Why Checking Your Cholesterol Regularly Could Be the Simplest Thing You Do for Your Health

More than 40 per cent of adults with elevated cholesterol have no idea their levels are too high. A simple, inexpensive blood test could change that — and potentially everything that follows.

Here is a number that should stop you in your tracks: more than 40 per cent of adults with elevated cholesterol have absolutely no idea their levels are too high. That finding, published in JAMA Cardiology in 2023, means that tens of millions of people — including a very large number here in the United Kingdom — are walking around with a significant, treatable risk factor for heart attack and stroke, and they have never been told about it, because they have never been tested.

Cardiovascular disease remains the single largest killer on the planet. In 2023, it claimed an estimated 19.2 million lives globally, according to the Global Burden of Disease study published in the Journal of the American College of Cardiology. Here in the UK, the British Heart Foundation estimates that 7.6 million people are currently living with heart and circulatory diseases. CVD is responsible for roughly one in four premature deaths — those occurring before the age of 75 — and claims one life every three minutes, on average, across the country.

Among the handful of modifiable risk factors that drive this epidemic — along with high blood pressure, dietary patterns, and air pollution — elevated LDL cholesterol consistently ranks near the top. And yet, unlike many other threats to your health, this one can be identified with a straightforward blood draw that takes less than ten minutes and costs very little. Through the NHS, it often costs nothing at all.

This article explores what cholesterol actually is, why it matters far more than most people realise, what the latest clinical guidelines from NICE, the NHS, and the European Society of Cardiology recommend, and — perhaps most importantly — why making a habit of regular screening may be one of the most powerful and uncomplicated things you do for your long-term wellbeing.

What Cholesterol Actually Is — and Why Your Body Needs It

Before diving into the reasons you should be checking your cholesterol regularly, it is worth clearing up a common misconception: cholesterol is not inherently bad. In fact, your body depends on it.

Cholesterol is a waxy, fat-like substance found in every cell of your body. Your liver produces most of it — roughly 80 per cent — while the remaining portion comes from animal-derived foods such as meat, eggs, and dairy. It plays a critical role in several biological processes. Your body uses cholesterol to build and maintain cell membranes, produce essential hormones including oestrogen, testosterone, and cortisol, synthesise vitamin D when your skin is exposed to sunlight, and manufacture bile acids in the liver that help you digest dietary fats.

Without cholesterol, you could not survive. The trouble arises only when there is too much of a certain kind circulating in your bloodstream.

The cast of characters: LDL, HDL, triglycerides, and the rest

Because cholesterol is a fatty substance, it cannot dissolve in blood. Instead, it travels through your arteries packaged inside proteins called lipoproteins. A standard lipid panel — the blood test used to measure your cholesterol — typically reports several key numbers. In the UK, cholesterol is measured in millimoles per litre (mmol/L).

LDL cholesterol is the number that typically gets the most clinical attention. When you have too much of it in your blood, it can lodge in the walls of your arteries and, over time, combine with other substances to form deposits known as plaque. This process — called atherosclerosis — gradually narrows and stiffens your arteries, restricting blood flow and raising the risk of heart attack, stroke, and peripheral artery disease.

What makes LDL particularly dangerous is its stealth. Dr Seth Martin, a preventive cardiologist at Johns Hopkins Medicine, has described it clearly: very high cholesterol levels can occasionally cause visible cholesterol deposits in the eyes or tendons, but the vast majority of people with elevated cholesterol will notice absolutely nothing until a cardiovascular event occurs. In most cases, a blood test is the only reliable way to catch it.

The Silent Epidemic: Why So Many People Don’t Know Their Numbers

The research on awareness gaps is striking — and sobering.

The landmark 2023 study published in JAMA Cardiology, led by researchers from institutions across the United States, Pakistan, and Egypt, analysed data from the National Health and Nutrition Examination Survey (NHANES) covering more than 23,000 participants between 1999 and 2020. Among those with LDL cholesterol levels between 4.1 and 4.9 mmol/L — a range where pharmacotherapy may be appropriate — 42.7 per cent were both unaware of their condition and untreated as of the most recent survey period. Among those with levels of 4.9 mmol/L or higher, where guidelines clearly indicate drug treatment, 26.8 per cent remained unaware and untreated.

