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About the British Heart Foundation
The British Heart Foundation (BHF) is the nation’s heart
charity, saving lives through pioneering research, patient
care and vital information.
British Heart Foundation website
You may find other useful information on our website at:
bhf.org.uk
What you can do for us
We rely on donations of time and money to
continue our life-saving work. If you would like to
make a donation, please:

call our donation hotline on 0300 330 3322

visit bhf.org.uk/donate, or

post it to us at the address on the back cover.
If you wish to make a gift to the BHF in your will, call
0844 847 2787 or email legacy@bhf.org.uk and ask
for our free booklet, My generation.
For other ways to support our work, see
bhf.org.uk/supportus
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Contents
About this booklet ..........................................................................4
What is cholesterol, and what are blood lipids? ..................5
How is blood cholesterol measured? ......................................9
What part does cholesterol play in coronary heart
disease? ............................................................................................11
What causes high blood cholesterol? ...................................14
How can physical activity help improve my cholesterol
level? ..................................................................................................15
How can healthy eating help improve my cholesterol
level? ..................................................................................................17
Will I need to take medicine? ...................................................30
How can medicine help? ............................................................33
Familial hypercholesterolaemia (FH) .....................................41
For more information ..................................................................43
Technical terms ..............................................................................47
Index ..................................................................................................49
Have your say .................................................................................50
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About this booklet
This booklet is for people with a high blood cholesterol
level, and for their family and friends. It explains:

what cholesterol and blood lipids are

how blood cholesterol is measured

the role of cholesterol in coronary heart disease

what causes high blood cholesterol

how physical activity and healthy eating can help

the medicines that are used to treat high blood
cholesterol levels and how they can help, and

why it’s especially important that people with high
cholesterol levels also control their blood pressure and
don’t smoke.
It also gives some information about the condition familial
hypercholesterolaemia (FH).
We explain the technical terms used in this booklet on
page 47.
This booklet does not replace the advice that your doctors,
nurses or dietitians may give you, but it should help you to
understand what they tell you.
4 | British Heart Foundation
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What is cholesterol, and what are
blood lipids?
Blood lipids is the name for all the fats in the blood,
including cholesterol and triglycerides.
Cholesterol
Cholesterol is a waxy substance which is mainly made in
the body. The liver makes some of the cholesterol in your
body from the saturated fats in the foods you eat. (Very
little cholesterol is found in foods, except for eggs, liver
and kidneys, and seafood such as prawns, all of which do
contain some cholesterol.)
Cholesterol plays a vital role in how every cell works,
throughout the body. It is also the material which the
body uses to make other vital chemicals. However, having
too much cholesterol in the blood can increase your risk
of getting heart and circulatory disease. (Heart and
circulatory disease includes coronary heart disease,
stroke, and diseases that affect the circulation such as
peripheral arterial disease. We explain more about
coronary heart disease on page 11.)
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LDL cholesterol and HDL cholesterol
Cholesterol has a special ‘transport system’ for reaching
all the cells which need it. It uses the blood circulation as
its ‘road system’ and is carried on ‘vehicles’ made up of
proteins. These combinations of cholesterol and proteins
are called lipoproteins.
There are two main types of lipoproteins – LDL
(low-density lipoprotein) and HDL (high-density
lipoprotein). The lower the density of the lipoprotein, the
more fats it contains.

Low-density lipoproteins – sometimes called LDL
cholesterol – carry cholesterol from the liver, through
the bloodstream, to the cells.

High-density lipoproteins – sometimes called HDL
cholesterol – return the extra cholesterol, that isn’t
needed, from the bloodstream to the liver. HDL
cholesterol is a ‘good’ type of cholesterol because it
removes the bad cholesterol from the bloodstream
rather than depositing it in the arteries.
6 | British Heart Foundation
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Triglycerides
Triglycerides are another type of fatty substance in the
blood. They are found in foods such as dairy products,
meat and cooking oils. They can also be produced in the
body, either by the body’s fat stores or in the liver. People
who are very overweight, eat a lot of fatty and sugary
foods, or drink too much alcohol are more likely to have a
high triglyceride level.
Total cholesterol
Your total cholesterol level is the total of the LDL, HDL
and other fats in your blood.
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Blood lipids
Blood lipids include cholesterol and triglycerides.
Some types are ‘bad’, but one type (HDL cholesterol)
is good.
Cholesterol
LDL cholesterol – bad
HDL cholesterol – good
Triglycerides – bad
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Cholesterol, triglycerides and the risk of
coronary heart disease and stroke
People who have a high total cholesterol level have a
higher risk of coronary heart disease than those with
lower levels. The risk is particularly high if you have a high
level of LDL cholesterol and a low level of HDL
cholesterol (the ‘good’ cholesterol).
People with a high triglyceride level have a greater risk
of coronary heart disease and stroke than people with
lower levels. The risk is even greater if you also have other
risk factors – for example, if you have a high cholesterol
level, or you smoke, or you have diabetes or high blood
pressure. (A risk factor is something that increases your
chances of getting a disease.)
We explain more about how cholesterol increases the risk
of coronary heart disease on page 11.
8 | British Heart Foundation
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How is blood cholesterol measured?
Measuring blood cholesterol involves a simple blood test.
It can be done in two ways.

Either a blood sample is taken with a syringe and
needle and sent to a laboratory for analysis.

Or a finger prick (capillary sample) is taken and
analysed on a desktop analyser.
You may be given some special instructions before your
blood test. For example, if you’re having your triglyceride
level measured, you will be asked not to eat anything and
to drink only clear fluids for 12 hours before the test. You
may also be asked not to drink any alcohol for 24 hours
before the test. You should always follow the instructions
that your doctor or nurse gives you.
Cholesterol and triglycerides are measured in units called
millimols per litre of blood, usually shortened to
‘mmol/litre’ or ‘mmol/l’. It is important to know what the
levels of LDL and HDL are, and not just the total
cholesterol level. People who are at high risk of, or who
already have, heart and circulatory disease should aim
for:

a total cholesterol level under 4 mmol/l

an LDL cholesterol level under 2 mmol/l
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an HDL cholesterol level above 1 mmol/l, and

a triglyceride level under 1.7 mmol/l.
There can be quite a lot of variation in the levels of
cholesterol in the blood – both from day to day and
at different times of the day. So your doctor will not
usually make a decision about whether to prescribe
cholesterol-lowering medicines for you until he or she
has a series of these readings.
Doctors can use your cholesterol measurements to assess
your risk of coronary heart disease. To do this, they work
out the ratio of your total cholesterol to your HDL
cholesterol level. You can work this out by dividing your
total cholesterol level by your HDL cholesterol level. (For
example, if you have a total cholesterol of 4.5 mmol/l and
an HDL level of 1.2 mmol/l, your ratio would be 4.5
divided by 1.2, which equals 3.75.) The higher your ratio
is, the greater your risk of coronary heart disease. You
need to aim for this figure to be below 4.
10 | British Heart Foundation
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What part does cholesterol play in
coronary heart disease?
Coronary heart disease is caused when the coronary
arteries (the arteries that supply the heart muscle with
oxygen-containing blood) become narrowed by a gradual
build-up of fatty material within their walls. This process is
called atherosclerosis, and the fatty substance is called
atheroma.
Atheroma develops when the level of the ‘bad’ LDL
cholesterol is too high. On the other hand, HDL cholesterol
is ‘good’ because it removes excess cholesterol from the
circulation, and helps to protect against coronary heart
disease.
The aim is to have:

a low total cholesterol level

a low level of LDL cholesterol, and

a high level of HDL cholesterol.
Eating a healthy diet can help to improve your
cholesterol levels. It is important to understand
how the different types of fats in foods affect your
cholesterol level. On page 17 we describe the
different types of fats and how to choose the healthier
fats to help keep your cholesterol low.
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When does a high blood cholesterol
level matter?
The average total blood cholesterol level of adults living
in England and Scotland is 5.3 mmol/l. This average level
has fallen steadily over the last 10 years, but it is
important to get cholesterol levels down even further.
A high level of cholesterol is one of the most important
risk factors for coronary heart disease. The other major
risk factors are:

smoking

having high blood pressure

not being physically active enough

being overweight or obese

having diabetes

being of South Asian origin, and

having a family history of premature coronary heart
disease. (This means if a close blood relative of yours
developed coronary heart disease before the age of 55
for a man, or 65 for a woman.)
Your overall risk of having a heart attack is much
greater if you have a high cholesterol level as well as
one or more of the other major risk factors listed
above. This means, for example, if you have a high
cholesterol level and diabetes, or if you also smoke or
12 | British Heart Foundation
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have high blood pressure, or if you are not physically
active or are overweight. The more risk factors you have,
the higher your risk of having a heart attack.
There is also a greater risk of heart attacks among people
who have familial hypercholesterolaemia – an inherited
condition in which the blood cholesterol level is very
high. For more on this, see page 41.
Other important ways to reduce your risk of
coronary heart disease
As well as following the advice on pages 15 to 39 for
reducing your cholesterol level, there are other things
you can do to reduce your risk of coronary heart disease.

If you smoke, stop smoking. Within one year of quitting
smoking, you can halve your risk of having a heart
attack.

