Total cholesterol alone tells you very little. The breakdown and your overall risk are what matter.
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Cholesterol is essential — it builds cell membranes and hormones. The problem is the balance, and specifically LDL, which deposits in artery walls.
A single total cholesterol number is close to meaningless on its own. What matters is the breakdown, the ratio, and how it combines with your age, blood pressure, smoking status and family history to produce an actual risk figure.
None. Raised cholesterol produces no symptoms whatsoever until it causes a cardiovascular event.
The exception is familial hypercholesterolaemia, an inherited condition affecting roughly 1 in 250 people, which can cause visible signs — fatty deposits around the eyes or in tendons — and carries very high risk from a young age.
Total cholesterol on its own is close to meaningless. What matters is the breakdown:
Non-fasting samples are acceptable for routine lipid testing and are what UK guidance now uses.
Where triglycerides are markedly raised, a fasting repeat is worth doing — those move most with recent eating.
Treatment depends on your ten-year cardiovascular risk, not on cholesterol alone. That calculation combines age, sex, blood pressure, smoking, diabetes, weight, ethnicity and family history.
Two people with identical cholesterol can have very different risks and therefore very different advice. A cholesterol result without a risk score is half an answer.
Thyroid function — an underactive thyroid raises cholesterol, and treating it can resolve the problem without a statin. This is missed regularly.
HbA1c, kidney and liver function, all of which affect the decision.
Familial hypercholesterolaemia affects roughly 1 in 250 people and is substantially underdiagnosed. Very high cholesterol from a young age, or relatives with heart attacks before 60, warrants specialist assessment — free on the NHS, and it matters for your children too.
Lipoprotein(a) is largely genetic, not measured in standard testing, and worth considering where family history is strong.
A full lipid profile gives total, LDL, HDL, non-HDL and triglycerides. Where family history is strong, an extended panel adding lipoprotein(a) is worth considering — Lp(a) is largely genetic and is not measured in standard testing.
Your results review includes a formal ten-year risk calculation, because the treatment decision depends on overall risk rather than the cholesterol number alone. Thyroid function is checked, since an underactive thyroid raises cholesterol and treating it can resolve the problem.
Cholesterol itself is not an emergency. Its consequences are.
Call 999 for chest pain or tightness, particularly with breathlessness, sweating or pain spreading to the arm or jaw.
Stopping smoking. It does relatively little to cholesterol and a great deal to the risk cholesterol is being treated to reduce.
These do work — the fortified spreads and drinks lower LDL modestly and measurably.
They are also expensive for the effect, and they do not replace a statin where one is indicated.
The NHS Health Check, free every five years from 40 to 74, includes cholesterol, blood pressure and a cardiovascular risk score — which is most of what a paid panel gives you.
NHS care for cholesterol is free and thorough — the lipid profile, the QRISK cardiovascular assessment, statins as very cheap generics, and monitoring. The NHS Health Check for people aged 40 to 74 is free and includes all of this, and is worth taking up when offered.
The most useful point is that the cholesterol number on its own means very little. Treatment decisions are based on overall cardiovascular risk — QRISK3 — which combines cholesterol with age, blood pressure, smoking, diabetes, family history and other factors. A raised cholesterol in a low-risk 35-year-old and the same figure in a 65-year-old smoker are entirely different situations.
That is why buying a private cholesterol test in isolation rarely helps. The number without the risk calculation cannot be acted on sensibly, and QRISK is free and takes two minutes.
Where a private consultation genuinely earns its fee is having the statin conversation properly — absolute rather than relative risk, what the evidence actually shows about muscle symptoms, and what happens if you do nothing. That conversation is regularly rushed, and it is why a great many people stop statins without discussing it.
The one thing worth flagging: very high cholesterol, particularly alongside a family history of heart disease before the age of 60, may be familial hypercholesterolaemia — an inherited condition that is substantially under-diagnosed in the UK. It warrants NHS lipid clinic referral and testing of close relatives, since each first-degree relative has a one in two chance of carrying it.
NICE NG238, Cardiovascular disease: risk assessment and reduction, including lipid modification, is the governing guideline. It recommends using QRISK3 to estimate 10-year cardiovascular risk and offering atorvastatin 20mg for primary prevention where risk is 10% or above.
NG238 recommends statins be considered even below that threshold where informed preference and clinical judgement support it, and sets out a target of more than 40% reduction in non-HDL cholesterol.
NG238 covers secondary prevention with atorvastatin 80mg, and the addition of ezetimibe, and NICE technology appraisals cover inclisiran and PCSK9 inhibitors through specialist services.
NICE CG71, Familial hypercholesterolaemia, recommends suspecting FH where total cholesterol is above 7.5 mmol/L with a family history of premature coronary disease, and offering specialist assessment and cascade testing of relatives.
NG238 also addresses statin muscle symptoms, recommending discussion and re-challenge rather than automatic discontinuation.
It depends on your overall risk, not on the number. A ten-year cardiovascular risk score is what decides it.
Someone with moderately raised cholesterol and no other risk factors may need nothing. Someone with the same result who smokes and has high blood pressure may benefit substantially.
Usually no. Non-fasting samples are acceptable for routine lipid testing.
A fasting repeat is worth doing if triglycerides come back markedly raised, since those are most affected by recent eating.
They are among the best-studied medicines in use, and serious side effects are rare.
Muscle aches are the common complaint — and in blinded trials, most people who report them on a statin report them on placebo too. That does not mean the ache is imagined; it means the statin is often not the cause.
Where symptoms are genuine, switching statin or lowering the dose usually resolves them. Stopping without saying anything is the outcome worth avoiding.
Cholesterol is substantially genetic. Diet influences it, but it does not determine it.
Very high levels in someone with a good diet raise the question of familial hypercholesterolaemia, which affects around 1 in 250 people and is badly underdiagnosed.
An underactive thyroid, which is common and easily checked. Treating it can normalise cholesterol without any lipid medication at all.
Also poorly controlled diabetes, kidney disease, and some medications.
Total cholesterol minus HDL — so it captures all the harmful fractions in one figure.
UK practice now favours it over LDL because it does not require fasting and reflects risk slightly better.
Higher HDL is associated with lower risk, but raising it with medication has not been shown to help.
Treat the LDL and non-HDL — that is where the benefit lies.
If familial hypercholesterolaemia is suspected or confirmed in you, yes. It is inherited, and identifying it early changes outcomes considerably.
NHS genetic and lipid clinics do this free, and testing relatives is a routine part of the pathway.
August 23, 2026
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Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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