High cholesterol

Also called Hyperlipidaemia, Familial hypercholesterolaemia

No symptoms, and one of the largest preventable causes of heart attack and stroke. Statins are the most argued-about safe drug there is.

What it is

Around half of adults in England have raised cholesterol. It causes no symptoms whatsoever until it causes a heart attack or a stroke.

Cholesterol itself is essential. The problem is the balance: LDL carries cholesterol into artery walls, HDL carries it away, and persistently high LDL drives the fatty plaques that narrow arteries.

Familial hypercholesterolaemia deserves separate mention. It is an inherited condition affecting around 1 in 250 people, causing very high cholesterol from birth and heart disease decades early. Most people who have it in the UK are undiagnosed, and finding one case should trigger testing of the whole family.

Statins have been the subject of more public argument than almost any medicine. The evidence base is very large and it is clear: they substantially reduce heart attacks and strokes, and serious side effects are rare.

Signs you might notice

Nothing at all, in almost every case.

In familial hypercholesterolaemia: fatty deposits around the eyes, in the tendons of the hands or the Achilles tendon, and a pale ring around the iris in someone under 45.

A family history of heart attack or stroke before 60 is itself a sign worth acting on.

How it can affect day-to-day life

Adherence is the problem, and it is entirely understandable: a daily tablet, for no symptom, to prevent something that might not happen.

Muscle aches are the commonest reported side effect, and trials suggest most muscle symptoms on statins are not caused by them. That does not mean somebody's aches are imaginary; it means a proper trial of stopping and restarting, or switching statin, is worth doing rather than abandoning treatment.

Diet helps but rarely enough on its own for people at high risk, and framing it as a personal failure when diet does not fix it is both wrong and demotivating.

Supporting someone well

Know your numbers. Ask for the total, the LDL and the QRISK score, and ask what the target is.

Take the statin daily and attach it to an existing habit.

If muscle aches occur, discuss switching or reducing rather than stopping altogether.

Look at the family. Very high cholesterol, or early heart disease in relatives, means the whole family should be tested.

Reduce saturated fat, increase fibre, move regularly, and stop smoking. All of these work; they work alongside medication rather than instead of it.

Get an NHS Health Check if you are 40 to 74 and have not had one in five years.

Where to get help

A GP or practice nurse; many pharmacies also test.

HEART UK run a helpline and specialise in familial hypercholesterolaemia.

Chest pain or stroke symptoms are emergencies regardless of cholesterol.