If you have high blood pressure, reducing your blood
pressure can lower your risk of having a stroke, a heart
attack, or kidney failure.
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What causes high blood cholesterol?
A common cause of high blood cholesterol levels in
people in the UK is eating too much saturated fat.
However, some people have high blood cholesterol levels
even though they eat healthily. Some have high
cholesterol levels as a result of an underactive thyroid
gland, long-term kidney problems, or having too much
alcohol. Also, about 1 in every 500 people in the UK has a
high cholesterol level because they have an inherited
condition called familial hypercholesterolaemia
(pronounced ‘hyper-cholesterol-ee-me-ah’) – or FH for
short (see page 41).
14 | British Heart Foundation
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How can physical activity help improve
my cholesterol level?
Doing regular physical activity – for example, brisk
walking or cycling – for 30 minutes a day on at least five
days a week can help improve your cholesterol level. You
can do the 30 minutes all in one go, or in shorter bouts of
at least 10 minutes at a time.
Being active can increase the level of HDL cholesterol
(the ‘good’ cholesterol). It can also help lower your blood
pressure, help you to maintain a healthy weight, and
reduce your risk of getting diabetes.
To get the most benefit, you need to be active enough to
make you feel warm and slightly puffed but still able to
have a conversation. It’s important to build up gradually
the amount of activity that you do.
Here are some examples of how you can start to include
physical activity in your daily routine.

Walk rather than use the car.

Get off the bus or train a stop early and walk the rest of
the way.

Climb the stairs rather than use the lift.
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For more about how to get more active, see our booklets
Physical activity and your heart and Get active, stay active!
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How can healthy eating help improve
my cholesterol level?
Changing to a healthier diet can help reduce your
cholesterol levels by over 10%. Some people may find
that healthy eating has a greater effect on their
cholesterol level than other people. But it’s important to
remember that, as well as helping to lower your
cholesterol, making healthy changes to your diet benefits
your heart health in many other ways. For example, it can
help protect against high blood pressure, diabetes and
putting on weight.
Choosing healthier fats
Foods containing fat are made up of a combination of
saturated fats, monounsaturated fats and
polyunsaturated fats. On page 20 we give examples of
foods that contain all these different types of fats.
To help improve your cholesterol level you need to do
the following.

Cut right down on saturated fats and replace them
with monounsaturated fats and polyunsaturated fats.

Reduce the total amount of fat you eat – especially if
you are overweight. Choosing healthier fats can help
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18 | British Heart Foundation
protect your heart, but remember that all fats are high
in calories. For example, cut down on foods such as
pastries, crisps and biscuits, and replace them with
healthier alternatives such as fruit or vegetables.

Avoid foods containing trans fats wherever possible.
These fats are most likely to be found in processed
foods like biscuits and cakes, fast food, pastries and
some margarines.
What are trans fats?
Trans fats occur naturally in small amounts in dairy
foods and meat. However, it is the industrially
produced trans fats which have been linked to an
increased risk of coronary heart disease. Industrially
produced trans fats are formed when vegetable oils
are processed into solid fat through a process called
hydrogenation. Trans fats produced in this way have a
similar effect to saturated fat, as they can increase your
LDL cholesterol and reduce HDL cholesterol. Foods
that have ‘hydrogenated oils’ or ‘hydrogenated fat’ in
the list of ingredients are likely to contain trans fats.
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Eat oily fish regularly. Oily fish provide the richest
source of a particular type of polyunsaturated fat
known as omega-3 fats. They can also help to lower
blood triglyceride levels, help prevent the blood from
clotting, and help keep the heart rhythm regular. Eating
oily fish can also help to improve your chance of
surviving after a heart attack. For more about oily fish
and omega-3 fats, see page 22.
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20 | British Heart Foundation
Choosing healthier fats
To help reduce your cholesterol level, you need to cut
down on saturated fats and trans fats and replace them
with monounsaturated and polyunsaturated fats.
Omega-3 fats are good for your heart too.
Which foods are
these fats found
in?
Monounsaturated
fats
Found in:

olive oil and
rapeseed oil

avocado

nuts and seeds
(almonds,
cashews,
hazelnuts,
peanuts and
pistachios).
Some spreads are
made from
monounsaturated
fats.
Found in:

corn oil,
sunflower oil
and soya oil

nuts and seeds
(walnuts, pine
nuts, sesame
seeds and
sunflower
seeds).
Some spreads are
made from
polyunsaturated
fats.
Polyunsaturated
fats
Unsaturated fats
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Found in:

fish oil

oily fish such
as herring,
mackerel,
pilchards,
sardines,
salmon, trout
and fresh tuna.
See page 22 for
more about
omega-3 fats
from sources
other than fish.
Found in:

butter

hard cheese

whole milk

fatty meat

meat products

biscuits

cakes

cream

lard

dripping

suet

ghee

coconut oil

palm oil

pastry
Found in:

pastries

cakes

biscuits

crackers

fried foods

takeaways

hard margarines.
Foods that have
‘hydrogenated oils
or fats’ or ‘partially
hydrogenated oils
or fats’ in the list of
ingredients are
likely to contain
trans fats.
Omega-3 fats Saturated fats Trans fats
Saturated fats
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Oily fish and omega-3 fats
Oily fish such as herring, mackerel, pilchards, sardines,
salmon, trout and fresh tuna are good sources of
omega-3 fats. If you have had a heart attack, aim to
have 2 to 3 portions of oily fish a week. (1 portion of oily
fish = 140 grams or half a medium can of fish.) Otherwise
you should aim to have 2 portions of fish a week, one of
which should be oily fish. Try to eat a variety of fish and,
if possible, choose those that are ‘sustainably sourced’,
such as those carrying the Marine Stewardship Council
(MSC) logo. (This means that the fish come from fisheries
that aim to secure fish stocks for the future and help to
protect the marine environment.)
If you don’t like oily fish, you can get omega-3 fats from
vegetable sources. These include flaxseed, rapeseed, soya
and walnut oils, unsalted nuts such as walnuts, pecans,
peanuts and almonds, soya beans and tofu, dark green
vegetables, sweet potatoes and wholegrain foods. There
are also foods which have been enriched with omega-3
such as some eggs, milk and yoghurts. However, we don’t
yet know for certain if the omega-3 fats in these foods
bring exactly the same benefits as the omega-3 fats from
oily fish.
Omega-3 supplements are only prescribed for people
who have recently had a heart attack and who cannot eat
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2 to 3 portions of oily fish a week. Before taking fish oil
supplements that have not been prescribed for you, it’s
important to talk to your doctor or dietitian about
whether you should take them.
How do the different types of fat in foods affect my
cholesterol levels?
Saturated fats can increase total cholesterol and LDL
cholesterol. LDL cholesterol increases the risk of fatty
deposits developing in your arteries.
Monounsaturated fats can lower the LDL level and
don’t lower the level of HDL cholesterol (the ‘good’
cholesterol).
Polyunsaturated fats are an essential part of the diet.
They can help lower LDL cholesterol (which is a good
effect), but they also lower HDL cholesterol (the ‘good’
cholesterol).
Trans fats can increase LDL cholesterol and lower HDL
cholesterol.
The omega-3 fats found in oily fish can help to reduce
triglyceride levels in the blood.
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24 | British Heart Foundation
What about the cholesterol found in foods?
The cholesterol found in some foods – such as egg yolk,
liver and kidneys, shellfish such as prawns and fish roes
(fish eggs) – does not usually make a great contribution
to the level of cholesterol in your blood. If you need to
reduce your cholesterol level, it is much more important
that you eat foods that are low in saturated fat. However,
if you have FH (see page 41), you will need to be more
careful about the amounts of foods you eat which are
high in cholesterol. Talk to your doctor or a dietitian for
advice on these foods.
Other ways to improve your cholesterol levels
Eat more high-fibre foods
Foods high in fibre – especially those high in soluble fibre
– help to lower total and LDL cholesterol by reducing the
amount of cholesterol that is absorbed into the
bloodstream from your intestine. Good sources of foods
that are high in soluble fibre include oats, barley, pulses
such as baked beans, kidney beans, soya beans, peas,
lentils and chickpeas, and certain fruit and vegetables like
apples, pears, artichokes and sweet potato. Foods that are
high in fibre also help to fill you up, which can be helpful
if you are trying to lose weight.
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What about using foods with added plant stanols
and sterols?
Plant stanols and sterols are substances which have been
added to certain foods including some types of
margarines, spreads, soft cheeses and yoghurt. Although
they are not routinely recommended, there is some
evidence that eating between 2 grams and 2.5 grams of
plant stanols and sterols a day can lower cholesterol by
an extra 10% on top of having a healthy diet low in
saturated fat and taking a statin (a cholesterol-lowering
medicine). However, it’s important to remember that
plant stanols and sterols are not a substitute for a
healthy diet. And they’re not a replacement for
cholesterol-lowering medicines. If you decide to use
these products, follow the manufacturer’s serving
instructions to make sure you have the recommended
amount of stanol or sterol a day. You can have these
foods containing stanols and sterols as well as taking any
cholesterol-lowering medicines your doctor has
prescribed for you.
Plant sterol or stanol products are not recommended for
adults who don’t have a high cholesterol level, and
they’re not suitable for women who are pregnant or
breastfeeding.
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26 | British Heart Foundation
Enjoy a range of unsalted nuts and seeds
Unsalted nuts and seeds contain healthy unsaturated
fats, antioxidants and fibre, which can help lower total,
and LDL, cholesterol. See page 20 for examples of healthy
nuts. However, nuts and seeds also contain a lot of
calories, so keep to the recommended one handful
(30 grams or about 1 ounce) of unsalted nuts a day.
Have some soya
Soya products include soya milk and yoghurts, tofu, miso,
textured soya protein, soya nuts and soya beans. They are
naturally low in saturated fat and a good source of
soluble fibre, antioxidants and protein, which may help to
lower your cholesterol. Choosing soya, particularly as a
replacement for meats or other foods that are high in
saturated fat, is likely to be good for your heart.
Choose more wholegrains
Wholegrains such as wheat, barley, rice and oats are not
only good sources of cholesterol-lowering soluble fibre,
but they also contain other nutrients that are good for
heart health, such as omega-3 fats and antioxidants. Try
to choose wholegrain versions for half of the starchy
carbohydrates you eat – for example, choose brown rice,
wholemeal bread, wholemeal pitta and wholegrain
cereals.
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Other important ways to eat well to
protect your heart
While it is important to lower your cholesterol level, it is
also important to eat well and protect your heart
generally. You can do this in the following ways.
Eat more fruit and vegetables
Aim to have at least 5 portions of a variety of fruit and
vegetables every day. Fresh, frozen, chilled, canned and
dried fruit and vegetables, and 100% juice, all count.
There is evidence that people who eat more than 5
portions of fruit and vegetables a day have a lower risk of
heart disease. We still need to do more research to find
out why this is. What we do know is that they contain
fibre and a variety of vitamins and minerals, which make
them an important part of a healthy, balanced diet. Eating
more fruit and vegetables also means there is less room
in your diet for other foods that are high in saturated fat,
salt and sugar. Taking dietary supplements doesn’t seem
to have the same health benefits as eating fruit and
vegetables.
For more information on fruit and vegetables, see our
booklet Eating well.
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28 | British Heart Foundation
Cut down on salt
Eating less salt can lower your risk of getting high blood
pressure, which is linked to heart disease and stroke. Try
not to add salt to your food. Use extra pepper, herbs,
garlic or spices to add flavour to your food instead.
Choosing more fresh foods rather than ready meals or
processed foods will also help you cut down on salt. Low-
salt alternatives may not be suitable for some people, for
example those with kidney problems or heart failure. So
check with your doctor before using these products.
For more information, see our booklet Blood pressure.
Drink alcohol within the sensible limits
Drinking moderate amounts of alcohol can offer some
benefit to heart health as it can raise HDL cholesterol (the
‘good’ cholesterol). But you can achieve the same benefit
in other ways, such as eating healthily and being
physically active (see pages 17 and 15). Drinking more
than the sensible limits of alcohol can lead to muscle
damage, high blood pressure, stroke and some types of
cancer. Men should drink no more than 3 to 4 units of
alcohol each day, and women no more than 2 to 3 units
each day.
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Be a healthy body weight and shape
Being overweight and carrying too much weight around
your middle – that is, having a waist size of more than 94
centimetres (about 37 inches) for men, 90 centimetres
(about 35½ inches) for men of South Asian origin, or 80
centimetres (about 31½ inches) for women – can put you
at greater risk of developing heart problems, high blood
pressure and diabetes. If you’re not sure whether you are
overweight or if your body shape puts your health at risk,
ask your doctor or practice nurse.
For more information on how to lose weight, see our
booklet So you want to lose weight … for good.
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30 | British Heart Foundation
Will I need to take medicine?
Whether you need to take cholesterol-lowering medicine
or not depends not just on your total cholesterol, HDL
and LDL levels, but also on your overall risk of coronary
heart disease and whether you have the inherited
condition familial hypercholesterolaemia (FH). People
with this condition have very high blood cholesterol
levels from birth (see page 41).
Doctors prescribe cholesterol-lowering medicines for
people who are at greatest overall risk of suffering from
coronary heart disease. So your doctor is likely to
prescribe cholesterol-lowering medicines, such as statins:

