Patient information
Cholesterol, heart health and statins
This leaflet explains what cholesterol is, how it affects your risk of heart attack and stroke, the everyday changes that help, and what to expect if you are offered a statin.
Your results
Name:
Total cholesterol: mmol/L HDL ("good"): mmol/L
Non-HDL ("bad"): mmol/L
Your 10-year risk of heart attack or stroke (QRISK):
Your goal:
Medicine:
Next blood test / review:
What is cholesterol?
Cholesterol is a fatty substance carried in your blood. Your body needs some, but too much of the wrong kind builds up in the walls of your arteries. Over time this narrows them and can lead to a heart attack, stroke or poor circulation in the legs.
- Non-HDL cholesterol (which includes LDL) is the "bad" cholesterol that clogs arteries. Lower is better.
- HDL cholesterol is the "good" cholesterol that helps clear cholesterol away.
High cholesterol does not usually cause symptoms, so a blood test is the only way to know. You do not need to fast before the test.
What is my risk score?
Your GP practice uses a calculator called QRISK to estimate your chance of having a heart attack or stroke in the next 10 years. It combines your age, sex, blood pressure, cholesterol, smoking, family history, ethnicity and other health conditions. A score of 10% means that, out of 100 people like you, about 10 would be expected to have a heart attack or stroke in the next 10 years. Some people, such as those with heart disease, kidney disease, type 1 diabetes or an inherited cholesterol condition, are already known to be at higher risk, so a score is not needed.
What can I do to lower my cholesterol and risk?
Healthy changes lower your risk whether or not you take a medicine. Start with one or two and build up.
1. Swap saturated fats for healthier fats
- Cut down on foods high in saturated fat: fatty and processed meats, butter, lard, ghee, cream, hard cheese, pastries, cakes, biscuits, and foods containing coconut or palm oil.
- Replace them with foods containing unsaturated fats: olive, rapeseed or sunflower oils and spreads, nuts, seeds and avocado.
- Grill, bake, steam or poach rather than fry, and choose lean meat and lower-fat dairy.
2. Eat a heart-healthy diet
- At least 5 portions of fruit and vegetables a day.
- Wholegrain bread, pasta, brown rice and oats, plus beans, lentils and pulses.
- At least 2 portions of fish a week, including one of oily fish such as salmon, mackerel or sardines (if you are pregnant, check the NHS advice on limits for oily fish).
- Cut down on sugar, sugary drinks and salt.
Foods and drinks with added plant stanols or sterols are not recommended to prevent heart disease, and you do not need supplements.
3. Be more active
Aim for at least 150 minutes of moderate activity a week, such as brisk walking, cycling or swimming, plus strengthening activities on 2 days. Any activity is better than none, so start slowly if you are not used to it. If you have a heart condition, ask your GP or nurse what is safe.
4. Keep to a healthy weight
Losing even a small amount of weight, if you need to, improves cholesterol and blood pressure. The free NHS Weight Loss Plan app and local weight management services can help.
5. Drink less alcohol
Keep to no more than 14 units a week, spread over 3 or more days, with several alcohol-free days. Heavy drinking raises cholesterol, triglycerides and blood pressure.
6. Stop smoking
Smoking damages artery walls and lowers your good cholesterol. Stopping is one of the best things you can do for your heart, and your risk starts to fall straight away. Free support from your local NHS Stop Smoking Service, GP practice or pharmacy makes you much more likely to succeed.
About statins
Statins lower the amount of cholesterol your liver makes. They reduce your risk of heart attack and stroke, and this benefit is well proven. The most common one offered is atorvastatin. Statins work best alongside lifestyle changes, not instead of them.
Taking your statin
- Take it once a day, every day, and keep taking it unless your doctor or pharmacist tells you otherwise. The benefit only lasts while you take it.
- Any statin, at any dose, lowers your risk, so if one does not suit you there are usually other options.
- Some medicines and supplements interact with statins, including some antibiotics. Tell anyone prescribing for you that you take a statin. Avoid drinking large amounts of grapefruit juice.
- If you are asked to pause your statin, for example while taking an antibiotic, remember to restart it afterwards.
Side effects
Most people take statins without problems. Some people get muscle aches, but in studies these were usually just as common in people taking a dummy tablet, so they are often not caused by the statin. Serious muscle damage is very rare. If you get aches, talk to us before stopping. We can check a blood test, try a break and restart, change the dose or switch to a different statin.
Statins can slightly raise blood sugar. This is not a reason to stop, because the heart benefits are much greater.
Blood tests
You will have a blood test for cholesterol and liver function about 2 to 3 months after starting or changing a statin, a liver test at 12 months, and a review at least once a year.
Pregnancy: statins must not be taken in pregnancy. If you could become pregnant, use reliable contraception. Stop your statin 3 months before trying for a baby, and do not restart it until you have finished breastfeeding. Tell your GP straight away if you become pregnant.
Other medicines
If your cholesterol does not fall enough, or you cannot take statins, other medicines may be offered. These include ezetimibe (a daily tablet), inclisiran (an injection usually given twice a year), bempedoic acid, or, for some people under specialist care, injections called PCSK9 inhibitors. Your clinician will talk you through what is suitable.
When to get help
Call 999 if you have chest pain, sudden weakness or numbness of the face, arm or leg, slurred speech or sudden confusion.
Contact your GP the same day, or call 111, if you have unexplained muscle pain, tenderness or weakness, especially if you also feel unwell, have a fever or your urine is dark. Also seek advice if you develop yellowing of the skin or eyes.
Where to find more help
- NHS – high cholesterol: nhs.uk/conditions/high-cholesterol
- NHS – statins: nhs.uk/conditions/statins
- NHS Better Health (eating, activity, weight, drinking, quitting): nhs.uk/better-health
- HEART UK – The Cholesterol Charity: heartuk.org.uk
- British Heart Foundation: bhf.org.uk
Based on NICE guideline NG238, Cardiovascular disease: risk assessment and reduction, including lipid modification, and NHS healthy living advice. This leaflet is general information and does not replace advice from your own healthcare team.