A more recent analysis, published in 2025 by researchers from the Smith Centre for Outcomes Research at Beth Israel Deaconess Medical Centre and Harvard Medical School, confirmed that the problem persists. Their assessment found that one in four young adults were unaware of having high cholesterol, a finding they described as especially concerning because early adulthood is precisely when identification and intervention can have the greatest impact over a lifetime.

The UK Picture: A Growing Concern Closer to Home

While much of the epidemiological data on cholesterol awareness comes from the United States, the situation in the United Kingdom is far from reassuring. The British Heart Foundation estimates that around 7.6 million people in the UK are living with heart and circulatory diseases. Cardiovascular disease causes approximately one in four premature deaths — those occurring before the age of 75 — and, according to data from the Office for Health Improvement and Disparities, the premature mortality rate from circulatory diseases in England has actually been rising since 2019, reaching 77.8 per 100,000 in 2022 after decades of steady decline.

In January 2024, the British Heart Foundation reported that over 39,000 people in England died prematurely from cardiovascular conditions — including heart attacks, coronary heart disease, and stroke — in 2022 alone. Premature deaths from CVD had reached their highest level in 14 years, reversing progress that had been made since the turn of the century. The BHF attributed this, in part, to a lack of meaningful government action on prevention over the preceding decade, combined with growing pressure on NHS services.

Data from the Health Survey for England paints a detailed picture of how common elevated cholesterol is across the population. In the 35-to-44 age group, 63 per cent of men and 40 per cent of women had total cholesterol of 5.0 mmol/L or higher. In the 45-to-54 bracket, those figures rose to 63 per cent for men and 69 per cent for women. For the 55-to-64 age group, 58 per cent of men and 76 per cent of women exceeded that threshold. These numbers suggest that elevated cholesterol is the norm, not the exception, among middle-aged adults in England — and many of those affected have never been told.

Several factors contribute to this awareness gap. High cholesterol produces no pain, no visible symptoms, and no obvious warning signs in the vast majority of cases. Many adults — particularly younger men, those in deprived communities, and people who rarely visit their GP — may not have had their cholesterol checked in years, if ever. The NHS Health Check programme, which invites adults aged 40 to 74 for a free cardiovascular risk assessment every five years, provides an important safety net, but uptake remains patchy and the programme does not reach everyone.

The consequences of this silence can be devastating. As Dr Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York, has noted, atherosclerosis is a systemic disease affecting blood vessels throughout the body. By the time it manifests as a heart attack or stroke, the underlying damage may have been accumulating for decades.

What the Latest Guidelines Say: The 2025 Landscape

Clinical guidelines around cholesterol testing and treatment have evolved significantly in recent years, and 2025 has been a particularly active period for updates from major medical societies on both sides of the Channel.

What the NHS and NICE recommend

In the UK, the National Institute for Health and Care Excellence (NICE) guideline NG238 provides the framework for cardiovascular risk assessment and lipid modification. NICE recommends a non-fasting lipid profile — measuring total cholesterol, HDL cholesterol, non-HDL cholesterol, and triglycerides — as part of an initial baseline assessment for anyone being evaluated for cardiovascular risk. Your GP will use these results alongside the QRISK score, an algorithm that estimates your 10-year risk of a heart attack or stroke based on factors including age, sex, ethnicity, blood pressure, cholesterol ratio, smoking status, diabetes, and family history.

Under NICE guidance, adults with a 10-year cardiovascular risk of 10 per cent or greater should be offered atorvastatin 20 mg daily for primary prevention. For people with existing cardiovascular disease, NICE recommends atorvastatin 80 mg regardless of cholesterol level, with a target of reducing LDL cholesterol to 2.0 mmol/L or less, or non-HDL cholesterol to 2.6 mmol/L or less. Anyone with a total cholesterol above 9.0 mmol/L or a non-HDL cholesterol above 7.5 mmol/L should be referred for specialist assessment, even without a family history of premature heart disease, as these levels may indicate familial hypercholesterolaemia.