if you have diabetes

if you have high blood cholesterol levels, particularly if
you also have other risk factors – for example, if you
have high blood pressure or if you smoke

if you have familial hypercholesterolaemia (FH)

if you have had a heart attack or stroke

if you have angina or peripheral arterial disease, or

if you have had bypass surgery or angioplasty.
The higher your risk of coronary heart disease, the more
likely it is that your doctor will recommend
cholesterol-lowering medicines for you.
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Even if you don’t have high cholesterol levels, your
doctor may still feel that you will benefit from taking
cholesterol-lowering medicines, such as statins, if you
have a combination of major risk factors for coronary
heart disease. These include, for example, if you have high
blood pressure, if you smoke, if you have a strong family
history of coronary heart disease (if a close relative
developed coronary heart disease before the age of 55
for a man, or 65 for a woman), or if you are of South Asian
origin. Your age is also relevant, as your risk of coronary
heart disease and stroke usually increases with age. Your
sex is relevant too, as women before the menopause
have some protection from hormones.
There are various sets of guidelines to help doctors
decide whether to recommend that you take
cholesterol-lowering medicines. All of this means that
people with a wide range of cholesterol levels may be
treated with cholesterol-lowering medicines. For
example, someone with low cholesterol levels but with
several major risk factors might be given statins. On the
other hand, a person with a slightly higher cholesterol
level but with no other risk factors might not be treated
with cholesterol-lowering medicines.
We explain more about the different types of
cholesterol-lowering medicines on pages 33 to 39.
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32 | British Heart Foundation
Cholesterol-lowering medicines are a long-term and
effective treatment. However, it is important to lower your
overall risk of coronary heart disease as much as possible.
This includes getting your lifestyle right as well as taking
cholesterol-lowering medicines. Stopping smoking,
eating a healthy diet, taking regular physical activity,
controlling your weight and making sure your blood
pressure is normal, will all help.
Currently there is no recommendation that people
should take a statin as ‘primary prevention’. This means
that, if you are not at risk of getting coronary heart
disease or having a stroke, and you don’t have angina
and you haven’t had a heart attack, your doctor will
probably not prescribe statins for you as a way of
preventing heart disease. If you are concerned about
being at risk, talk to your doctor or nurse and discuss any
changes you could make to your lifestyle to reduce your
risk.
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Reducing your blood cholesterol | 33
How can medicine help?
Statins
The main type of medicine used to reduce cholesterol
levels is statins.
Statins can reduce total cholesterol levels by more than
20%, and LDL levels by more than 30%. Overall, they can
reduce the risk of having a heart attack or stroke by
about a quarter.
Statins can help to stabilise the atheroma (the build-up of
fatty deposits) within the lining of the arteries and so
reduce your risk of having a heart attack or stroke. This is
why most people who are at high risk of coronary heart
disease, stroke or peripheral arterial disease, or who have
diabetes, are prescribed a statin drug even if they have a
normal cholesterol level.
There are several statins available in the UK. Many of
these have been tested in long-term trials that have
looked not just at the cholesterol levels they produce but
also at their effect on health and long-term safety. For
people who are already at high risk of having a heart
attack, the benefits of taking statins are likely to outweigh
the possible risk of side effects.
Your doctor will choose the best statin and dose for you,
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34 | British Heart Foundation
depending on your medical history and your target
cholesterol level. Your doctor may change your statin if it
does not help to lower your cholesterol level as much as
it needs to. However, if your doctor is planning to change
your statin, you should have a blood cholesterol test and
liver function tests before and after the change. This will
help to make sure that the new medicine works well for
you.
Statins are not suitable for people who have liver disease
or for women who are pregnant or breastfeeding. If
you’re already taking statins, and are thinking of starting
a family, you should speak to your doctor before stopping
your medicines.
Most statins should be taken in the evening, because our
bodies make most of our cholesterol at night. However,
you can take atorvastatin and rosuvastatin at any time
that has been prescribed for you.
If you are taking the statin drug simvastatin, you should
avoid drinking grapefruit juice or eating grapefruit.
However, if you’re taking another type of statin, you may
be able to have small quantities of grapefruit juice (or
grapefruit). If you have any questions about statins and
grapefruit, talk to your doctor or pharmacist.
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Reducing your blood cholesterol | 35
Possible side effects of statins
Side effects of statins can include feeling sick, being sick,
diarrhoea and headaches.
A rare side effect of statins is inflammation of the muscles
(myositis). If you have any unexpected muscle pain,
tenderness or weakness, you should tell your doctor. He
or she may change the type of statin you are taking, or
the dose.
Over-the-counter statins
These are statins that people can buy from their local
pharmacist’s without a prescription from a doctor.
They are not a substitute for adjusting your lifestyle to
reduce your cholesterol, and they are not suitable for
everyone. Your pharmacist will be able to tell you
whether these medicines are suitable for you. Before
giving you any advice, he or she will ask you about
your risk factors for heart disease – such as whether
you smoke, or have high blood pressure. They will also
tell you if you need to have regular blood tests to
check that your liver and kidneys are working
properly.
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36 | British Heart Foundation
Other cholesterol-lowering medicines
There are other types of medicines which can be used to
control blood cholesterol levels either instead of, or as
well as, statins. These are:

