The symptoms of high cholesterol – and how to know if it’s ‘good’ or ‘bad’

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High cholesterol often has no symptoms, but it significantly increases the risk of heart disease and stroke. Photo / 123RF
We all know that high cholesterol is not a good thing, but why is it unhealthy for you – and what’s the difference between “good” and “bad”?

If you have high cholesterol, you
are not alone. A recent study from Our Future Health found 54% of us have high total cholesterol levels. “The good news is that once you become aware of it, high cholesterol is preventable and treatable,” says Dr Dermot Neely, a former lipid specialist and trustee with Heart UK, the cholesterol charity. “Cholesterol is a type of blood fat that is made in the liver, found in some foods too. We all need some cholesterol in our bodies to keep us functioning, but having high cholesterol can clog up your arteries.”

High cholesterol is symptomless, which is a major concern because if left untreated, it can lead to heart attack and stroke,” says Ruth Goss, a senior cardiac nurse at the British Heart Foundation.
Overt symptoms of high cholesterol may manifest in people with familial hypercholesterolaemia (FH), a hereditary disorder in which the liver is unable to adequately handle cholesterol, where you may suffer from:
High cholesterol doesn’t have one cause but is affected by many factors, says Goss.
Ask your GP to check your cholesterol levels, which are measured using a simple blood test, sometimes referred to as a “lipid profile”. Your GP or practice nurse will take a blood sample to check for the following:
“If there is too much non-HDL in the blood, cholesterol can fur up the blood vessel walls, clogging them up – that’s why it’s called ‘bad cholesterol’,” says Neely.
HDL (high-density lipoprotein) cholesterol contains lots of protein and very little cholesterol. It carries cholesterol away from the cells and back to the liver, removing the cholesterol from the body in the process, which is why it’s called “good cholesterol”.
There is another kind of fat in our blood called triglycerides, which are found in fat cells. These can also make arteries shrink. Triglyceride amounts can be high if:
“Your GP should not make any decision on the results of a cholesterol test alone. You need to look at all the potential risk factors for heart disease at the same time. We have very sophisticated computer algorithms these days which look at body weight, height, cholesterol results, blood pressure, blood sugar and will give you a risk estimate for the next 10 years,” says Neely.
Heart UK recommends the following:
“High cholesterol can significantly increase the risk of several health conditions,” says Goss.
There is a lot you can do to help lower your cholesterol.
Some people find it difficult to tolerate statins. New cholesterol-lowering medications called PCSK9 inhibitors lower non-HDL levels in high-risk patients. Researchers found when compared with placebos, cholesterol dropped 59% and cardiovascular events dropped 15%.
Dietary recommendations have also changed. A recent study suggests instead of trying to cut out cholesterol-rich foods such as butter, we should simply focus on healthy dietary patterns. For example, Mediterranean-style and Dietary Approaches to Stop Hypertension (Dash) diets that encourage us to eat fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds and liquid vegetable oil.
A growing body of research suggests young people should be aware of their cholesterol levels earlier in order to take statins. Rather than attempting to undo damage, Neely recommends that statins could be offered at a younger age to keep arteries healthy.
Certain people may require special consideration:
Contact the New Zealand Heart Foundation for support and information.
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