Clinical cardiology
High Cholesterol (Dyslipidemia)
- Consultation & follow-up
Cholesterol and other blood fats (lipids) play a central role in the build-up of plaque in the arteries. Lowering “bad” LDL cholesterol reduces the risk of heart attack and stroke, and the right target depends on your overall cardiovascular risk.
At a glance
- LDL cholesterol is the main treatment target
- Targets are lower for people at higher risk
- Lp(a) should be measured at least once in adulthood
- Lifestyle changes plus medicines such as statins when needed
What is cholesterol?
Cholesterol is a fat carried in the blood by particles called lipoproteins. Too much LDL cholesterol leads to plaque building up in the artery walls (atherosclerosis), which can narrow the arteries and trigger heart attacks and strokes.
Understanding your lipid profile
- LDL cholesterol: the main target of treatment
- HDL cholesterol: often called “good” cholesterol
- Triglycerides: another blood fat, affected by diet, weight, alcohol and diabetes
- Non-HDL cholesterol: total cholesterol minus HDL
- Lipoprotein(a), or Lp(a): largely inherited. European guidance recommends measuring it at least once in every adult’s lifetime.
Dr. Qureshi explains · YouTube
Whats cholesterol? کولیسٹرول کیا ہے
Video · 1:23 · Watch on YouTube
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Who should be checked?
Adults should have their cholesterol checked as part of a cardiovascular risk assessment. It is especially important, and may need to be done earlier, if you have a family history of early heart disease or of very high cholesterol, or if you have diabetes, high blood pressure or kidney disease, or smoke.
Lifestyle and medicines
Healthy eating (less saturated and trans fat, more fibre, vegetables, pulses and whole grains), regular physical activity, a healthy weight and not smoking all help. Statins are the first-line medicine for lowering LDL cholesterol. Others, such as ezetimibe or PCSK9 inhibitors, may be added when needed. Do not stop statins without advice, as side effects can usually be managed.
Targets depend on your risk
European guidelines set LDL cholesterol targets according to your overall risk. For people at very high risk, for example those with established coronary artery disease, the target is an LDL below 1.4 mmol/L (55 mg/dL) together with at least a 50% reduction from the starting level. Your own target will be explained at your consultation.
Questions patients ask
My cholesterol is normal. Can I still have heart disease?
Yes. Cholesterol is one of several risk factors. Smoking, diabetes, high blood pressure, family history and Lp(a) also matter, which is why overall risk is assessed.
Do I need to fast before a cholesterol test?
Non-fasting samples are generally acceptable for routine testing. Your doctor may ask for a fasting sample in some cases, for example if your triglycerides are high.
Will I need statins for life?
Usually the benefit continues only while you take them. Discuss any concerns with your cardiologist rather than stopping on your own.
References
- Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 2020;41:111–188. doi.org/10.1093/eurheartj/ehz455 (opens in a new tab)
- Mach F, Koskinas KC, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 2025;46:4359–4378. doi.org/10.1093/eurheartj/ehaf190 (opens in a new tab)
- Kronenberg F, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43:3925–3946. doi.org/10.1093/eurheartj/ehac361 (opens in a new tab)
This page is general information about the condition or procedure, not personal medical advice. Whether a test or treatment is right for you is decided at your consultation. Medical disclaimer.
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