High Cholesterol


Cholesterol is a fatty substance which is made in the liver and is in every cell in your body. It can also be found in some foods. It has many important roles in how your body functions, especially your nerves, brain and skin.

Some of the roles cholesterol plays include:

·       Making up your cells (it’s in the outer layer of all your cells)

·       Making bile which helps to digest any fats you’ve eaten

·       Making vitamin D from sunlight and some hormones which can help to keep your teeth, muscles and bones healthy

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NOTE: This article/page uses the terms ‘male/man/men’ and/or ‘female/woman/women’. Please note, this is in reference to the sex assigned at birth.


Cholesterol is an important substance in our bodies. High levels of certain types of cholesterol can cause health problems, including problems for your heart. Knowing the different types of cholesterol, the causes of high cholesterol and how to reduce it (if it’s high) is important.

Having high cholesterol means you have too much cholesterol in your blood. You might have heard of the term “hypercholesterolaemia”. This word can be broken down to “hyper” which means too much, “cholesterol” which refers to cholesterol and “anaemia” which means in the blood. This term means too much cholesterol in the blood.

Having too much cholesterol can be damaging to your health, as it can block your blood vessels, leaving you more likely to have problems such as a heart attack or a stroke.

There are no symptoms of having high cholesterol. The only way to find out if you have it is to get tested.

There are several risk factors that can increase your risk of developing high cholesterol. Some of these you can control and some of them you can’t. Some of the things you can control are lifestyle factors.

Your lifestyle

Having a diet high in saturated fat can make it harder for your liver to remove cholesterol. This means that the cholesterol can build up in your blood. Not leading a very active lifestyle can cause the levels of “bad” cholesterol in your blood to rise. Being physically active can help you increase the level of “good” cholesterol and lower the levels of “bad” cholesterol in your blood. We’ll be talking you through the difference between the types of cholesterol later in the page.

Smoking can also cause high cholesterol levels as it causes tar to build up in your arteries. Tar is a sticky substance, so this can make it easier for cholesterol to build up in your blood and stick to your artery walls.

Just like there are things you can control, there are also risk factors you can’t control.

Your genes

Familial Hypercholesterolaemia (FH) is an inherited condition which can make your cholesterol levels extremely high. It can be passed down through families in your genes.

Having FH can mean that your cholesterol is higher than other people’s even if you lead a very healthy lifestyle. This is because it affects the way your body breaks down cholesterol.

How does Familial hypercholesterolaemia (FH) increase cholesterol?

If you have FH, it means you’ve inherited a ‘faulty’ or ‘altered’ gene that’s involved in removing cholesterol from your blood. This means that low-density lipoprotein (LDL) cholesterol, which is sometimes known as the bad cholesterol, can’t be removed from your blood quickly, so it builds up. You can learn more about LDL later in the “HDL vs LDL” section of the page.

Your biological sex, ethnicity & age

·       Age – as you get older, you have a higher chance of having higher cholesterol

·       Biological sex – if you were assigned male at birth, you’re more likely to have high cholesterol

·       Ethnicity – if your ethnic background is South Asian, you’re more likely to have high cholesterol

Your overall health

There are risk factors with your general health that can increase your risk of developing high cholesterol. These include:

·       Type 2 diabetes

·       Having an underactive thyroid (hypothyroidism)

·       Liver disease – if you have liver disease, your liver may struggle to clear cholesterol from your body, which can increase your risk of high cholesterol

·       Kidney disease – if you have kidney disease, your body may handle cholesterol differently, which can lead to high cholesterol

·       Being overweight, especially around your middle

·       Having a growth hormone deficiency 

High cholesterol doesn’t usually cause any symptoms. The only way to find out if you have it is by getting a blood test.

In some cases, your GP might think your cholesterol is high. This could be due to:
·       Your age

·       Your weight

·       If you have another condition, like high blood pressure or diabetes

If your GP thinks your cholesterol levels could be high, they might suggest that you have a blood test.

You can also ask your GP surgery or pharmacy for a cholesterol test, for example, if you haven’t had your cholesterol tested before and:
·       You’re over the age of 40

·       You’re overweight

·       High cholesterol runs in your family

·       Heart problems run in your family

Cholesterol can be tested in two ways. Having your cholesterol tested can give you a good indication of your heart health

A finger prick test

During this test, your finger is pricked and a drop of blood is put on a strip of paper. A machine can then check your cholesterol within a few minutes.

A finger prick test can be done during an NHS Health Check. If you’re aged between 40 and 74 and you don’t have any pre-existing health conditions, you should be invited to an NHS Health Check by your GP or local council every five years. Some pharmacies also offer NHS Health Checks.

Taking blood

Your cholesterol can be tested by taking blood from your arm with a needle. This can then be sent to a lab to be checked. Results are usually available in a few days. In some cases, you might be asked not to eat anything for up to 12 hours before your test. If this is needed, your doctor or nurse will let you know.

If your tests come back showing that you have high cholesterol, your doctor or nurse will talk to you about how you can help reduce it. There’ll be more on reducing your cholesterol levels in the “How can I reduce my cholesterol?” section of the page.

Your doctor or nurse might also calculate your risk of having a heart attack or stroke in the next 10 years. This is done using your:

·       Cholesterol levels

·       Blood pressure

·       Weight

·       Height

·       Age

·       Ethnicity

·       Sex

Lowering your cholesterol can help to reduce your risk of having a heart attack or stroke.

Boots also sells home self-test kits which can give an indication of your cholesterol levels.

What should my cholesterol be?

