rather than waiting for a cholesterol assessment.
Written by Dr Zohaib Iqbal, Consultant Endocrinologist & Specialist in Lipidology
The Lipid Clinic
Last reviewed: August 2026
Contact
GMC Registered | NHS Consultant Endocrinologist
For Patients
© 2026. All rights reserved.
For Healthcare Professionals
Book a Consultation
Refer a Patient