fibrates

medicines which bind bile acids

nicotinic acid medicines, and

ezetimibe.
Many of these medicines act by preventing the intestine
from absorbing cholesterol. This in turn prevents
cholesterol entering the bloodstream and raising blood
cholesterol levels.
Fibrates
Fibrates are useful for people who have a high level of
triglycerides. They may also be used with other medicines
to lower your cholesterol if you cannot take statins. You
will not usually be given fibrates if you are also taking
statins (see page 33), except under strict medical
supervision. You should not use fibrates during
pregnancy, or if you have liver or kidney disease.
Medicines which bind bile acids
These medicines (which are also called ‘bile-binding
medicines’ or ‘bile-acid-binding resins’) work by
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Reducing your blood cholesterol | 37
preventing the bile acids, which the liver makes from
cholesterol, from getting re-absorbed into the
bloodstream.
They come in powder form, in sachets. You have to soak
some types in fruit juice before you take them. Others are
already mixed with fruit flavouring and you just need to
add water. You should take these medicines immediately
before or during a meal. They may make you feel fuller
than usual at first, but most people gradually get used to
this.
These medicines are not absorbed into the body, so they
can also be used safely by children and pregnant women.
If you also take other medicines, you will need to take
them at least one hour before, or four hours after, your
bile-acid-binding medicines.
Possible side effects
Some people who take these medicines may get
heartburn or constipation, but this is more likely with
larger doses.
These medicines can also interfere with the absorption of
fat-soluble vitamins (vitamins A, D, E and K), so your
doctor may advise you to take vitamin supplements.
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Nicotinic acid medicines
Nicotinic acid medicines help to lower LDL levels and
increase the level of ‘good’ HDL cholesterol.
Possible side effects
Common side effects of these medicines are flushing of
the face and itching over the body. However, a new
preparation, which also contains an antihistamine, can
reduce these effects as far as possible.
If you are also taking medicines to reduce your blood
pressure, or if you have low blood pressure, taking
nicotinic acid can lower your blood pressure further. You
should discuss this with your doctor before taking
nicotinic acid.
Ezetimibe
Ezetimibe is another type of cholesterol-lowering
medicine. It can be used along with a statin. Or, people
who can’t take statins can take ezetimibe on its own.
Ezetimibe helps to lower blood cholesterol levels by
preventing the small intestine from absorbing
cholesterol.
Ezetimibe can help reduce LDL cholesterol by about 20%,
and if it is combined with low-dose statins it can be even
more effective. More research is needed to confirm the
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Reducing your blood cholesterol | 39
long-term benefits of this medicine.
Possible side effects
Side effects of ezetimibe include headaches, pain in the
abdomen and diarrhoea.
Medicines which reduce triglyeride levels
(fish oils)
If you regularly eat oily fish, control your weight, and limit
how much alcohol you have and yet you still have a high
triglyceride level, your doctor may prescribe fish oils for
you.
If you’re taking fish oils which have not been prescribed
for you, tell your doctor about them so that he or she can
make sure that they don’t interfere with any other
medicines you are taking, such as warfarin.
For more information on cholesterol-lowering medicines,
see our booklet Medicines for your heart.
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40 | British Heart Foundation
How your support helps
Over recent decades, thanks to our supporters,
research funded by the BHF has contributed to a
substantial reduction in the number of people dying
from heart attacks and strokes. For example, the BHF
part-funded one of the world’s largest research trials of
cholesterol-lowering medicines for people known to
be at high risk of heart disease. Millions of people are
now benefiting from using statins, and it is now
thought that they save over 10,000 lives a year in
England alone.
We need your support to continue our research so that
heart and circulatory disease is no longer a major
cause of disability in the UK. See page 2 for how to
make a donation.
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Reducing your blood cholesterol | 41
Familial hypercholesterolaemia (FH)
What is familial hypercholesterolaemia?
About 1 in 500 people in the UK have inherited a high
blood cholesterol level due to a condition called familial
hypercholesterolaemia, or FH for short.
In people with FH, the blood cholesterol levels are high
from birth. The way LDL cholesterol is removed from the
blood circulation works only about half as effectively as
normal. So, an adult with FH may have a total cholesterol
level of between 7.5 and 12 mmol/l, and sometimes
much higher. Children and young women may have
lower levels, but the level is usually above 6.7 mmol/l in
children.
For more information
For more information on FH, how it is inherited and the
treatment for it, see our booklet Familial
hypercholesterolaemia.
You can also get more information on FH from:
Heart UK – The Cholesterol Charity
7 North Road
Maidenhead
Berkshire SL6 1PE
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42 | British Heart Foundation
Helpline: 0845 450 5988 (Monday to Friday, 10am to 3pm.
Calls are charged at a local rate.)
Website: www.heartuk.org.uk
Email: ask@heartuk.org.uk
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Reducing your blood cholesterol | 43
For more information
British Heart Foundation website
bhf.org.uk
For up-to-date information on heart disease, the BHF
and its services.
Heart Helpline
0300 330 3311(a similar cost to 01 and 02 numbers)
For information and support on anything heart-related.
Genetic Information Service
0300 456 8383(a similar cost to 01 and 02 numbers)
For information and support on inherited heart conditions.
Booklets and DVDs
To order our booklets or DVDs:

call the BHF Orderline on 0870 600 6566, or

email orderline@bhf.org.uk, or

visit bhf.org.uk/publications
You can also download many of our publications from our
website. For a list of resources available from the BHF, ask
for a copy of Our heart health catalogue. Our booklets are
free of charge, but we would welcome a donation. (See
page 2 for how to make a donation.)
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44 | British Heart Foundation
Heart Information Series
This booklet is one of the booklets in the Heart Information
Series. The other titles in the series are as follows.
Angina
Atrial fibrillation
Blood pressure
Cardiac rehabilitation
Caring for someone with a heart condition
Coronary angioplasty
Diabetes and your heart
Having heart surgery
Heart attack
Heart rhythms
Heart transplantation
Heart valve disease
Implantable cardioverter defibrillators (ICDs)
Keep your heart healthy
Living with heart failure
Medicines for your heart
Pacemakers
Peripheral arterial disease
Physical activity and your heart
Reducing your blood cholesterol
Returning to work with a heart condition
Tests for heart conditions
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Reducing your blood cholesterol | 45
My progress record
This is a personal health record for people with a heart
condition. You can use it to keep a record of important
information, and to chart the progress you are making in
tackling your risk factors for coronary heart disease. You
can order a copy from the BHF (see page 43), and work
through it with your health professional. A short version,
My progress card, is also available.
Heart Matters
Heart Matters is the BHF’s free, personalised service to
help you live with a healthy heart. Join today and enjoy
the benefits, including heart matters magazine, a Heart
HelpLine and an online members’ area with articles,
recipes and lifestyle tips. You can join online at
bhf.org.uk/heartmatters or call 0300 330 3300 (a similar
cost to 01 and 02 numbers).
Emergency life-support skills
Heartstart
For information about a free, two-hour course in
emergency life-support skills, contact Heartstart at the
British Heart Foundation. The course teaches you to:

recognise the warning signs of a heart attack

help someone who is choking or bleeding
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46 | British Heart Foundation

deal with someone who is unconscious

know what to do if someone collapses, and

perform cardiopulmonary resuscitation (CPR) if
someone has stopped breathing and his or her heart
has stopped pumping.
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Reducing your blood cholesterol | 47
Technical terms
atheroma
cholesterol
coronary heart disease
familial
hypercholesterolaemia
HDL
LDL
lipids
lipoproteins
mmol/l
omega-3 fat
trans fats
Fatty deposits that can build up
within the walls of the arteries.
A fatty substance mainly made in
the body by the liver.
When the walls of the arteries
become narrowed by a gradual
build-up of fatty deposits called
atheroma.
An inherited condition in which the
blood cholesterol level is very high.
High-density lipoprotein. The ‘good’
cholesterol.
Low-density lipoprotein. The ‘bad’
cholesterol.
Fatty substances in the blood.
Combinations of cholesterol and
proteins.
Millimols per litre. Unit used for
measuring cholesterol and other
fats in the blood.
A type of polyunsaturated fat found
in certain types of fish.
A type of fatty acid that acts like
saturated fats.
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48 | British Heart Foundation
triglycerides A type of fatty substance found in
the blood.
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Reducing your blood cholesterol | 49
Index
bile-acid-binding medicines ..................................................................36
blood pressure .....................................................................................12, 27
causes of high blood cholesterol ....................................................... 14
children ...................................................................................................37, 41
cholesterol ......................................................................................................5
in foods ..................................................................................................24
measurement of ....................................................................................9
role in coronary heart disease .......................................................11
targets .......................................................................................................9
test .............................................................................................................9
diet ..................................................................................................................17
eggs ................................................................................................................24
ezetimibe ......................................................................................................38
familial hypercholesterolaemia .....................................................14, 41
fats ...................................................................................................................17
FH .............................................................................................................14, 41
fibrates ...........................................................................................................36
fish oil supplements ...........................................................................23, 39
HDL ....................................................................................................................6
healthy eating .............................................................................................17
LDL .....................................................................................................................6
lipids ..................................................................................................................5
medicines ...............................................................................................30, 33
monounsaturated fats ................................................................17, 20, 23
nicotinic acid medicines .........................................................................38
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oily fish ....................................................................................................18, 22
omega-3 fats ..................................................................................21, 22, 23
over-the-counter statins .........................................................................35
physical activity ..........................................................................................15
polyunsaturated fats ...................................................................17, 20, 23
pregnancy ..............................................................................................34, 37
saturated fats ..........................................................................14, 17, 21, 23
smoking ..................................................................................................12, 13
stanols ............................................................................................................25
statins ......................................................................................................30, 33
sterols .............................................................................................................25
supplements: fish oil supplements................................................23, 39
thyroid gland ...............................................................................................14
trans fats ..........................................................................................18, 21, 23
triglycerides ................................................................................................7, 8
unsaturated fats .........................................................................................20
Have your say
We would welcome your comments to help us produce
the best information for you. Why not let us know what
you think? Contact us through our website at
bhf.org.uk/contact. Or, write to us at the address on the
back cover.
BHF_No3_Reducing Blood Colesterol:34625 BHF HIS template_Q5 26/7/11
Acknowledgements
The British Heart Foundation would like to thank all the
GPs, cardiologists and nurses who helped to develop the
booklets in the Heart Information Series, and all the
patients who commented on the text and design.
Particular thanks for their work on this booklet are due to:
• Clare Neuwirth, Lipid Specialist Nurse, Imperial College
Healthcare NHS Trust.
Edited by Wordworks.
This booklet was last updated in July 2011.
BHF_No3_Reducing Blood Colesterol:34625 BHF HIS template_Q5 26/7/11
Heart Helpline
0300 330 3311
bhf.org.uk
British Heart Foundation
Greater London House
180 Hampstead Road
London NW1 7AW
T 020 7554 0000
F 020 7554 0100
bhf.org.uk
Information & support on anything heart-
related. Phone lines open 9am to 5pm
Monday to Friday.
Similar cost to 01 or 02 numbers.
©

