Total Cholesterol

What it is

Cholesterol is a type of fatty substance that your body needs to work properly. It's essential for building healthy cells and making certain hormones. Your body actually produces most of the cholesterol it needs, particularly in the liver. However, we also get cholesterol from the food we eat, especially animal products like meat, dairy, and eggs.

Cholesterol travels around your body in your blood, carried by particles called lipoproteins. There are different types of lipoproteins, but the ones most commonly discussed in relation to your health are LDL (low-density lipoprotein) and HDL (high-density lipoprotein).

A "total cholesterol" blood test measures the combined amount of all the cholesterol in your blood, including both LDL and HDL cholesterol, as well as another type of fat called triglycerides. The result is usually given in millimoles per litre (mmol/L). In the UK, a typical reference range for total cholesterol is often considered to be below 5 mmol/L, though this can vary slightly between laboratories and is interpreted in the context of your individual health.

Why it matters

Cholesterol itself isn't inherently bad; it's a vital component for life. The concern arises when the levels of certain types of cholesterol become too high, or when the balance between different types is off.

High levels of total cholesterol, particularly when driven by high LDL cholesterol, can contribute to the build-up of fatty deposits (atheroma) in your arteries. This process is known as atherosclerosis. Over time, these deposits can narrow the arteries, making it harder for blood to flow through. If a plaque ruptures, it can lead to a blood clot, which can block blood flow entirely, potentially causing a heart attack or stroke.

Therefore, monitoring your total cholesterol is an important part of assessing your cardiovascular health. It's a key indicator that helps healthcare professionals understand your risk of developing heart disease or stroke.

What can cause it to be high or low

Several factors can influence your total cholesterol levels.

Factors that can contribute to higher total cholesterol:

• Diet: A diet high in saturated and trans fats, found in many processed foods, fatty meats, butter, and some baked goods, can increase LDL cholesterol.
• Weight: Being overweight or obese can often lead to higher cholesterol levels.
• Lack of physical activity: Regular exercise helps to improve cholesterol levels, so a sedentary lifestyle can have a negative impact.
• Genetics: Some people inherit a tendency to have higher cholesterol levels, a condition known as familial hypercholesterolemia.
• Age and Sex: Cholesterol levels tend to rise with age. Before the menopause, women generally have lower cholesterol levels than men, but levels can increase after the menopause.
• Smoking: Smoking can lower HDL (good) cholesterol and damage artery walls, contributing to atherosclerosis.
• Certain medical conditions: Conditions like an underactive thyroid (hypothyroidism), kidney disease, and diabetes can affect cholesterol levels.
• Some medications: Certain drugs can influence cholesterol.

Factors that can contribute to lower total cholesterol:

While high cholesterol is a more common concern, very low cholesterol levels can also sometimes be an issue, though this is less frequent. This can be associated with:

• Malnutrition or malabsorption: Conditions that affect your body's ability to absorb nutrients from food.
• Overactive thyroid (hyperthyroidism): This can sometimes lower cholesterol.
• Certain genetic conditions: Rare inherited disorders can lead to very low cholesterol.
• Severe illness or infection: The body's metabolism can change during significant illness.

It's important to remember that a single reading doesn't always tell the whole story, and your GP will consider your overall health picture.

Lifestyle factors that may help

Making certain lifestyle changes can be beneficial for managing cholesterol levels and supporting heart health. These are areas you might wish to discuss with your GP.

• Dietary choices: Focusing on a diet rich in fruits, vegetables, whole grains, and lean proteins can be helpful. Limiting intake of saturated and trans fats, found in processed foods, fried items, and fatty cuts of meat, is often recommended. Opting for healthier fats, such as those found in olive oil, nuts, seeds, and oily fish, may be beneficial.
• Regular physical activity: Engaging in regular aerobic exercise, like brisk walking, jogging, swimming, or cycling, can help to improve cholesterol profiles. Aiming for at least 150 minutes of moderate-intensity activity per week is a common guideline.
• Maintaining a healthy weight: If you are overweight, losing even a small amount of weight can have a positive impact on your cholesterol levels.
• Giving up smoking: Smoking cessation is one of the most significant steps you can take to improve your cardiovascular health.
• Limiting alcohol intake: Consuming alcohol in moderation is generally advised.

Questions to discuss with your GP

When you receive your total cholesterol results, it's a good opportunity to have a conversation with your GP. Here are some questions you might consider asking:

• What does my total cholesterol result mean for my individual risk of heart disease or stroke?
• Could you explain the breakdown of my cholesterol, including my LDL and HDL levels, if they were measured?
• Are there any specific dietary changes you would recommend for me based on my results?
• What are your thoughts on the role of regular exercise in managing my cholesterol?
• Are there any other health factors or tests that we should consider alongside my cholesterol levels?
• How often should I have my cholesterol levels checked in the future?