Here’s What You Need To Know About Cholesterol

By Angela Hartley on 17 August 2021

What is Cholesterol?

Cholesterol is a fatty substance found throughout the body. It is essential for synthesizing vitamin D, stress hormones and sex hormones. Cholesterol is also an important part of bile, required for digestion of fats, and is essential for healthy cell membranes. So it’s no wonder that it’s so confusing when we are constantly told to get our cholesterol as low as possible. And should we take a statin if our levels are high? Angela Hartley, a cardiac nurse and cardiac exercise specialist ( helps to explain what we need to know about cholesterol. 

Where does cholesterol come from?

The liver manufactures most cholesterol that is in our bodies (around 80%) although a small amount is obtained from our diet (around 20%). If you eat foods that are higher in cholesterol, the body can adjust and make less.  However that isn’t a free pass to eat whatever you like as we’ll find out below!


Cholesterol acts as a ‘fire engine’ to a fire, thus when damage occurs to an artery (eg through high blood glucose levels, chronic stress, high blood pressure, smoking etc), cholesterol goes to the area to assist in the repair process.  Unfortunately, if the damage continues to occur, more and more cholesterol is taken to the area of repair, resulting in a build up.


Types of cholesterol


Not all cholesterol is bad. Cholesterol circulates around the body in the blood stream attached to specific proteins called lipoproteins of which there are two types - HDL and LDL. 


High density lipoprotein (HDL) contains high amounts of protein and a small amount of cholesterol. Often known as 'good' cholesterol, it helps to sweep up LDL cholesterol. You ideally want to have a good level of HDL - more than 1.2mmol/L


Low density lipoprotein (LDL) contains high amounts of cholesterol and small amount of protein. Often known as 'bad' cholesterol, it can stick to artery walls and cause a build up of plaque over time, leading to heart attack or stroke. 


So is all high cholesterol bad? The answer is, it depends. It’s not as straightforward as having a blood test and being told ‘you have high cholesterol’, as this may not always be a bad thing. You may have high cholesterol but have no damage to your artery walls and thus no active heart disease. Talk to your doctor about your overall risk of heart disease if high cholesterol appears to be your only risk factor. 


Let’s go through some of the best ways to manage your LDL cholesterol, which will in turn reduce your risk of heart disease and stroke. 


Firstly, what increases LDL cholesterol?

  • A high sugar diet - eating foods high in sugar constantly increases your blood sugar levels, which over time causes damage to your blood vessels. This sends a signal to the body to produce more cholesterol to ‘patch up’ those damaged blood vessels.
  • Smoking
  • Being overweight
  • Lack of exercise
  • Excess alcohol
  • Low thyroid levels (hypothyroidism) - this can lead to a build up of LDL as the body needs thyroid hormones to clear it from the body.
  • High alcohol intake

What can help to reduce your LDL cholesterol?

  • Reduce sugar in your diet - avoid processed foods like biscuits, cakes, chocolates, sweets and ice cream. Check labels for added sugar - it may be called glucose, syrup, sucrose or corn syrup. 
  • Exercise for at least 150 minutes per week at a level that leaves you slightly breathless. Start out small with 10 minutes at a time and gradually build up to 30 minutes a day, 5 days per week.
  • Quit smoking - talk to your GP or pharmacist about getting help to do this through patches, gum or E-cigarettes.
  • Fill up on nutritious foods that are mostly unprocessed eg vegetables, proteins, healthy fats founding nature such as nuts and seeds and some lean meats. 
  • Reduce your consumption of damaged fats that are found in takeaways and processed foods
  • Consume a diet high in fibre - aim for 25-30g per day. Fibre is found in wholegrain like oats, fruits, vegetables and beans.
  • Drinking alcohol in small amounts only - the NHS advises no more than 14 units per week for men or women (preferably drink less than this!). 

How to increase your HDL ‘protective’ cholesterol:

  • Include regular exercise every week - exercise has been shown to improve HDL levels. 
  • Increase your intake of healthy fats - avocado, oily fish, olive oil, nuts and seeds all contain good fats that can be protective. 
  • Lose weight - even a small decrease in weight can improve your cholesterol.
  • Include foods rich in antioxidants - think foods that are colourful - yellow peppers, purple cabbage, green leafy vegetables, pink raspberries - these colourful foods contain compounds that can help to fight inflammation and increase your HDL cholesterol.

Who should be taking statins?


The decision whether to start a statin should be made after an informed discussion with your doctor about the risks and benefits of statins. They should take into account the potential benefits from lifestyle modifications, risk factors such as family history, current illnesses and life expectancy. Remember that statins are used as a preventative measure and should be used alongside other lifestyle measures as statins cannot ‘outrun’ a bad lifestyle. 


Some people who may be recommended a statin include:

  • Those at high risk of heart attack or stroke - talk to your doctor about what your risk levels are and ask by how much will statins reduce your risk. You can work out your current risk here: and also see how changing things like your smoking status lowers your risk.
  • Those diagnosed with familial hypercholestremia - a genetic condition where your body overproduces cholesterol.
  • If you’ve had a heart attack or stroke in the past or have active heart disease.
  • Diabetics are often put on statins as they are at higher risk of developing heart disease. Talk to your doctor about whether they are appropriate for you.

About Me
I'm Angela Hartley, Cardiac Nurse and Exercise Coach and I'm here to help you get fitter, stronger and get your mojo back. 

No matter how unfit you are or what heart condition you have, we can help! As part of the programmes on offer you will feel part of a community, be able to use a range of tools to keep you motivated and have access to a members area on the website where you can interact with others, learn more about your heart condition and track your progress.

Learn more about my programmes here.