Hypercholesterolaemia

Key facts

• Hypercholesterolaemia means LDL cholesterol in the blood is persistently high enough to raise the risk of coronary artery disease, heart attack and stroke. Most people have no symptoms, so it is usually found on a routine fasting lipid panel.
• Genetics, diet, physical inactivity, obesity and type 2 diabetes all contribute. Familial hypercholesterolaemia, an inherited form, produces very high LDL from early life and carries a substantially elevated lifetime risk if untreated.
• Statins are first-line treatment: atorvastatin and rosuvastatin are high-potency options, while simvastatin and pitavastatin suit moderate-risk profiles. Ezetimibe can be added when statins alone are not enough.
• Diet and exercise changes reduce the dose of medicine needed and improve outcomes on top of it.

Why cholesterol becomes a problem

Cholesterol itself is essential, but excess LDL particles deposit in artery walls and gradually narrow them. There are usually no symptoms until a serious event occurs, which is why the condition is most often picked up on a routine blood test. A fasting lipid panel, measuring total cholesterol, LDL, HDL and triglycerides, remains the standard way to confirm the diagnosis.

Medicines used to lower LDL

Statins are the backbone of cholesterol management. They block the enzyme the liver uses to make cholesterol, cutting LDL by roughly 30 to 55 percent depending on the agent and dose. Atorvastatin and rosuvastatin are high-potency statins used when larger reductions are needed, while simvastatin and pitavastatin suit moderate-risk profiles.

When statins alone are not enough, ezetimibe can be added; it blocks cholesterol absorption in the gut rather than production in the liver, and the two mechanisms together lower LDL more than either alone. Colestyramine is a bile acid sequestrant sometimes used for people who cannot tolerate statins.

Lifestyle changes that help

Diet and medicine work best together. Cutting saturated fat, increasing soluble fibre (oats, legumes, vegetables) and swapping refined carbohydrates for whole grains all help. Regular aerobic activity raises HDL and modestly lowers LDL, and stopping smoking improves overall cardiovascular risk on top of any cholesterol benefit. None of this removes the need for medicine in someone at high risk, but it can lower the dose required.

When to get tested

Ask for a lipid panel if you have not had one checked in several years, and sooner if you have a family history of early heart disease or very high cholesterol.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.