Your ideal cholesterol level depends on things like your age and if you have other health conditions like diabetes or cardiovascular disease.

Your doctor or nurse can tell you what your cholesterol level should be, but as a guide:

The medical term for “good” cholesterol is high-density lipoprotein (HDL) and “bad” cholesterol is low-density lipoprotein (LDL) and non-HDL cholesterol.

HDL cholesterol is key for keeping healthy. It helps to remove fat from the walls of your arteries which can lower your risk of cardiovascular disease. However, if you have too much HDL, it can lose its protective effects.

HDL cholesterol can help protect you against cardiovascular disease as:

·       It can remove excess cholesterol from your blood vessels

·       It’s anti-inflammatory so it can help protect the artery walls against LDL cholesterol

·       It has an antioxidant effect so it can help protect your cells from being broken down

LDL cholesterol carries cholesterol to cells that need it. It’s known as “bad” cholesterol as if there’s too much cholesterol in the blood, it can build up in the walls of your arteries. This can cause heart problems later.

Non-HDL cholesterol includes your total cholesterol minus your HDL cholesterol. This means that it’s all the ‘bad’ cholesterol added together (including your LDL cholesterol). This should be as low as possible.

Even though HDL cholesterol has protective properties and too much LDL cholesterol is harmful, high HDL cholesterol can’t offset high LDL cholesterol, so it’s important to keep your cholesterol levels under control.

If you’re at risk of having high cholesterol or you have high cholesterol, there are things you can do to help reduce it.

You can start making changes today by:
·       Lowering the amount of saturated fat in your diet

·       Getting active and exercising more

·       If you smoke, quit smoking

·       Reducing your alcohol intake, if you drink

For more tips, you can take a look at our advice for reducing your cholesterol at home.

In some cases, your doctor might also prescribe a medicine for you to take. For example if:
·       Your cholesterol level hasn’t lowered after lifestyle changes like changing your diet

·       You have a high risk of having a heart attack or stroke

You can manage your repeat prescriptions with the Boots Online Prescription Service31If you’re over 40, live in England and want more ways to look after your health, you could be eligible for our Free Health MOT at Boots service11.

The Free Health MOT includes the NHS Blood Pressure Check Service with an optional BMI and waist circumference measurement. It can help with lifestyle guidance – some of which can help you lower your cholesterol levels like tips for exercise, nutrition and stopping smoking.

Having a thyroid disorder can mean that your thyroid is producing too much or too little thyroid hormones. This can affect the cholesterol levels in your blood.

One of your thyroid’s jobs is to make hormones that help your liver process and remove extra LDL cholesterol from your body. If you have an underactive thyroid (hypothyroidism), your thyroid doesn’t produce enough of the T3 hormone.

The T3 hormone encourages cholesterol to be broken down. As this is reduced, your body isn’t able to remove and break down cholesterol properly, which can cause higher levels in your blood.

In some cases, people with an overactive thyroid (hyperthyroidism) can have lower cholesterol levels. This hasn’t been seen to cause any health concerns yet. 

There are usually no symptoms of high cholesterol but in some cases, there may be visible signs of high cholesterol, some of which can be seen in the eye.


Xanthelasma is the most common eye symptom. They are yellow patches on your eyelids which are sometimes caused by having high cholesterol which can build up under the skin. Xanthelasmas don’t usually affect your vision.

Xanthelasmas are more common in women who have an Asian or Mediterranean background.

You’re more likely to develop xanthelasmas if you:

·       Are overweight

·       Smoke

·       Have diabetes

·       Have high blood pressure

Arcus senilis

Arcus senilis happens when a blue, white or light grey ring forms around the outside of the front of your eye. It usually starts as an arc and may become a ring.

The ring can show around the coloured part of your eye (the iris). It doesn’t usually affect your ability to see.

Not everyone who has arcus senilis has high cholesterol, but you’re more likely to develop it if you have a family history of high cholesterol.

Hollenhorst plaque

Hollenhorst plaques happen when the blood vessels in your eye get blocked. They can cause damage to your eye, including problems with your vision.

The blockages are made up of sticky substances like cholesterol and fat. As the plaque builds up, your arteries become narrow and hard. Hollenhorst plaques can be created if plaque from another part of your body breaks free and this can block blood vessels in your retina.

They usually develop over time so don’t usually have any symptoms that you notice. It’s difficult to know if you have a Hollenhorst plaque until damage has been caused. The best way to help prevent them is to keep your cholesterol and blood pressure levels under control.

If you spot any changes or have any concerns about your vision, it’s important to speak to your GP or opticians. They can take a look at your eyes and refer you for further investigations if there are any changes.


Anyone can develop high cholesterol even if you’re young, eat a healthy diet and exercise. This is because high cholesterol can be caused by different things. You can learn more about this in the “What causes high cholesterol?” section of the page.

As high cholesterol doesn’t usually cause any symptoms, you can only know if you have high cholesterol from having your blood tested. You can find out more in the “How do I test my cholesterol levels?” section of the page. 

Statins are a prescribed group of medicines. They’re given to help reduce the amount of cholesterol your body makes. There are different types of statins available in the UK. Your GP may prescribe statins for you depending on your medical history and the cholesterol level they want you to be at. 

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The language surrounding sex, gender, and sexuality is always evolving, and different people have different views on the words that should be used. Therefore, we only mention sex, gender or sexuality when it's relevant, such as when providing our customers with the correct health information and treatment they need. We try to follow the NHS guidance for healthcare providers. You can find that here.

Page last reviewed by Boots Pharmacy team on 17/01/2024