High cholesterol (dyslipidaemia)

Overview

Cholesterol is a waxy, fat-like substance made mostly by the liver. The body needs a little of it to build cells, make hormones and digest fat. It travels in the blood in small packages. LDL cholesterol is often called bad cholesterol because extra LDL is laid down in the walls of the arteries (the tubes that carry blood from the heart). HDL cholesterol is called good cholesterol because higher levels are linked with a lower risk of heart disease. Triglycerides are another type of blood fat that the body uses for energy. Dyslipidaemia means any unhealthy pattern of these fats: high LDL, high total cholesterol, high triglycerides or low HDL.

High cholesterol does not make you feel ill. Over many years the extra fat builds up into plaques (fatty lumps) that narrow and harden the arteries. This is called atherosclerosis. It reduces blood flow to the heart, brain and legs, and a plaque can break open and form a clot that causes a heart attack or stroke.

The only way to know your level is a blood test called a lipid profile. Doctors do not look at cholesterol on its own. They combine it with your age, blood pressure, smoking, diabetes and family history to work out your overall risk of heart disease. A healthy diet, regular activity and not smoking help everyone. Many people also need a statin, a well-studied medicine that lowers LDL cholesterol and protects the heart.

Symptoms

• Usually no symptoms at all; most people only find out from a blood test
• Fatty lumps or deposits in the skin or around tendons (xanthomas), which a doctor may look for during an examination, especially in inherited high cholesterol
• Chest pain or tightness on effort (angina), when narrowed arteries cannot bring enough blood to the heart
• Pain or cramping in the legs when walking, from narrowed leg arteries (peripheral artery disease)
• In some people the first sign is a heart attack or stroke, which is why testing before symptoms matters

Causes and risk factors

Causes

• Lifestyle: a diet high in saturated fat (ghee, butter, fatty meat, fried and processed food) and trans fats, too little physical activity, being overweight, smoking and drinking alcohol
• Inherited (genetic) causes: some families pass on genes that raise cholesterol from a young age, such as familial hypercholesterolaemia; most high cholesterol comes from many genes acting together with lifestyle
• Other illnesses (secondary causes): type 2 diabetes that is not well controlled, an underactive thyroid (hypothyroidism), chronic kidney disease, nephrotic syndrome (a kidney disorder that leaks protein into the urine), liver disease and polycystic ovary syndrome
• Some medicines, including steroid tablets, some water tablets (thiazide diuretics), beta-blockers, hormone birth control pills, some antidepressants and some HIV medicines
• Pregnancy and other states that raise female hormone levels

What makes it more likely

• Getting older, especially after the age of 50
• Being a man, or being a woman after the menopause
• South Asian family origin, which includes people from Pakistan
• A parent, brother or sister with high cholesterol or early heart disease
• Being overweight or carrying extra fat around the waist
• A diet high in saturated and trans fats, and little physical activity
• Smoking and drinking alcohol
• Type 2 diabetes

Complications

The main danger of high cholesterol is atherosclerosis, the slow build-up of fatty plaques inside artery walls. Narrowed arteries to the heart cause coronary artery disease, with angina (chest pain) and heart attacks. If a plaque breaks open, a blood clot can form on it and suddenly block the artery, causing a heart attack or, in the brain, a stroke. Narrowed leg arteries cause peripheral artery disease, with pain on walking and poor healing. Fatty damage can also weaken an artery wall so that it bulges (an aneurysm). Heart disease and stroke are leading causes of death worldwide. People with inherited high cholesterol often have very high levels that are harder to control, and they can develop heart disease at a young age.

Diagnosis

High cholesterol is found with a blood test called a lipid profile (lipid panel). It measures total cholesterol, HDL cholesterol and triglycerides, and from these the lab works out LDL and non-HDL cholesterol (all the cholesterol except HDL). UK guidance says you do not need to fast before the test, but some labs and doctors still ask for an overnight fast, so check with yours. Adults with normal results are usually retested every few years, and more often if they have diabetes, kidney disease or heart disease.

A single number does not decide treatment. Your doctor estimates your chance of having a heart attack or stroke over the next ten years using a risk calculator, such as QRISK3 in the UK or SCORE in Europe, which adds in your age, sex, blood pressure, smoking, diabetes and family history. People who already have heart disease, type 1 diabetes, kidney disease or inherited high cholesterol are treated as high risk without a calculator. Before starting treatment, blood tests for sugar (HbA1c), kidney and liver function, and thyroid function look for other causes. Very high results, or a strong family history of early heart disease, lead to referral to a specialist to check for familial hypercholesterolaemia.

