High cholesterol (dyslipidaemia)
An unfavourable balance of fats in the blood. It causes no symptoms whatsoever, and it is one of the main drivers of the arterial narrowing behind heart attacks and strokes.
When to seek urgent care
- High cholesterol itself is never an emergency and does not cause acute symptoms
- Chest pain, breathlessness or one-sided weakness are emergencies regardless of cholesterol level — call 108
- Severe upper abdominal pain with very high triglycerides needs urgent assessment for pancreatitis
Call 108 for an ambulance, or go straight to the nearest emergency department. Do not wait for a reply from this website.
What it is
Cholesterol is not a poison; the body needs it to build cell membranes and hormones. The problem is the balance and the amount carried in particular particles.
LDL cholesterol is the fraction that deposits in artery walls, and it is the number that matters most for cardiac risk. HDL carries cholesterol away and is protective. Triglycerides are a separate fat that rises with excess sugar, refined carbohydrate, alcohol and poorly controlled diabetes.
There is no target LDL that applies to everyone. The right level depends on overall risk. Someone who has already had a heart attack or a stent needs their LDL far lower than someone with no risk factors at all, because the consequences of further deposition are immediate rather than theoretical.
South Asians develop coronary disease at younger ages and at lower thresholds of conventional risk factors than many other populations, which is a good reason to check lipids earlier rather than waiting until later middle age.
The condition is entirely silent. A first heart attack is a common way for it to present, which is the whole argument for measuring it.
What people notice
- Nothing. High cholesterol produces no symptoms at any level
- Very rarely, in severe inherited forms: fatty deposits in the tendons, particularly the Achilles, or yellowish deposits around the eyelids
- A pale ring around the cornea in someone under 45 can indicate a familial lipid disorder
- In practice it is found by a blood test, or it is not found at all until an artery blocks
What contributes
- Genetics — familial hypercholesterolaemia is under-diagnosed and causes very high LDL from childhood
- Diet high in saturated and trans fats, and in refined carbohydrate for triglycerides
- Excess weight, particularly central
- Physical inactivity, which lowers protective HDL
- Diabetes and insulin resistance, which produce a characteristic pattern of high triglycerides and low HDL
- Hypothyroidism, which is a reversible cause worth excluding
- Kidney and liver disease
- Alcohol, which raises triglycerides markedly
- Some medications, including steroids and certain diuretics
How it is assessed
- A lipid profile — total cholesterol, LDL, HDL and triglycerides. Most modern guidance accepts a non-fasting sample for screening
- Interpretation against overall cardiovascular risk rather than against a single universal cut-off
- Thyroid function, blood sugar, HbA1c, kidney and liver function, to identify secondary causes
- Family history, specifically for heart disease or sudden death at a young age
- Examination for tendon and skin deposits where a familial disorder is suspected
- Assessment of other risk factors — blood pressure, smoking, diabetes — because they are treated together, not separately
How it is treated
- Dietary change focused on replacing saturated fat rather than simply eating less, and on cutting refined carbohydrate and alcohol where triglycerides are high
- Regular aerobic activity, which improves triglycerides and HDL
- Weight reduction where relevant
- Statin therapy, chosen and dosed according to overall risk — the evidence base for reducing heart attack and stroke is large and consistent
- Additional lipid-lowering agents where a statin alone does not reach target, or is not tolerated
- Specific treatment of high triglycerides where the level is high enough to risk pancreatitis
- Treating the associated conditions — blood pressure, diabetes, tobacco — since risk is multiplicative rather than additive
Muscle aches on a statin are worth reporting rather than quietly stopping the medicine. Most are manageable by changing the drug, the dose or the schedule.
Reducing the risk
- Have a lipid profile checked in your twenties or thirties if there is heart disease in the family, and periodically thereafter.
- Replace fried and processed food and vanaspati-type fats with nuts, whole grains, pulses and vegetables.
- Treat high triglycerides as a signal to look at sugar, refined carbohydrate and alcohol.
- If a parent or sibling had a heart attack young, ask specifically about familial hypercholesterolaemia — it is inherited and it is treatable.
The things people most often ask in the consulting room.
Discuss high cholesterol with a cardiologist
Bring your previous reports and current medicines. A consultation turns a general guide into an answer about you.
- Clinic
- 13, Ground Floor, M.K. Plaza, Hospital Road, near Madhav Dispensary
Gwalior 474001
Directions - OPD hours
- Monday to Saturday
12:30–2:30 pm, 5:30–6:30 pm
Closed Sunday - In an emergency
- Do not use this site. Call 108 for an ambulance or go to the nearest emergency department.