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2011 is the British Heart Foundation’s 50th birthday.
Since 1961, we have been the nation’s heart charity,
dedicated to saving lives through pioneering
research, patient care, campaigning for change
and by providing vital information. But we
urgently need your help. We rely on your
donations of time and money to
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BHF_No3_Reducing Blood Colesterol:34625 BHF HIS template_Q5 26/7/11

About the British Heart Foundation
The British Heart Foundation (BHF) is the nation’s heart charity, saving lives through pioneering research, patient care and vital information. What you can do for us We rely on donations of time and money to continue our life-saving work. If you would like to make a donation, please:

• call our donation hotline on 0300 330 3322 • visit bhf.org.uk/donate, or • post it to us at the address on the back cover.
If you wish to make a gift to the BHF in your will, call 0844 847 2787 or email legacy@bhf.org.uk and ask for our free booklet, My generation. For other ways to support our work, see bhf.org.uk/supportus

British Heart Foundation website
You may find other useful information on our website at:

bhf.org.uk

Contents
About this booklet ..........................................................................4 What is cholesterol, and what are blood lipids? ..................5 How is blood cholesterol measured? ......................................9 What part does cholesterol play in coronary heart disease? ............................................................................................11 What causes high blood cholesterol? ...................................14 How can physical activity help improve my cholesterol level? ..................................................................................................15 How can healthy eating help improve my cholesterol level? ..................................................................................................17 Will I need to take medicine? ...................................................30 How can medicine help? ............................................................33 Familial hypercholesterolaemia (FH) .....................................41 For more information ..................................................................43 Technical terms ..............................................................................47 Index ..................................................................................................49 Have your say .................................................................................50

About this booklet
This booklet is for people with a high blood cholesterol level, and for their family and friends. It explains:

• • • • • •

what cholesterol and blood lipids are how blood cholesterol is measured the role of cholesterol in coronary heart disease what causes high blood cholesterol how physical activity and healthy eating can help the medicines that are used to treat high blood cholesterol levels and how they can help, and cholesterol levels also control their blood pressure and don’t smoke.

• why it’s especially important that people with high

It also gives some information about the condition familial hypercholesterolaemia (FH). We explain the technical terms used in this booklet on page 47. This booklet does not replace the advice that your doctors, nurses or dietitians may give you, but it should help you to understand what they tell you.

4

|

British Heart Foundation

What is cholesterol, and what are blood lipids?
Blood lipids is the name for all the fats in the blood, including cholesterol and triglycerides.

Cholesterol
Cholesterol is a waxy substance which is mainly made in the body. The liver makes some of the cholesterol in your body from the saturated fats in the foods you eat. (Very little cholesterol is found in foods, except for eggs, liver and kidneys, and seafood such as prawns, all of which do contain some cholesterol.) Cholesterol plays a vital role in how every cell works, throughout the body. It is also the material which the body uses to make other vital chemicals. However, having too much cholesterol in the blood can increase your risk of getting heart and circulatory disease. (Heart and circulatory disease includes coronary heart disease, stroke, and diseases that affect the circulation such as peripheral arterial disease. We explain more about coronary heart disease on page 11.)

Reducing your blood cholesterol

|5

LDL cholesterol and HDL cholesterol Cholesterol has a special ‘transport system’ for reaching all the cells which need it. The lower the density of the lipoprotein. through the bloodstream. the more fats it contains. There are two main types of lipoproteins – LDL (low-density lipoprotein) and HDL (high-density lipoprotein). It uses the blood circulation as its ‘road system’ and is carried on ‘vehicles’ made up of proteins. that isn’t needed. 6 | British Heart Foundation . • High-density lipoproteins – sometimes called HDL cholesterol – return the extra cholesterol. • Low-density lipoproteins – sometimes called LDL cholesterol – carry cholesterol from the liver. from the bloodstream to the liver. HDL cholesterol is a ‘good’ type of cholesterol because it removes the bad cholesterol from the bloodstream rather than depositing it in the arteries. to the cells. These combinations of cholesterol and proteins are called lipoproteins.

People who are very overweight. eat a lot of fatty and sugary foods. Some types are ‘bad’. either by the body’s fat stores or in the liver. Cholesterol LDL cholesterol – bad HDL cholesterol – good Triglycerides – bad Total cholesterol Your total cholesterol level is the total of the LDL. They are found in foods such as dairy products. meat and cooking oils. Reducing your blood cholesterol |7 . or drink too much alcohol are more likely to have a high triglyceride level. Blood lipids Blood lipids include cholesterol and triglycerides. HDL and other fats in your blood. but one type (HDL cholesterol) is good.Triglycerides Triglycerides are another type of fatty substance in the blood. They can also be produced in the body.

) We explain more about how cholesterol increases the risk of coronary heart disease on page 11. triglycerides and the risk of coronary heart disease and stroke People who have a high total cholesterol level have a higher risk of coronary heart disease than those with lower levels. or you have diabetes or high blood pressure.Cholesterol. People with a high triglyceride level have a greater risk of coronary heart disease and stroke than people with lower levels. 8 | British Heart Foundation . or you smoke. (A risk factor is something that increases your chances of getting a disease. if you have a high cholesterol level. The risk is particularly high if you have a high level of LDL cholesterol and a low level of HDL cholesterol (the ‘good’ cholesterol). The risk is even greater if you also have other risk factors – for example.

• Either a blood sample is taken with a syringe and needle and sent to a laboratory for analysis.How is blood cholesterol measured? Measuring blood cholesterol involves a simple blood test. It can be done in two ways. and not just the total cholesterol level. you will be asked not to eat anything and to drink only clear fluids for 12 hours before the test. You may also be asked not to drink any alcohol for 24 hours before the test. if you’re having your triglyceride level measured. It is important to know what the levels of LDL and HDL are. You should always follow the instructions that your doctor or nurse gives you. • Or a finger prick (capillary sample) is taken and analysed on a desktop analyser. People who are at high risk of. For example. Cholesterol and triglycerides are measured in units called millimols per litre of blood. heart and circulatory disease should aim for: • a total cholesterol level under 4 mmol/l • an LDL cholesterol level under 2 mmol/l Reducing your blood cholesterol |9 . usually shortened to ‘mmol/litre’ or ‘mmol/l’. or who already have. You may be given some special instructions before your blood test.

5 divided by 1. There can be quite a lot of variation in the levels of cholesterol in the blood – both from day to day and at different times of the day.5 mmol/l and an HDL level of 1.• an HDL cholesterol level above 1 mmol/l. You need to aim for this figure to be below 4. So your doctor will not usually make a decision about whether to prescribe cholesterol-lowering medicines for you until he or she has a series of these readings.75. they work out the ratio of your total cholesterol to your HDL cholesterol level. Doctors can use your cholesterol measurements to assess your risk of coronary heart disease. 10 | British Heart Foundation . if you have a total cholesterol of 4. your ratio would be 4. which equals 3.) The higher your ratio is. To do this.7 mmol/l.2 mmol/l. You can work this out by dividing your total cholesterol level by your HDL cholesterol level. the greater your risk of coronary heart disease. (For example.2. and • a triglyceride level under 1.

On page 17 we describe the different types of fats and how to choose the healthier fats to help keep your cholesterol low. On the other hand. and helps to protect against coronary heart disease. Atheroma develops when the level of the ‘bad’ LDL cholesterol is too high. It is important to understand how the different types of fats in foods affect your cholesterol level. and • a high level of HDL cholesterol.What part does cholesterol play in coronary heart disease? Coronary heart disease is caused when the coronary arteries (the arteries that supply the heart muscle with oxygen-containing blood) become narrowed by a gradual build-up of fatty material within their walls. This process is called atherosclerosis. The aim is to have: • a low total cholesterol level • a low level of LDL cholesterol. and the fatty substance is called atheroma. Eating a healthy diet can help to improve your cholesterol levels. Reducing your blood cholesterol | 11 . HDL cholesterol is ‘good’ because it removes excess cholesterol from the circulation.

The other major risk factors are: • • • • • • • smoking having high blood pressure not being physically active enough being overweight or obese having diabetes being of South Asian origin. but it is important to get cholesterol levels down even further. This average level has fallen steadily over the last 10 years. or if you also smoke or 12 | British Heart Foundation . if you have a high cholesterol level and diabetes.3 mmol/l. and having a family history of premature coronary heart disease.) Your overall risk of having a heart attack is much greater if you have a high cholesterol level as well as one or more of the other major risk factors listed above. (This means if a close blood relative of yours developed coronary heart disease before the age of 55 for a man. This means. or 65 for a woman. A high level of cholesterol is one of the most important risk factors for coronary heart disease. for example.When does a high blood cholesterol level matter? The average total blood cholesterol level of adults living in England and Scotland is 5.