The NHS Health Check, available free to adults in England aged 40 to 74 who do not already have a diagnosed cardiovascular condition, includes a cholesterol test as standard. If you are eligible and have not attended one, it is well worth booking — the check takes around 20 to 30 minutes and can identify risk factors you may not know you have.

The end of fasting: a welcome change

One of the most significant practical changes in recent years has been the shift toward non-fasting lipid panels. For decades, patients were told to fast for eight to 12 hours before a cholesterol test. This requirement often created logistical barriers — people would skip the test because they forgot to fast, or would need to rearrange their schedule around it.

That practice has now changed. NICE does not mandate a fasting sample for routine lipid screening, and non-fasting panels are standard practice across much of Europe. The rationale is sound: since people spend most of their day in a non-fasting state, measuring cholesterol under those conditions provides a more representative picture of what is actually happening in the body. The shift began in Denmark in 2009, was adopted across multiple European laboratory systems, and is now standard in roughly two-thirds of European laboratories. Your GP may still request a fasting sample in specific circumstances — for instance, if your non-fasting triglycerides come back above 4.5 mmol/L — but for most people, fasting is no longer necessary.

This is good news for anyone who has ever postponed a blood test because they could not face the morning without breakfast. The barrier is lower than ever.

Updated European treatment targets

The 2025 European Society of Cardiology and European Atherosclerosis Society guidelines, released in August 2025 at the ESC Congress in Madrid, reaffirmed LDL cholesterol targets based on risk level: below 1.8 mmol/L for high-risk individuals and below 1.4 mmol/L for very high-risk patients, including those with established cardiovascular disease. These European targets are more aggressive than the NICE targets for secondary prevention and reflect a growing consensus that, when it comes to LDL cholesterol, lower is better. The ESC guidelines also gave a strong endorsement to bempedoic acid as a non-statin option and highlighted lipoprotein(a) — Lp(a) — as an important genetically determined risk factor worthy of greater clinical attention.

The National Lipid Association’s most recent guidance reinforced a principle that decades of research support: when it comes to LDL cholesterol, lowering it early, intensively, and sustainably produces the best long-term outcomes. In their words, “lower for longer is better.”

Why Regular Screening Matters More Than a One-Off Test

Knowing your cholesterol at a single point in time is valuable. But the true power of screening lies in repetition — in establishing a pattern and tracking how your numbers change over the years.

Your body is not static

Cholesterol levels are not fixed. They fluctuate based on a complex interplay of genetics, diet, physical activity, weight, age, hormonal changes, medications, and even stress. A person who has a perfectly healthy total cholesterol of 4.5 mmol/L at 30 may find their numbers creeping toward 6.0 mmol/L or beyond by 45, particularly if their lifestyle has shifted — more sedentary work, less exercise, more convenience food, more stress. Women often experience a rise in LDL cholesterol after menopause, as declining oestrogen levels reduce the liver’s ability to remove LDL from the blood. Men, for their part, tend to see cholesterol levels climb earlier, often beginning in their thirties.

Without regular monitoring, these gradual shifts can go undetected for years, allowing plaque to build silently.

Catching risk early changes outcomes

A 2023 study demonstrated that individuals with low short-term cardiovascular risk but elevated 30-year predicted risk had a threefold higher incidence of atherosclerotic cardiovascular disease compared with those whose risk was low across both timeframes. This finding is important because it underscores a crucial reality: even if your QRISK score looks manageable today, the cumulative impact of moderately elevated cholesterol over decades can be profound.

This is precisely why guidelines increasingly emphasise the importance of assessing long-term as well as short-term risk. The earlier you identify a problem, the more time you have to intervene before irreversible damage accumulates.

