High cholesterol — when statins are considered
Reviewed by the My London Pharmacy clinical team, Zaynab Ali, Pharmacist Independent Prescriber
·29 July 2026
·7 min read
Quick answer
High cholesterol raises the long-term risk of heart disease and stroke. Whether a statin is considered depends less on a single number and more on your overall cardiovascular risk, assessed by a clinician. Lifestyle changes come first, with medication added when the balance of benefit supports it.
What cholesterol is and why it matters
Cholesterol is a fatty substance carried around the body in the blood. It is essential for building cells and making certain hormones, so we all need some, but the balance between different types matters a great deal. Low-density lipoprotein, often called LDL or non-HDL cholesterol, can build up in the walls of arteries, while high-density lipoprotein (HDL) helps carry cholesterol away from the tissues back to the liver. Over many years, raised LDL can contribute to the gradual narrowing and hardening of the arteries, a process that increases the risk of heart attack and stroke.
High cholesterol usually causes no symptoms, so it is often found through a routine blood test rather than because someone feels unwell. That is why it is sometimes described as a silent risk factor, and why understanding your numbers alongside your wider health is so useful. Cholesterol levels are influenced by diet and lifestyle, but also by factors you cannot change, such as your genes, age and family history. Some people inherit a condition called familial hypercholesterolaemia, which causes very high cholesterol from a young age and needs particular attention.
Because cholesterol builds up quietly over years, the aim of checking and managing it is to protect your heart and blood vessels long before any problem develops. Many people first learn their cholesterol is raised at an NHS Health Check, a review for another condition, or a private test. Whatever the route, a single result is only part of the picture, and it is most useful when considered alongside your blood pressure, weight, family history and lifestyle, which together give a fuller sense of your heart health.
What the numbers mean
A cholesterol blood test typically reports total cholesterol, LDL or non-HDL cholesterol, HDL cholesterol and triglycerides, and gives a ratio between total and HDL. Rather than reading any single figure in isolation, clinicians look at the overall pattern. A slightly raised total cholesterol may matter very differently in two people depending on their other risk factors, so the numbers are always interpreted in context rather than against a one-size-fits-all cut-off.
In the UK, clinicians often use a cardiovascular risk calculator that combines your cholesterol with factors such as age, sex, ethnicity, blood pressure, smoking status, family history and existing conditions like diabetes. This produces an estimate of your risk of a cardiovascular event over the next ten years, which helps guide the conversation about whether treatment is worthwhile. Some tests need to be done fasting, and your clinician will tell you if that applies. If a result is unexpectedly high, it is usually repeated and considered alongside your history before any decisions are made.
When statins are considered
NICE guidance frames the decision around cardiovascular risk rather than cholesterol alone. A statin is generally considered when your estimated ten-year risk reaches a certain threshold, or if you already have heart or circulatory disease, chronic kidney disease, type 1 or type 2 diabetes, very high cholesterol, or an inherited cholesterol condition. Statins work by reducing the amount of cholesterol the liver produces, which in turn lowers the level of LDL circulating in the blood.
For people for whom treatment is appropriate, Atorvastatin is one of the commonly used options in the UK, and different doses are chosen depending on whether the aim is to reduce existing disease risk further or to lower a raised level in someone at higher risk. The decision is always individual: a clinician weighs the likely benefit against your preferences, your other medicines and your circumstances, and treatment is offered and discussed rather than assumed. It may be suitable for some people and less so for others, which is exactly why a proper consultation matters before starting.
Lifestyle steps that support healthy cholesterol
Whether or not medication is considered, lifestyle changes remain central and can meaningfully improve your cholesterol profile and overall cardiovascular risk. They are worth maintaining alongside any treatment rather than instead of it, and even modest, consistent changes add up over time.
- Choose unsaturated fats, such as olive and rapeseed oils, nuts and avocado, over saturated fats.
- Eat plenty of vegetables, fruit, wholegrains, beans, pulses and oily fish such as salmon or mackerel.
- Reduce processed and fried foods, pastries and fatty meats that are high in saturated fat.
- Stay physically active, aiming for regular moderate exercise across most weeks.
- Stop smoking, which improves your HDL and lowers overall risk.
- Keep alcohol within recommended limits and aim for a healthy weight.
These steps also support blood pressure, blood sugar and weight, each of which further lowers your cardiovascular risk.
What to expect if a statin is started
If you and your clinician decide a statin is right for you, it is usually taken once a day over the long term, with a blood test to check your response and liver function after starting and periodically thereafter. Most people take statins without difficulty and notice no problems from day to day. Some report muscle aches, and while true statin-related muscle problems are uncommon, any troublesome symptoms should be discussed with your clinician rather than simply stopping the medicine, as often the dose or type can be adjusted.
Statins are not a reason to relax on lifestyle, and they are most effective as part of a broader approach to heart health that includes diet, activity and not smoking. It is also worth mentioning any other medicines or supplements you take, as a few can interact. Regular reviews let your clinician check that treatment is working, that your cholesterol is responding, and that you are comfortable continuing, adjusting the plan where needed.
It is common to have questions about starting a long-term medicine, and these are worth raising, as understanding why a treatment is recommended tends to make it easier to keep up with. Some people worry about taking a tablet indefinitely, while others are keen to do everything they can to lower their risk. There is no single right answer, and the best approach is the one you have agreed with your clinician after weighing the likely benefit against your own preferences and circumstances, with the freedom to revisit that decision at future reviews.
When to seek advice
Speak to a clinician if you have been told your cholesterol is raised, if heart disease or high cholesterol runs in your family, or if you would simply like your cardiovascular risk assessed for peace of mind. A simple blood test and a review of your history and lifestyle can clarify whether treatment is worth considering for you, and can also pick up related issues such as high blood pressure or raised blood sugar.
Seek urgent help for symptoms that could suggest a heart attack or stroke, such as central chest pain or tightness, pain spreading to the arm or jaw, sudden weakness, facial drooping or difficulty speaking, by calling 999 without delay. For everything else, a planned consultation is the best way to understand your numbers, weigh your options and put a sensible long-term plan in place.
High cholesterol is very common and, in itself, is not a reason to be alarmed, but it is a signal worth acting on because the steps that address it also protect your heart and circulation more broadly. Whether the answer for you is lifestyle change alone or lifestyle change alongside a statin, the earlier you understand your risk the more you can do about it. A clinician can help you make sense of the numbers, answer your questions, and support you in choosing an approach that fits your life and gives you confidence about your heart health.
Frequently asked questions
Does high cholesterol cause symptoms?
Usually not. It is typically found on a blood test, which is why routine checks matter, particularly if you have other risk factors or a family history.
Do I definitely need a statin if my cholesterol is high?
Not necessarily. Clinicians base the decision on your overall cardiovascular risk, not one number. Lifestyle changes come first, with medication considered when the benefit supports it.
How do statins work?
Statins reduce the amount of cholesterol your liver produces, lowering LDL levels in the blood. This can reduce the long-term risk of heart attack and stroke for suitable people.
Can I lower cholesterol without medication?
Diet, physical activity, stopping smoking and limiting alcohol can all improve cholesterol. For some people these steps are enough; others may also benefit from treatment after a consultation.
Are muscle aches from statins common?
Many people take statins without problems. Muscle aches can occur, but true statin-related muscle issues are uncommon. Discuss any symptoms with a clinician rather than stopping suddenly.
How often should cholesterol be checked?
It depends on your age, risk and whether you are on treatment. Your clinician will advise, but regular checks help track your numbers and guide any adjustments.