Within one year of quitting smoking. or if you are not physically active or are overweight. There is also a greater risk of heart attacks among people who have familial hypercholesterolaemia – an inherited condition in which the blood cholesterol level is very high. The more risk factors you have. For more on this. see page 41. reducing your blood pressure can lower your risk of having a stroke. stop smoking. or kidney failure. you can halve your risk of having a heart attack. • If you have high blood pressure.have high blood pressure. Other important ways to reduce your risk of coronary heart disease As well as following the advice on pages 15 to 39 for reducing your cholesterol level. there are other things you can do to reduce your risk of coronary heart disease. the higher your risk of having a heart attack. a heart attack. • If you smoke. Reducing your blood cholesterol | 13 .

about 1 in every 500 people in the UK has a high cholesterol level because they have an inherited condition called familial hypercholesterolaemia (pronounced ‘hyper-cholesterol-ee-me-ah’) – or FH for short (see page 41). 14 | British Heart Foundation . long-term kidney problems. Some have high cholesterol levels as a result of an underactive thyroid gland.What causes high blood cholesterol? A common cause of high blood cholesterol levels in people in the UK is eating too much saturated fat. However. or having too much alcohol. Also. some people have high blood cholesterol levels even though they eat healthily.

Here are some examples of how you can start to include physical activity in your daily routine. • Climb the stairs rather than use the lift. It can also help lower your blood pressure. It’s important to build up gradually the amount of activity that you do. Reducing your blood cholesterol | 15 . Being active can increase the level of HDL cholesterol (the ‘good’ cholesterol). • Get off the bus or train a stop early and walk the rest of the way. help you to maintain a healthy weight. To get the most benefit. you need to be active enough to make you feel warm and slightly puffed but still able to have a conversation.How can physical activity help improve my cholesterol level? Doing regular physical activity – for example. or in shorter bouts of at least 10 minutes at a time. You can do the 30 minutes all in one go. brisk walking or cycling – for 30 minutes a day on at least five days a week can help improve your cholesterol level. and reduce your risk of getting diabetes. • Walk rather than use the car.

For more about how to get more active. see our booklets Physical activity and your heart and Get active. stay active! 16 | British Heart Foundation .

as well as helping to lower your cholesterol. it can help protect against high blood pressure. But it’s important to remember that. Choosing healthier fats Foods containing fat are made up of a combination of saturated fats. • Reduce the total amount of fat you eat – especially if you are overweight. Choosing healthier fats can help Reducing your blood cholesterol | 17 . • Cut right down on saturated fats and replace them with monounsaturated fats and polyunsaturated fats. monounsaturated fats and polyunsaturated fats. making healthy changes to your diet benefits your heart health in many other ways. To help improve your cholesterol level you need to do the following.How can healthy eating help improve my cholesterol level? Changing to a healthier diet can help reduce your cholesterol levels by over 10%. Some people may find that healthy eating has a greater effect on their cholesterol level than other people. On page 20 we give examples of foods that contain all these different types of fats. diabetes and putting on weight. For example.

For example. Trans fats produced in this way have a similar effect to saturated fat. pastries and some margarines. Foods that have ‘hydrogenated oils’ or ‘hydrogenated fat’ in the list of ingredients are likely to contain trans fats. These fats are most likely to be found in processed foods like biscuits and cakes. crisps and biscuits. as they can increase your LDL cholesterol and reduce HDL cholesterol. cut down on foods such as pastries. What are trans fats? Trans fats occur naturally in small amounts in dairy foods and meat. it is the industrially produced trans fats which have been linked to an increased risk of coronary heart disease. • Avoid foods containing trans fats wherever possible. and replace them with healthier alternatives such as fruit or vegetables. 18 | British Heart Foundation . fast food. Industrially produced trans fats are formed when vegetable oils are processed into solid fat through a process called hydrogenation.protect your heart. However. but remember that all fats are high in calories.

They can also help to lower blood triglyceride levels.• Eat oily fish regularly. Reducing your blood cholesterol | 19 . help prevent the blood from clotting. Eating oily fish can also help to improve your chance of surviving after a heart attack. For more about oily fish and omega-3 fats. Oily fish provide the richest source of a particular type of polyunsaturated fat known as omega-3 fats. and help keep the heart rhythm regular. see page 22.

sunflower oil and soya oil • olive oil and rapeseed oil • avocado • nuts and seeds (almonds. • nuts and seeds (walnuts. Unsaturated fats Monounsaturated fats Which foods are these fats found in? Found in: Polyunsaturated fats Found in: • corn oil. peanuts and pistachios). Some spreads are made from monounsaturated fats. sesame seeds and sunflower seeds).Choosing healthier fats To help reduce your cholesterol level. 20 | British Heart Foundation . hazelnuts. cashews. you need to cut down on saturated fats and trans fats and replace them with monounsaturated and polyunsaturated fats. Omega-3 fats are good for your heart too. Some spreads are made from polyunsaturated fats. pine nuts.

See page 22 for more about omega-3 fats from sources other than fish. Reducing your blood cholesterol | 21 .Saturated fats Omega-3 fats Found in: Saturated fats Found in: Trans fats Found in: • • oily fish such fish oil as herring. sardines. • • • • • • • • • • • • • • • butter hard cheese whole milk fatty meat meat products biscuits cakes cream lard dripping suet ghee coconut oil palm oil pastry • • • • • • • pastries cakes biscuits crackers fried foods takeaways hard margarines. trout and fresh tuna. Foods that have ‘hydrogenated oils or fats’ or ‘partially hydrogenated oils or fats’ in the list of ingredients are likely to contain trans fats. pilchards. mackerel. salmon.

However. soya and walnut oils. rapeseed. Try to eat a variety of fish and. unsalted nuts such as walnuts. If you have had a heart attack. such as those carrying the Marine Stewardship Council (MSC) logo. dark green vegetables. These include flaxseed. trout and fresh tuna are good sources of omega-3 fats. (This means that the fish come from fisheries that aim to secure fish stocks for the future and help to protect the marine environment.) If you don’t like oily fish. Omega-3 supplements are only prescribed for people who have recently had a heart attack and who cannot eat 22 | British Heart Foundation . if possible. we don’t yet know for certain if the omega-3 fats in these foods bring exactly the same benefits as the omega-3 fats from oily fish. one of which should be oily fish. soya beans and tofu. choose those that are ‘sustainably sourced’.) Otherwise you should aim to have 2 portions of fish a week. salmon. pecans. you can get omega-3 fats from vegetable sources. There are also foods which have been enriched with omega-3 such as some eggs. (1 portion of oily fish = 140 grams or half a medium can of fish. peanuts and almonds. aim to have 2 to 3 portions of oily fish a week. sardines.Oily fish and omega-3 fats Oily fish such as herring. pilchards. sweet potatoes and wholegrain foods. mackerel. milk and yoghurts.

How do the different types of fat in foods affect my cholesterol levels? Saturated fats can increase total cholesterol and LDL cholesterol. The omega-3 fats found in oily fish can help to reduce triglyceride levels in the blood. Polyunsaturated fats are an essential part of the diet. Before taking fish oil supplements that have not been prescribed for you. Reducing your blood cholesterol | 23 . Monounsaturated fats can lower the LDL level and don’t lower the level of HDL cholesterol (the ‘good’ cholesterol). They can help lower LDL cholesterol (which is a good effect). it’s important to talk to your doctor or dietitian about whether you should take them. LDL cholesterol increases the risk of fatty deposits developing in your arteries. but they also lower HDL cholesterol (the ‘good’ cholesterol). Trans fats can increase LDL cholesterol and lower HDL cholesterol.2 to 3 portions of oily fish a week.

lentils and chickpeas. shellfish such as prawns and fish roes (fish eggs) – does not usually make a great contribution to the level of cholesterol in your blood. and certain fruit and vegetables like apples. pulses such as baked beans. Other ways to improve your cholesterol levels Eat more high-fibre foods Foods high in fibre – especially those high in soluble fibre – help to lower total and LDL cholesterol by reducing the amount of cholesterol that is absorbed into the bloodstream from your intestine. you will need to be more careful about the amounts of foods you eat which are high in cholesterol. If you need to reduce your cholesterol level. peas. if you have FH (see page 41). it is much more important that you eat foods that are low in saturated fat. However. kidney beans. soya beans.What about the cholesterol found in foods? The cholesterol found in some foods – such as egg yolk. barley. Talk to your doctor or a dietitian for advice on these foods. 24 | British Heart Foundation . Good sources of foods that are high in soluble fibre include oats. pears. which can be helpful if you are trying to lose weight. Foods that are high in fibre also help to fill you up. artichokes and sweet potato. liver and kidneys.

5 grams of plant stanols and sterols a day can lower cholesterol by an extra 10% on top of having a healthy diet low in saturated fat and taking a statin (a cholesterol-lowering medicine). follow the manufacturer’s serving instructions to make sure you have the recommended amount of stanol or sterol a day.What about using foods with added plant stanols and sterols? Plant stanols and sterols are substances which have been added to certain foods including some types of margarines. soft cheeses and yoghurt. spreads. there is some evidence that eating between 2 grams and 2. and they’re not suitable for women who are pregnant or breastfeeding. If you decide to use these products. it’s important to remember that plant stanols and sterols are not a substitute for a healthy diet. Although they are not routinely recommended. However. Reducing your blood cholesterol | 25 . You can have these foods containing stanols and sterols as well as taking any cholesterol-lowering medicines your doctor has prescribed for you. And they’re not a replacement for cholesterol-lowering medicines. Plant sterol or stanol products are not recommended for adults who don’t have a high cholesterol level.