It provides a baseline for your GP

Regular testing also gives your GP a longitudinal picture of your metabolic health. A single reading is a snapshot. A series of readings over time is a story. That story can reveal trends — gradual increases, sudden spikes, the impact of a lifestyle change or a new medication — that help guide clinical decisions far more effectively than any isolated number.

The Men’s Health Angle: Why This Matters Especially for Men

While cardiovascular disease affects people of all genders, there are specific reasons why men should pay particularly close attention to their cholesterol.

Men tend to develop heart disease roughly 10 years earlier than women, in part because they lack the protective effects of oestrogen on LDL metabolism that premenopausal women benefit from. According to the Office for National Statistics, coronary heart disease was the leading cause of death among men in the UK in 2022. Men are also more likely to experience their first cardiovascular event as a heart attack rather than as a less acute condition like angina.

And yet, research consistently shows that men are among the groups most likely to be unaware of their elevated cholesterol. The NHANES analysis found that younger adults and men had higher rates of being both unaware and untreated. Part of this is cultural: many men are socialised to avoid routine medical appointments, to dismiss health concerns as minor, and to wait until something feels wrong before seeking help. But cholesterol does not announce itself. By the time something feels wrong, the damage may already be extensive.

In England, the NHS Health Check is designed to catch precisely these kinds of silent risk factors — but men are less likely to attend preventive health appointments. Routine cholesterol screening is, in a sense, one of the simplest acts of self-care a man can undertake. It requires no gym membership, no dramatic dietary overhaul, no willpower — just a brief conversation with a GP and a quick blood draw.

What Happens During a Cholesterol Test — and What Your Results Mean

For anyone who has never had a lipid panel or is unsure what to expect, the process is straightforward.

The test itself

A standard lipid panel is a simple blood test. A healthcare professional draws a small sample of blood from a vein in your arm — the process typically takes two to five minutes. As noted above, fasting is no longer required for most routine screenings in the UK, though your GP may still request a fasting panel if your triglycerides are known to be very high.

Results are usually available within a few days. If you have your blood taken at a GP surgery, the results will typically appear in your NHS online health record, and your practice will contact you if anything needs attention.

Reading your results

Your results will typically include total cholesterol, HDL cholesterol, non-HDL cholesterol (which NICE now prefers to LDL for risk assessment), and triglycerides, all measured in mmol/L. Some reports will also include an LDL figure and a total-cholesterol-to-HDL ratio. But interpreting them is not quite as simple as looking at whether each number falls in the “normal” range.

Context matters enormously. Your GP will consider your cholesterol levels alongside your QRISK score and other risk factors: your age, your blood pressure, whether you smoke, whether you have diabetes, your family history, your ethnicity, and your overall cardiovascular risk profile. A total cholesterol of 5.5 mmol/L in a 30-year-old non-smoker with no other risk factors carries a very different clinical significance from the same reading in a 55-year-old man with high blood pressure and a family history of early heart disease.

In some cases, your GP or a specialist may also order additional markers that provide a more granular view of your risk. Apolipoprotein B (ApoB), for instance, is the main protein embedded in LDL and VLDL particles and is considered by many researchers to be a stronger predictor of cardiovascular risk than LDL cholesterol alone. Lipoprotein(a), or Lp(a), is a genetically determined risk factor that the 2025 European guidelines have highlighted as a key area of focus. Neither of these tests is yet standard in routine NHS screening, but they are increasingly available through specialist lipid clinics and private providers, and can be valuable for people whose risk is uncertain based on a standard panel alone.

Emerging markers and advanced testing

The landscape of cardiovascular risk assessment is evolving. Beyond the traditional lipid panel, several additional tools are gaining prominence in clinical practice. Coronary artery calcium (CAC) scoring uses a low-dose CT scan to detect calcified plaque in the coronary arteries and can help refine risk estimates for people who fall into an intermediate category. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that, when elevated alongside high cholesterol, can indicate a heightened risk of cardiovascular events.