Treatment

1. Your doctor first checks your overall heart risk and treats any other cause, such as poorly controlled diabetes, an underactive thyroid, kidney or liver disease, or heavy drinking.
2. Everyone starts with lifestyle changes: eat less saturated fat, be active, lose weight if needed, stop smoking and keep alcohol low or avoid it.
3. A statin is offered to all people who already have heart disease, a stroke or narrowed leg arteries, whatever their cholesterol level. It is also offered to people without heart disease whose risk of a heart attack or stroke in the next ten years is high (10% or more under UK guidance). Your doctor decides which statin and the dose; a stronger (high-intensity) statin is usually preferred.
4. A repeat lipid profile and a liver blood test are done about two to three months after starting or changing treatment. The usual aim is to lower non-HDL cholesterol by more than 40% for prevention, or to bring LDL cholesterol to 2.0 mmol/L or lower if you already have heart disease. European guidance sets lower goals for the highest-risk people, such as LDL below 55 milligrams per decilitre (mg/dL).
5. If the target is not reached, your doctor first checks that the tablets are being taken regularly, then may raise the statin strength or add ezetimibe. Specialists can add newer treatments such as PCSK9 inhibitor injections, inclisiran or bempedoic acid for people at very high risk.
6. If a statin causes side effects, do not simply stop. Your doctor can pause and restart it, switch to a different statin or lower the strength; ezetimibe is the usual choice for people who truly cannot take any statin.
7. Treatment is usually lifelong. Expect a medicine review every year, with a repeat lipid test, and keep up the healthy lifestyle alongside the tablets.

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): ezetimibe (on its own), bempedoic acid, alirocumab and evolocumab (PCSK9 inhibitor injections, specialist use), inclisiran (injection, specialist use), icosapent ethyl (a purified fish-oil medicine for some high-risk people with raised triglycerides)

Self-care and prevention

Self-care

• Cut down on saturated fat: use less ghee, butter, cream, fatty meat, fried snacks and bakery items
• Cook with unsaturated oils such as olive oil or canola (rapeseed) oil instead of ghee or banaspati
• Eat plenty of vegetables, fruit, whole grains, lentils and beans, and choose low-fat dairy
• Be active most days with aerobic exercise such as brisk walking, plus muscle-strengthening activity, and sit less
• Lose weight if you are overweight; it improves cholesterol and blood pressure together
• Stop smoking and all tobacco, and avoid alcohol or keep it low
• Take your statin regularly as prescribed, attend blood tests, and report any muscle pain rather than stopping on your own
• Do not rely on fish-oil capsules, plant sterol products or herbal remedies to protect your heart; guidelines do not recommend them for this

Prevention

• Eat a diet low in saturated and trans fats and rich in vegetables, fruit and whole grains
• Stay physically active and keep a healthy weight
• Do not smoke, and avoid alcohol
• Have a cholesterol test as an adult and repeat it as your doctor advises; test earlier and more often if heart disease or high cholesterol runs in your family
• Keep diabetes, blood pressure and thyroid problems well controlled

Common questions

What cholesterol level is normal?

In general, total cholesterol below 200 milligrams per decilitre (mg/dL), LDL around 100 or lower, triglycerides below 150, and HDL of at least 40 in men and 50 in women are considered healthy. Your own target depends on your heart risk, so people with heart disease or diabetes are usually given a lower LDL goal. Ask your doctor what your target is.

Do I need to fast before a cholesterol test?

UK guidance says fasting is not needed for a routine lipid profile. Some labs and doctors still ask for an overnight fast, especially when triglycerides are high or need to be rechecked. Follow the instructions of your doctor or lab.

Are statins safe? I have heard they cause muscle pain.

Statins are among the most studied medicines and reduce the risk of heart attack and stroke. Muscle aches can happen, but serious muscle damage is extremely rare, and many aches turn out to have another cause. If you get muscle pain, tell your doctor; they can check a blood test and change the statin or its strength instead of stopping protection altogether.

Can I stop my statin once my cholesterol is normal?

No, not without speaking to your doctor. Your cholesterol is normal because the statin is working, and it usually rises again when the medicine stops. Most people take a statin long term, with a yearly review.

Do fish-oil capsules lower my heart risk?

Guidelines do not recommend ordinary fish-oil supplements to prevent heart disease, and they should not be used instead of a statin. A purified prescription form called icosapent ethyl is an exception for some high-risk people with raised triglycerides who are already on a statin; your doctor decides whether it suits you.

Sources

1. NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238) (2023).
2. ESC/EAS. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias (2025).
3. ACC. 2019 ESC/EAS Guidelines for Management of Dyslipidemias - American College of Cardiology (2019).
4. CDC. About Cholesterol | Cholesterol | CDC (2024).
5. NHS. High cholesterol - NHS (2026).
6. MedlinePlus. High blood cholesterol levels: MedlinePlus Medical Encyclopedia (2026).
7. StatPearls (NCBI Bookshelf). Hyperlipidemia - StatPearls - NCBI Bookshelf (2023).
8. Pakistan Journal of Medical Sciences. Pattern of dyslipidemia and associated factors in coronary artery disease patients in Khyber Pakhtunkhwa: A cross-sectional secondary data analysis (2023).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

Related conditions

Coronary artery disease (angina)StrokeHigh blood pressure (hypertension)Type 2 diabetes mellitusUnderactive thyroid (hypothyroidism)

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