Silent Killers: Part two

Last month, we explored how hypertension can lurk unnoticed as a major risk factor for cardiovascular events such as heart attacks and strokes. The other silent killer is hypercholesterolaemia: high blood cholesterol levels.

Our blood cholesterol profile is a product of both genetic and environmental factors. We can’t influence our genetics, so some will unfortunately start with an unfavourable hand. In this situation, there is often a stronger family history of cardiovascular problems occurring at a younger age and it is important to see your GP if this applies to you; lifestyle approaches still matter but their impact can be more limited.

We talk about two main types of cholesterol; the healthy high density (HDL) component that is cardioprotective, and the more problematic low density (LDL) component that furs up our blood vessels and confers the added risk. Lifestyle strategies that help to drive down LDL include keeping active, maintaining a healthy weight, stopping smoking and limiting alcohol intake. Dietary strategies are also key, with a Mediterranean style of eating optimal for promoting favourable cholesterol profiles.

As with hypertension, you won’t know what your cholesterol profile is like unless you go looking. NHS health checks are available to those aged 40-74 with no known cardiovascular problems via most GP surgeries. A blood test that includes a check of cholesterol is offered as part of this. If you were concerned about a strong family history, then this can be offered at a younger age

If LDL levels are high, and respond insufficiently to lifestyle approaches, then a range of highly effective medications are available to use as adjuncts. “What about muscle pains?” I hear you say. Interestingly, new studies confirm that side effects have been over-reported. I would therefore encourage you to have a conversation with your primary care team before you’re put off by the sore toe that your neighbour’s aunty experienced after trialling a statin!

Dr Chris Humphrey

Published: Feb 26, 2026