These tools are not necessary for everyone, but they illustrate a broader point: the science of cardiovascular risk assessment is becoming more precise, and the starting point for all of it is still that basic lipid panel.

What You Can Do If Your Numbers Are High

If your cholesterol comes back elevated, there is reason for concern but absolutely no reason for despair. High cholesterol is one of the most well-understood and treatable risk factors in all of medicine. The range of interventions is wide, and the evidence behind them is robust.

Lifestyle modifications: the foundation

Regardless of whether medication is required, lifestyle changes form the foundation of cholesterol management. The evidence consistently supports several core strategies. A heart-healthy diet — rich in vegetables, fruits, whole grains, legumes, nuts, and oily fish, and low in processed foods, saturated fats, and added sugars — can meaningfully reduce LDL cholesterol. The NHS Eatwell Guide provides a practical framework, and the Mediterranean diet, in particular, has strong evidence behind it. Regular physical activity — at least 150 minutes per week of moderate-intensity aerobic exercise, as recommended by the NHS — has been shown to raise HDL cholesterol, lower triglycerides, and improve overall cardiovascular health. Maintaining a healthy weight, stopping smoking, moderating alcohol consumption, and managing stress all contribute meaningfully as well.

For people whose cholesterol is only mildly elevated and who have no other major risk factors, lifestyle modifications alone may be sufficient. Guidelines generally recommend a three-to-six-month trial of lifestyle changes before considering medication, provided the clinical risk allows it.

Medications: when lifestyle is not enough

When lifestyle changes alone are insufficient, or when the risk level warrants it, pharmacotherapy becomes essential. Statins remain the first-line treatment and have decades of evidence supporting their ability to reduce both LDL cholesterol and cardiovascular events. They are among the most studied drugs in the history of medicine. In the UK, atorvastatin is the statin of choice recommended by NICE — 20 mg for primary prevention, 80 mg for those with existing cardiovascular disease.

For patients who cannot tolerate statins or who need additional lowering beyond what statins provide, several alternatives are available on the NHS. Ezetimibe works by reducing cholesterol absorption in the intestine and can be added to a statin for greater effect. Bempedoic acid, which received a strong endorsement in the 2025 European guidelines, works along a similar pathway to statins but without some of the muscle-related side effects — an important consideration, given that muscle symptoms are the most commonly cited reason for statin discontinuation. PCSK9 inhibitors — such as evolocumab and alirocumab — and inclisiran, a newer injectable treatment available in the NHS, are highly effective at lowering LDL and are typically reserved for patients at very high risk or those with genetically elevated cholesterol, accessed through specialist lipid clinics.

It is worth acknowledging, as the 2025 ESC guidelines have done, that dietary supplements and vitamins without documented safety and significant LDL-lowering efficacy are not recommended to lower cardiovascular risk. This is not to say that a good diet does not matter — it profoundly does — but rather that specific supplement claims should be approached with appropriate scepticism.

The Bigger Picture: Cholesterol in the Context of Cardiovascular Health

Cholesterol does not exist in a vacuum. It is one piece — an important piece — of a larger cardiovascular puzzle. The American Heart Association’s framework, known as Life’s Essential 8, outlines eight key behaviours and health factors that together define cardiovascular health: not smoking, staying physically active, eating a healthy diet, maintaining a healthy weight, getting adequate sleep, and controlling cholesterol, blood pressure, and blood sugar. The NHS Health Check takes a similarly holistic approach, assessing multiple risk factors in a single appointment.

No single number determines your destiny. But cholesterol is unique among these factors in one important respect: it requires a test to measure. You can observe your own weight, you know whether you smoke, you can estimate your activity levels. But cholesterol is invisible without a blood draw. That is precisely why proactive screening is so important — it illuminates a dimension of your health that would otherwise remain hidden.