such as omega-3 fats and antioxidants. but they also contain other nutrients that are good for heart health. antioxidants and protein. nuts and seeds also contain a lot of calories. Have some soya Soya products include soya milk and yoghurts. tofu. which may help to lower your cholesterol. soya nuts and soya beans. They are naturally low in saturated fat and a good source of soluble fibre. miso. cholesterol. wholemeal bread. Try to choose wholegrain versions for half of the starchy carbohydrates you eat – for example. See page 20 for examples of healthy nuts. Choosing soya. choose brown rice.Enjoy a range of unsalted nuts and seeds Unsalted nuts and seeds contain healthy unsaturated fats. antioxidants and fibre. barley. 26 | British Heart Foundation . and LDL. However. rice and oats are not only good sources of cholesterol-lowering soluble fibre. which can help lower total. wholemeal pitta and wholegrain cereals. textured soya protein. particularly as a replacement for meats or other foods that are high in saturated fat. is likely to be good for your heart. so keep to the recommended one handful (30 grams or about 1 ounce) of unsalted nuts a day. Choose more wholegrains Wholegrains such as wheat.

chilled. Eating more fruit and vegetables also means there is less room in your diet for other foods that are high in saturated fat. Fresh. it is also important to eat well and protect your heart generally. and 100% juice. see our booklet Eating well. Reducing your blood cholesterol | 27 . There is evidence that people who eat more than 5 portions of fruit and vegetables a day have a lower risk of heart disease. which make them an important part of a healthy. canned and dried fruit and vegetables. What we do know is that they contain fibre and a variety of vitamins and minerals. You can do this in the following ways. We still need to do more research to find out why this is.Other important ways to eat well to protect your heart While it is important to lower your cholesterol level. Taking dietary supplements doesn’t seem to have the same health benefits as eating fruit and vegetables. balanced diet. frozen. salt and sugar. all count. For more information on fruit and vegetables. Eat more fruit and vegetables Aim to have at least 5 portions of a variety of fruit and vegetables every day.

herbs. Lowsalt alternatives may not be suitable for some people. such as eating healthily and being physically active (see pages 17 and 15). Men should drink no more than 3 to 4 units of alcohol each day. and women no more than 2 to 3 units each day. for example those with kidney problems or heart failure. stroke and some types of cancer. which is linked to heart disease and stroke. Drink alcohol within the sensible limits Drinking moderate amounts of alcohol can offer some benefit to heart health as it can raise HDL cholesterol (the ‘good’ cholesterol). high blood pressure. garlic or spices to add flavour to your food instead. Use extra pepper. Drinking more than the sensible limits of alcohol can lead to muscle damage. Try not to add salt to your food. see our booklet Blood pressure.Cut down on salt Eating less salt can lower your risk of getting high blood pressure. So check with your doctor before using these products. Choosing more fresh foods rather than ready meals or processed foods will also help you cut down on salt. For more information. 28 | British Heart Foundation . But you can achieve the same benefit in other ways.

If you’re not sure whether you are overweight or if your body shape puts your health at risk.Be a healthy body weight and shape Being overweight and carrying too much weight around your middle – that is. For more information on how to lose weight. having a waist size of more than 94 centimetres (about 37 inches) for men. see our booklet So you want to lose weight … for good. ask your doctor or practice nurse. Reducing your blood cholesterol | 29 . or 80 centimetres (about 31½ inches) for women – can put you at greater risk of developing heart problems. 90 centimetres (about 35½ inches) for men of South Asian origin. high blood pressure and diabetes.

HDL and LDL levels. the more likely it is that your doctor will recommend cholesterol-lowering medicines for you. if you have high blood pressure or if you smoke • • • • if you have familial hypercholesterolaemia (FH) if you have had a heart attack or stroke if you have angina or peripheral arterial disease. particularly if you also have other risk factors – for example. but also on your overall risk of coronary heart disease and whether you have the inherited condition familial hypercholesterolaemia (FH). such as statins: • if you have diabetes • if you have high blood cholesterol levels. So your doctor is likely to prescribe cholesterol-lowering medicines.Will I need to take medicine? Whether you need to take cholesterol-lowering medicine or not depends not just on your total cholesterol. Doctors prescribe cholesterol-lowering medicines for people who are at greatest overall risk of suffering from coronary heart disease. or if you have had bypass surgery or angioplasty. The higher your risk of coronary heart disease. People with this condition have very high blood cholesterol levels from birth (see page 41). 30 | British Heart Foundation .

or 65 for a woman). We explain more about the different types of cholesterol-lowering medicines on pages 33 to 39. For example.Even if you don’t have high cholesterol levels. if you have high blood pressure. There are various sets of guidelines to help doctors decide whether to recommend that you take cholesterol-lowering medicines. for example. if you smoke. Your age is also relevant. as your risk of coronary heart disease and stroke usually increases with age. if you have a combination of major risk factors for coronary heart disease. such as statins. These include. someone with low cholesterol levels but with several major risk factors might be given statins. a person with a slightly higher cholesterol level but with no other risk factors might not be treated with cholesterol-lowering medicines. as women before the menopause have some protection from hormones. All of this means that people with a wide range of cholesterol levels may be treated with cholesterol-lowering medicines. On the other hand. Reducing your blood cholesterol | 31 . your doctor may still feel that you will benefit from taking cholesterol-lowering medicines. if you have a strong family history of coronary heart disease (if a close relative developed coronary heart disease before the age of 55 for a man. Your sex is relevant too. or if you are of South Asian origin.

32 | British Heart Foundation . talk to your doctor or nurse and discuss any changes you could make to your lifestyle to reduce your risk. and you don’t have angina and you haven’t had a heart attack. If you are concerned about being at risk. However. Stopping smoking. taking regular physical activity. eating a healthy diet. Currently there is no recommendation that people should take a statin as ‘primary prevention’. if you are not at risk of getting coronary heart disease or having a stroke.Cholesterol-lowering medicines are a long-term and effective treatment. controlling your weight and making sure your blood pressure is normal. This includes getting your lifestyle right as well as taking cholesterol-lowering medicines. will all help. your doctor will probably not prescribe statins for you as a way of preventing heart disease. This means that. it is important to lower your overall risk of coronary heart disease as much as possible.

or who have diabetes. and LDL levels by more than 30%. Reducing your blood cholesterol | 33 . This is why most people who are at high risk of coronary heart disease. For people who are already at high risk of having a heart attack.How can medicine help? Statins The main type of medicine used to reduce cholesterol levels is statins. are prescribed a statin drug even if they have a normal cholesterol level. Statins can help to stabilise the atheroma (the build-up of fatty deposits) within the lining of the arteries and so reduce your risk of having a heart attack or stroke. the benefits of taking statins are likely to outweigh the possible risk of side effects. stroke or peripheral arterial disease. Statins can reduce total cholesterol levels by more than 20%. Overall. There are several statins available in the UK. they can reduce the risk of having a heart attack or stroke by about a quarter. Your doctor will choose the best statin and dose for you. Many of these have been tested in long-term trials that have looked not just at the cholesterol levels they produce but also at their effect on health and long-term safety.

if you’re taking another type of statin. Most statins should be taken in the evening. if your doctor is planning to change your statin. you can take atorvastatin and rosuvastatin at any time that has been prescribed for you. Your doctor may change your statin if it does not help to lower your cholesterol level as much as it needs to. talk to your doctor or pharmacist. If you are taking the statin drug simvastatin. If you’re already taking statins. However. and are thinking of starting a family. you should have a blood cholesterol test and liver function tests before and after the change. 34 | British Heart Foundation .depending on your medical history and your target cholesterol level. because our bodies make most of our cholesterol at night. However. This will help to make sure that the new medicine works well for you. However. you may be able to have small quantities of grapefruit juice (or grapefruit). you should speak to your doctor before stopping your medicines. Statins are not suitable for people who have liver disease or for women who are pregnant or breastfeeding. If you have any questions about statins and grapefruit. you should avoid drinking grapefruit juice or eating grapefruit.

Possible side effects of statins Side effects of statins can include feeling sick. Reducing your blood cholesterol | 35 . he or she will ask you about your risk factors for heart disease – such as whether you smoke. If you have any unexpected muscle pain. or the dose. Over-the-counter statins These are statins that people can buy from their local pharmacist’s without a prescription from a doctor. you should tell your doctor. and they are not suitable for everyone. They will also tell you if you need to have regular blood tests to check that your liver and kidneys are working properly. being sick. tenderness or weakness. Before giving you any advice. Your pharmacist will be able to tell you whether these medicines are suitable for you. or have high blood pressure. They are not a substitute for adjusting your lifestyle to reduce your cholesterol. A rare side effect of statins is inflammation of the muscles (myositis). diarrhoea and headaches. He or she may change the type of statin you are taking.

