At Queen Camel the Metabolic & Lipid Clinic, our multidisciplinary team is dedicated to helping you manage cholesterol and reduce your risk of heart disease.
Understanding Cholesterol
Cholesterol is a fatty substance your body needs to build cells and make hormones. But too much LDL (“bad”) cholesterol in the blood can increase your risk of heart disease, while HDL (“good”) cholesterol helps protect your heart.
Cholesterol types in the blood:
- LDL cholesterol (“bad” cholesterol): Increases the build-up of fatty deposits in the arteries
- HDL cholesterol (“good” cholesterol): Helps remove cholesterol from the blood and protects against heart disease
Does High Cholesterol Cause Symptoms?
Most people with high cholesterol have no symptoms. Rarely, visible signs may appear:
- Yellow fatty deposits around the eyes (xanthelasma)
- Fatty lumps under the skin (xanthomas)
These signs are uncommon and usually linked to inherited cholesterol conditions.
Why Do Some People Have High Cholesterol?
Everyone develops some fatty build-up in blood vessels over time, but certain factors increase the risk:
Lifestyle factors (can be changed):
- Unhealthy diet (high in saturated fat, sugar, and salt)
- Physical inactivity
- Smoking
- Excess alcohol
- Overweight or obesity
Medical factors (treatable):
- High blood pressure
- Diabetes
- Kidney disease
- Underactive thyroid
Fixed risk factors (cannot be changed):
- Strong family history of early heart disease
- Age
- Male sex
- Early menopause
- South Asian ethnic background
If you have fixed risk factors, addressing lifestyle factors becomes even more important.
Primary vs Secondary Prevention of Heart Disease
What is the difference?
| Feature | Primary Prevention | Secondary Prevention |
| Goal | Prevent first heart attack or stroke | Prevent repeat heart attacks, strokes, or complications |
| Who it’s for | People without cardiovascular disease but with QRISK2 score is greater than 10% | People who have already had a heart attack, stroke, or other cardiovascular events |
| Approach | Lifestyle changes + medication if needed | Stricter lifestyle changes + medication to lower cholesterol aggressively |
| Cholesterol targets | ≥40% reduction in non-HDL cholesterol, or non-HDL <2.5 mmol/L | LDL <2.0 mmol/L (or lower depending on risk) |
What’s my risk
We can calculate your QRISK2 score, which estimates your chance of having a heart attack or stroke in the next 10 years.
Understanding Your Risk
- Low risk: <10% → less than 1 in 10 chance of heart attack/stroke in 10 years
- Moderate risk: 10–20% → 1–2 in 10 chance
- High risk: >20% → 2 or more in 10 chance
NICE recommends offering preventive treatment (lifestyle support or statins) for anyone with a QRISK2 score above 10%.
Managing Cholesterol – Lifestyle First
Lowering cholesterol significantly reduces the risk of heart attack and stroke. Treatment usually combines lifestyle changes with medication if needed.
Heart-Healthy Habits
- Be active – aim for 150 minutes of moderate exercise/week
- Stop smoking
- Eat a healthy, balanced diet
- Maintain a healthy weight (BMI 20–25)
- Limit alcohol to under 14 units/week
Diet and Cholesterol
Foods that can worsen cholesterol:
- Fatty and processed meats
- Butter, cream, full-fat dairy
- Coconut and palm oil
- Cakes, biscuits, pastries, chocolate
- White bread, white rice, white pasta
- Sugary drinks, crisps, sweets
Foods such as eggs, shellfish, and offal contain dietary cholesterol but are low in saturated fat and can be eaten in moderation.
Foods that help lower cholesterol:
- Replace saturated fats with unsaturated fats
- Increase fibre intake
Choose more:
- Olive, rapeseed, or sunflower oil
- Nuts, seeds, avocado
- Oily fish (2 portions/week)
- Fruit and vegetables (≥5 portions/day)
- Wholegrains, oats, lentils, beans, chickpeas
Medications
Statins
- How they work: Block an enzyme needed to make cholesterol and help remove cholesterol from the blood
- Common types: Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin, Simvastatin
- Use: Reduce LDL cholesterol and cardiovascular risk
- Effectiveness: High-intensity statins (atorvastatin 20–80 mg) can reduce LDL by ≥40%
- Side effects: Usually minor – headache, tummy upset, muscle aches. Rare: severe muscle damage or liver effects
Ezetimibe
- How it works: Reduces cholesterol absorption from the gut, increases liver clearance of LDL
- Use: Once-daily tablet, often added if statins alone aren’t enough. Reduces LDL by ~25%
- Side effects: Rare, mild abdominal discomfort or diarrhoea
Bempedoic Acid
- How it works: Boosts liver’s removal of LDL cholesterol
- Use: Added if statins and ezetimibe are insufficient or not tolerated. Reduces LDL by ~30%
- Side effects: Rare; possible muscle/joint pain, anaemia, constipation, gout
Inclisiran
- How it works: Twice-yearly injection reducing LDL by ~50%
- Use: High-risk patients not reaching LDL targets with statins, or those who cannot tolerate statins
- Side effects: Mild injection-site reactions; systemic effects are rare
Frequently Asked Questions (FAQ)
- What is cholesterol?
Cholesterol is a fatty substance your body needs for building cells, making hormones, and supporting metabolism. LDL (“bad”) cholesterol can increase heart disease risk, while HDL (“good”) cholesterol helps protect your heart.
- How do I know if my cholesterol is high?
- Most people have no symptoms. Occasionally, inherited cholesterol conditions may cause:
- Yellow deposits around the eyes (xanthelasma)
- Fatty lumps under the skin (xanthomas)
The only reliable way to know is a blood test.
- How quickly will cholesterol improve?
- Lifestyle changes: improvements usually appear in a few months
- Medications (statins, ezetimibe, inclisiran): changes are usually measurable within 8–12 weeks
- Do statins cause memory loss or other serious side effects?
- Memory loss: No proven link
- Common mild side effects: headache, tummy upset, muscle aches
- Rare serious effects: severe muscle damage or liver problems
Most people tolerate statins well.
- What is inclisiran and how is it different from statins?
- A twice-yearly injection that lowers LDL by ~50%
- Used for patients not reaching cholesterol targets on statins or who cannot tolerate statins
- Side effects are usually mild and limited to injection-site reactions
- Are there alternatives to statins?
- Yes, if statins aren’t enough or not tolerated:
- Ezetimibe: reduces cholesterol absorption (~25% LDL reduction)
- Bempedoic acid: boosts liver clearance of LDL (~30% reduction)
- Do my family members need testing?
Some forms of high cholesterol are inherited. Relatives may need testing, particularly if:
- Your cholesterol is very high
- You have a strong family history of early heart disease
- Do I still need treatment if I feel fine?
- High cholesterol usually causes no symptoms, but it still increases your risk of heart attack, stroke, and other cardiovascular disease.
- Isn’t diet enough to manage cholesterol?
- Diet and lifestyle are essential first steps, but some people—especially those at higher risk—may also need medication to reach target cholesterol levels.
- Is all cholesterol harmful?
- HDL cholesterol is protective, while LDL cholesterol contributes to artery blockages. Both types have important roles in the body.
- HDL cholesterol is protective; not all cholesterol is harmful.
✅ Sources & References:
- NICE guidelines: Cardiovascular disease prevention and lipid management
- British Heart Foundation: Diet, cholesterol, and heart health
- European Society of Cardiology/European Atherosclerosis Society Guidelines 2019–2021
- Clinical Knowledge Summaries (CKS): Cardiovascular risk assessment and lipid management
