Hypercholesterolaemia

Hypercholesterolaemia means having higher-than-healthy levels of cholesterol in the blood. It often causes no noticeable symptoms, so many people discover it during a routine blood test. Over time, excess cholesterol can contribute to fatty deposits in artery walls and increase the risk of cardiovascular disease. It can affect adults and children, particularly when it runs in a family, but lifestyle and other health conditions can also play a role.

Diagnosis usually begins with a lipid profile, a blood test that measures total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. Testing may be arranged during a routine health assessment or because of a family history, another health condition or concerns about cardiovascular risk. Because raised cholesterol commonly causes no symptoms, a blood test is often the first indication that levels are high.

Interpreting the result and finding the cause

A clinician may repeat the test when appropriate and review your medical and family history, medicines, diet, activity levels and other lifestyle factors. They may examine you and assess for secondary causes, such as thyroid or kidney disease, before calculating your overall cardiovascular risk. This assessment helps determine whether the result may be inherited and what treatment or follow-up is suitable.

Inherited and acquired causes

More than one factor can contribute to hypercholesterolaemia. Clinicians may look for treatable secondary causes, while also considering whether an inherited lipid disorder is likely.

Having a risk factor does not guarantee that someone will develop hypercholesterolaemia. Several inherited, medical and lifestyle factors may act together, so an individual assessment is important.

Cholesterol-containing deposits can build up in artery walls, causing atherosclerosis and gradually restricting blood flow. This process may develop without symptoms for many years. If arteries become significantly narrowed or blocked, it can contribute to several cardiovascular complications.

Lifestyle measures

Medicines and follow-up

Statins are a common first-line treatment, and other cholesterol-lowering medicines may be used if a statin is not suitable, is not tolerated or does not lower cholesterol enough. Taking treatment as prescribed, attending follow-up and having repeat blood tests can help assess response and guide adjustments. People with suspected familial hypercholesterolaemia may need specialist assessment and may be offered additional treatment or family testing. Treatment intensity and targets are individualised according to cardiovascular risk, cholesterol results, other conditions, medicine tolerance and response.

A heart-healthy lifestyle can reduce the chance of acquired hypercholesterolaemia and support overall cardiovascular health. However, lifestyle changes cannot prevent inherited forms caused by genetic changes. People with inherited risk can still benefit from early testing and appropriate treatment.

Who may be offered testing?

Cholesterol testing may be offered during routine health assessments or when someone has risk factors, a family history of high cholesterol, diabetes or cardiovascular disease. Repeat testing depends on the results, treatment, age, other health conditions and local clinical guidance rather than one universal interval. Ask a healthcare professional when testing and follow-up are appropriate for you.

Hypercholesterolaemia is often manageable rather than rapidly progressive, but it usually requires ongoing attention. Cholesterol can rise again if lifestyle measures or prescribed treatment are stopped, so regular follow-up may be needed.

Lowering cholesterol and addressing other cardiovascular risk factors can reduce the likelihood of complications. The long-term outlook depends on the cause, response to treatment and whether artery disease is already present.