Many of these medicines act by preventing the intestine from absorbing cholesterol. or as well as.Other cholesterol-lowering medicines There are other types of medicines which can be used to control blood cholesterol levels either instead of. You will not usually be given fibrates if you are also taking statins (see page 33). They may also be used with other medicines to lower your cholesterol if you cannot take statins. except under strict medical supervision. Medicines which bind bile acids These medicines (which are also called ‘bile-binding medicines’ or ‘bile-acid-binding resins’) work by 36 | British Heart Foundation . These are: • • • • fibrates medicines which bind bile acids nicotinic acid medicines. Fibrates Fibrates are useful for people who have a high level of triglycerides. and ezetimibe. statins. You should not use fibrates during pregnancy. This in turn prevents cholesterol entering the bloodstream and raising blood cholesterol levels. or if you have liver or kidney disease.

but most people gradually get used to this. which the liver makes from cholesterol.preventing the bile acids. These medicines are not absorbed into the body. so they can also be used safely by children and pregnant women. D. You have to soak some types in fruit juice before you take them. Others are already mixed with fruit flavouring and you just need to add water. you will need to take them at least one hour before. Reducing your blood cholesterol | 37 . in sachets. They may make you feel fuller than usual at first. E and K). but this is more likely with larger doses. If you also take other medicines. They come in powder form. your bile-acid-binding medicines. or four hours after. You should take these medicines immediately before or during a meal. These medicines can also interfere with the absorption of fat-soluble vitamins (vitamins A. from getting re-absorbed into the bloodstream. so your doctor may advise you to take vitamin supplements. Possible side effects Some people who take these medicines may get heartburn or constipation.

which also contains an antihistamine. More research is needed to confirm the 38 | British Heart Foundation . Ezetimibe Ezetimibe is another type of cholesterol-lowering medicine. Ezetimibe helps to lower blood cholesterol levels by preventing the small intestine from absorbing cholesterol. a new preparation. Or. taking nicotinic acid can lower your blood pressure further. Ezetimibe can help reduce LDL cholesterol by about 20%. If you are also taking medicines to reduce your blood pressure. It can be used along with a statin. However. and if it is combined with low-dose statins it can be even more effective. people who can’t take statins can take ezetimibe on its own. Possible side effects Common side effects of these medicines are flushing of the face and itching over the body.Nicotinic acid medicines Nicotinic acid medicines help to lower LDL levels and increase the level of ‘good’ HDL cholesterol. You should discuss this with your doctor before taking nicotinic acid. can reduce these effects as far as possible. or if you have low blood pressure.

control your weight. tell your doctor about them so that he or she can make sure that they don’t interfere with any other medicines you are taking. For more information on cholesterol-lowering medicines. pain in the abdomen and diarrhoea. Medicines which reduce triglyeride levels (fish oils) If you regularly eat oily fish. If you’re taking fish oils which have not been prescribed for you. Reducing your blood cholesterol | 39 . such as warfarin. and limit how much alcohol you have and yet you still have a high triglyceride level. your doctor may prescribe fish oils for you. see our booklet Medicines for your heart.long-term benefits of this medicine. Possible side effects Side effects of ezetimibe include headaches.

How your support helps Over recent decades. and it is now thought that they save over 10. thanks to our supporters. For example. Millions of people are now benefiting from using statins. 40 | British Heart Foundation . the BHF part-funded one of the world’s largest research trials of cholesterol-lowering medicines for people known to be at high risk of heart disease.000 lives a year in England alone. See page 2 for how to make a donation. We need your support to continue our research so that heart and circulatory disease is no longer a major cause of disability in the UK. research funded by the BHF has contributed to a substantial reduction in the number of people dying from heart attacks and strokes.

Familial hypercholesterolaemia (FH) What is familial hypercholesterolaemia? About 1 in 500 people in the UK have inherited a high blood cholesterol level due to a condition called familial hypercholesterolaemia.7 mmol/l in children. see our booklet Familial hypercholesterolaemia. Children and young women may have lower levels. The way LDL cholesterol is removed from the blood circulation works only about half as effectively as normal. and sometimes much higher.5 and 12 mmol/l. but the level is usually above 6. You can also get more information on FH from: Heart UK – The Cholesterol Charity 7 North Road Maidenhead Berkshire SL6 1PE Reducing your blood cholesterol | 41 . So. or FH for short. how it is inherited and the treatment for it. For more information For more information on FH. the blood cholesterol levels are high from birth. In people with FH. an adult with FH may have a total cholesterol level of between 7.

heartuk.) Website: www. Calls are charged at a local rate.org.org. 10am to 3pm.Helpline: 0845 450 5988 (Monday to Friday.uk 42 | British Heart Foundation .uk Email: ask@heartuk.

uk. Genetic Information Service 0300 456 8383 (a similar cost to 01 and 02 numbers) For information and support on inherited heart conditions. Our booklets are free of charge.) Reducing your blood cholesterol | 43 . the BHF and its services. Booklets and DVDs To order our booklets or DVDs: • call the BHF Orderline on 0870 600 6566.uk For up-to-date information on heart disease.uk/publications You can also download many of our publications from our website. or • visit bhf. but we would welcome a donation.org.org. Heart Helpline 0300 330 3311 (a similar cost to 01 and 02 numbers) For information and support on anything heart-related. For a list of resources available from the BHF. or • email orderline@bhf. (See page 2 for how to make a donation. ask for a copy of Our heart health catalogue.For more information British Heart Foundation website bhf.org.

The other titles in the series are as follows.Heart Information Series This booklet is one of the booklets in the Heart Information Series. Angina Atrial fibrillation Blood pressure Cardiac rehabilitation Caring for someone with a heart condition Coronary angioplasty Diabetes and your heart Having heart surgery Heart attack Heart rhythms Heart transplantation Heart valve disease Implantable cardioverter defibrillators (ICDs) Keep your heart healthy Living with heart failure Medicines for your heart Pacemakers Peripheral arterial disease Physical activity and your heart Reducing your blood cholesterol Returning to work with a heart condition Tests for heart conditions 44 | British Heart Foundation .

contact Heartstart at the British Heart Foundation. A short version. My progress card. including heart matters magazine.uk/heartmatters or call 0300 330 3300 (a similar cost to 01 and 02 numbers). is also available. Heart Matters Heart Matters is the BHF’s free. You can use it to keep a record of important information. a Heart HelpLine and an online members’ area with articles. personalised service to help you live with a healthy heart. recipes and lifestyle tips. and work through it with your health professional. You can order a copy from the BHF (see page 43). and to chart the progress you are making in tackling your risk factors for coronary heart disease. two-hour course in emergency life-support skills. The course teaches you to: • recognise the warning signs of a heart attack • help someone who is choking or bleeding Reducing your blood cholesterol | 45 .My progress record This is a personal health record for people with a heart condition. Emergency life-support skills Heartstart For information about a free. Join today and enjoy the benefits. You can join online at bhf.org.

• deal with someone who is unconscious • know what to do if someone collapses. and • perform cardiopulmonary resuscitation (CPR) if someone has stopped breathing and his or her heart has stopped pumping. 46 | British Heart Foundation .

The ‘good’ cholesterol. High-density lipoprotein. A type of fatty acid that acts like saturated fats. A type of polyunsaturated fat found in certain types of fish. When the walls of the arteries become narrowed by a gradual build-up of fatty deposits called atheroma. The ‘bad’ cholesterol. Millimols per litre. An inherited condition in which the blood cholesterol level is very high. Combinations of cholesterol and proteins. Reducing your blood cholesterol familial hypercholesterolaemia HDL LDL lipids lipoproteins mmol/l omega-3 fat trans fats | 47 . Low-density lipoprotein. A fatty substance mainly made in the body by the liver.Technical terms atheroma cholesterol coronary heart disease Fatty deposits that can build up within the walls of the arteries. Fatty substances in the blood. Unit used for measuring cholesterol and other fats in the blood.

triglycerides A type of fatty substance found in the blood. 48 | British Heart Foundation .

..............................................5 in foods ........................9 diet .................. 23 nicotinic acid medicines ...............................................................................................................................................38 familial hypercholesterolaemia ...........................37..38 Reducing your blood cholesterol | 49 ...............................................................6 lipids ................................30...................................................................Index bile-acid-binding medicines ......12....................................................................14..................................................................................................................................................................................................................................................................................................................................................................................................................................24 ezetimibe ....................9 test ..14...................................................5 medicines .........36 blood pressure .................................................................... 27 causes of high blood cholesterol ........................................................................................................................................................................................................................24 measurement of .............. 20............................................................................17 FH .................... 41 fibrates .....................................................9 role in coronary heart disease ................................................................. 39 HDL ...................................................17 eggs ...................................................................................... 41 cholesterol ........................................................................................................................................................36 fish oil supplements ...............6 healthy eating ........................................23.................................................... 41 fats ................... 14 children ............... 33 monounsaturated fats ...............................................................................................................17...................................17 LDL ................................................................................................................................................................11 targets ................................................................................

.......................................................................................18................................35 physical activity ............20 Have your say We would welcome your comments to help us produce the best information for you...................................................................... 50 | British Heart Foundation ............. 20........................................... Why not let us know what you think? Contact us through our website at bhf.............................................................21.................uk/contact......... 13 stanols ................................................................ Or...............................7.................... 23 over-the-counter statins .........org........................................................................... 23 triglycerides .............12.................................. 22 omega-3 fats ....................25 statins ............................23....................... 22......................................................................................................................................................... 8 unsaturated fats .............................................................. 21.......................... 21...............................................................15 polyunsaturated fats ........... 37 saturated fats .......17.................................................oily fish ...................................................... 23 pregnancy ................................................. 17...................... write to us at the address on the back cover........34....................30........ 39 thyroid gland ..........................................18............... 33 sterols .......14 trans fats ........................................25 supplements: fish oil supplements. 23 smoking .............................................................14..............................................................................

Lipid Specialist Nurse. Imperial College Healthcare NHS Trust. and all the patients who commented on the text and design. cardiologists and nurses who helped to develop the booklets in the Heart Information Series.Acknowledgements The British Heart Foundation would like to thank all the GPs. . Particular thanks for their work on this booklet are due to: • Clare Neuwirth. Edited by Wordworks. This booklet was last updated in July 2011.

org.org. we have been the nation’s heart charity. registered charity in England and Wales (225971) and in Scotland (SC039426) Print code: xxxx . dedicated to saving lives through pioneering research.uk Heart Helpline 0300 330 3311 bhf.2011 is the British Heart Foundation’s 50th birthday. Phone lines open 9am to 5pm Monday to Friday. Because together we can beat heart disease. campaigning for change and by providing vital information. 6353 bhf. Similar cost to 01 or 02 numbers. British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW T 020 7554 0000 F 020 7554 0100 HIS03/0711 © British Heart Foundation 2011. But we urgently need your help. patient care. Since 1961.uk Information & support on anything heartrelated. We rely on your donations of time and money to continue our life-saving work.