The global trajectory adds urgency to this message. Projections published in the European Heart Journal using data from the Global Burden of Disease study estimate that between 2025 and 2050, cardiovascular prevalence will increase by approximately 90 per cent, with an expected 35.6 million cardiovascular deaths annually by 2050, up from 20.5 million in 2025. The primary drivers are population growth, ageing, and continued exposure to modifiable risk factors — prominently including high blood pressure, dietary risks, and high cholesterol. In the UK specifically, the trend of rising premature CVD deaths since 2019, documented by the British Heart Foundation, suggests that the progress made in previous decades is not guaranteed to continue without sustained investment in prevention.

These are not abstract statistics. They represent lives — your colleagues, your neighbours, your parents, potentially you. And the evidence is clear that roughly 80 per cent of the cardiovascular disease burden is attributable to modifiable risk factors. That means the vast majority of these outcomes are, at least in theory, preventable.

Practical Steps: Making Cholesterol Screening Part of Your Routine

The gap between knowing that cholesterol testing is important and actually doing it is where most people get stuck. Here are some concrete, practical suggestions for closing that gap.

Book an NHS Health Check. If you are between 40 and 74 and do not have a pre-existing cardiovascular condition, you are entitled to a free NHS Health Check every five years. It includes a cholesterol test as standard, along with blood pressure, BMI, and a QRISK assessment. Contact your GP surgery to find out if you are due one. Many pharmacies also offer the service.

Talk to your GP. If you are under 40 but have risk factors — a family history of early heart disease, diabetes, high blood pressure, South Asian or African-Caribbean heritage, or if you smoke — ask your GP for a cholesterol check. There is no reason to wait until you are 40 if the clinical picture warrants earlier screening.

Take advantage of non-fasting panels. Since fasting is no longer required for most routine cholesterol screenings, you can schedule your test at any time of day. This eliminates one of the most common excuses for postponing it.

Consider at-home or private testing options. A growing number of services now offer blood test kits that can be completed at home or at a walk-in clinic, with results reviewed by a clinician. While these should not replace a full clinical assessment with your GP, they can be a useful entry point for people who face barriers to visiting a surgery — whether that is a packed work schedule, difficulty getting an appointment, or simply wanting to take a proactive first step. The Coleebri Health platform, for instance, can help you navigate the blood testing process and understand your results in context.

Know your family history. If a parent or sibling developed heart disease before the age of 55 (for men) or 65 (for women), your risk may be higher, and earlier and more frequent screening is warranted. Familial hypercholesterolaemia — a genetic condition that causes very high LDL levels from birth — affects roughly one in 250 people in the UK. NICE recommends that anyone with a total cholesterol above 7.5 mmol/L and a family history of premature coronary heart disease should be assessed for FH. The condition often goes undiagnosed until a cardiovascular event occurs, which makes family-history awareness all the more important.

Set a recurring reminder. If your GP recommends follow-up screening, put it in your calendar. Treat it like an MOT — a routine maintenance check that prevents far more expensive and dangerous breakdowns down the line.

Your Next Step

Understanding your cholesterol is a conversation between you, your blood, and your GP. If it has been more than two years since your last lipid panel — or if you have never had one — make it your next health priority. The test is quick, the information is invaluable, and the potential to change your long-term health trajectory is enormous.

Conclusion: The Simplest Intervention with the Greatest Potential

In a world of complex health advice, expensive supplements, conflicting dietary claims, and an overwhelming amount of wellness noise, there is something refreshingly straightforward about cholesterol testing. It is a proven, inexpensive, widely available blood test — free on the NHS for those who are eligible — that provides objective, actionable data about one of the most significant risk factors for the world’s leading cause of death.

The science has never been clearer. The guidelines have never been more accessible. The barriers to testing — including the old fasting requirement — have never been lower. And the consequences of inaction, as the data unambiguously shows, remain devastatingly high.

Over 40 per cent of people with high cholesterol do not know it. In the UK, the majority of middle-aged adults have total cholesterol above the recommended 5.0 mmol/L. That statistic does not have to include you.

Get tested. Know your numbers. Talk to your GP about what they mean and what, if anything, you should do about them. It may well be the simplest, most impactful thing you do for your health this year.