What to do when your doctor says your cholesterol is high

Step 1: understand what "high" means for you

High cholesterol has no symptoms. It matters because, over years, too much LDL builds up in artery walls and raises the risk of heart attack and stroke. How worried to be depends on two things: which numbers are high, and your overall risk.

Get all your numbers, not just total cholesterol. Ask for your LDL, HDL, non-HDL cholesterol and triglycerides. The NHS gives these as a guide for healthy adults:

Our guide to reading your cholesterol test results explains every line of the report, with ranges by age in both units.

Ask for your risk score. Your doctor combines your cholesterol with your age, blood pressure, smoking, diabetes and other factors to estimate your chance of a heart attack or stroke:

• In the UK, GPs use QRISK3, a 10-year risk. NICE says to offer a statin (atorvastatin 20mg) when it's 10% or more, after talking through lifestyle changes. A statin isn't ruled out below 10% if you'd prefer one or your risk may be underestimated.
• In the US, the 2026 ACC/AHA guideline uses the PREVENT calculator. It recommends a statin at a 10-year risk of 5% or more, and says one is reasonable at 3% to under 5% after discussion.
• At any risk level, an LDL of 190 mg/dL (4.9 mmol/L) or more counts as severe hypercholesterolaemia, which usually needs medication. NICE recommends specialist assessment if total cholesterol is above 9.0 mmol/L or non-HDL above 7.5 mmol/L (about 290 mg/dL).

The 2026 guideline also recommends that every adult has Lipoprotein(a) measured at least once. It's a largely inherited risk factor that diet doesn't change much. Our explainer on the 2026 cholesterol guidelines covers PREVENT, Lp(a) and the new LDL goals.

Step 2: rule out other causes

Before treating cholesterol on its own, doctors check for things that raise it. NICE lists excess alcohol, uncontrolled diabetes, an underactive thyroid, liver disease and kidney (nephrotic) disease. The 2026 guideline adds some medicines (such as steroids and some diuretics), pregnancy, the menopause transition, rapid weight loss and very-low-carb ketogenic diets. If your LDL went up after starting keto, read why LDL can go up on keto.

Your 30-day action plan

Thirty days won't fix everything, but it's long enough to build the habits that lower LDL and to give your next test something to measure. Focus on one week at a time.

Week 1: get a baseline

• Write down your numbers, your risk score and any target your doctor gave you.
• Log everything you eat for seven days without changing anything. You're looking for where your saturated fat actually comes from. For most people it's one or two habits: cheese, butter, processed meat, pastries or takeaways.
• Book your follow-up appointment or retest now, so there's a date to work towards.

Week 2: fix the fats

• Swap your biggest saturated fat source first. Aim for about 13g of saturated fat a day or less on 2,000 calories (the American Heart Association target). The NHS upper limits are 20g for women and 30g for men. Our guide to how much saturated fat per day shows how to work out your number.
• Cook with olive or rapeseed oil instead of butter, ghee or coconut oil, and use a plant-oil spread on bread. See the best oils and fats for high cholesterol.
• Replace rather than remove. The 2026 guideline warns that the benefit of cutting saturated fat is lost if the gap is filled with sugar and ultra-processed food.

Week 3: add foods that lower LDL

• Soluble fibre: porridge or barley, beans, lentils and chickpeas most days. See how much soluble fibre you need.
• A handful of nuts a day: the 2026 guideline cites a 4.8 mg/dL (0.12 mmol/L) fall in LDL for one serving a day.
• Soya foods such as tofu, edamame and soya milk, plus plenty of fruit and vegetables.
• Combined, these add up. The Portfolio diet (nuts, soya protein, fibre and a plant sterol spread) lowered LDL by an average of 26 mg/dL (0.67 mmol/L). For meal-by-meal ideas, use our 100 cholesterol-lowering food swaps.
• Keep the treats, change the recipe: try our heart-healthy desserts and low-cholesterol snacks.

Week 4: move more and tackle the rest

• Build up to at least 150 minutes of moderate activity a week (brisk walking, cycling, swimming) or 75 minutes of vigorous activity, as the NHS recommends. See what actually raises HDL.
• If you smoke, get help to stop: smoking raises cholesterol and heart risk.
• Keep alcohol to 14 units a week or less, spread over three or more days, with several drink-free days.
• Compare this week's food log with week 1. Keep what worked and pick the next thing to change.

When to retest

• On lifestyle changes alone: NICE says people should be offered a new risk assessment after they've tried to change their lifestyle. Ask your doctor when; a few months is common.
• After starting or changing a statin: NICE recommends a full lipid profile at 2–3 months. The 2026 ACC/AHA guideline says 4–12 weeks, then every 6–12 months.
• Results vary a little from test to test, so look at the direction over more than one result rather than a single number.

Questions to ask your doctor

1. Which of my numbers is the problem: LDL, non-HDL, triglycerides, or all of them?
2. What's my 10-year risk score (QRISK3 or PREVENT), and what would lower it most?
3. Do I need a statin now, or can I try lifestyle changes first? If so, for how long?
4. What target should I aim for? NICE aims for a more than 40% fall in non-HDL cholesterol on a statin for primary prevention, and an LDL of 2.0 mmol/L (77 mg/dL) or less after a heart attack or stroke. The 2026 US guideline sets LDL goals from under 100 mg/dL (2.6 mmol/L) down to under 55 mg/dL (1.4 mmol/L), depending on risk.
5. Could anything else be raising my cholesterol, like my thyroid, a medicine or my diet?
6. Should I have Lp(a) measured, and should my family be tested?
7. If treatment has lowered my cholesterol but not to target, what's next? NICE advises checking you're taking the statin regularly, continuing diet and lifestyle changes, and considering a higher statin dose. After that, extra medicines such as ezetimibe can be added, especially if you've had a heart attack or stroke.

Keep track so the next appointment is easier

Bring your food log and results to your follow-up. It's much easier to decide what to do next when you can see what changed. Our roundup of the best cholesterol tracking apps compares the apps that log both food and lipid results.

High cholesterol: quick answers

What should I do first if my cholesterol is high?

Find out which numbers are high (LDL, non-HDL, triglycerides) and ask for your 10-year heart risk score: QRISK3 in the UK or PREVENT in the US. Your risk, not cholesterol alone, decides whether you need a statin as well as diet and lifestyle changes.

Can I lower my cholesterol without medication?

Often by a useful amount, especially if your risk is low. Replacing saturated fat with unsaturated fat, eating more soluble fibre, nuts and soya, exercising and stopping smoking all help. The Portfolio diet lowered LDL by about 26 mg/dL (0.67 mmol/L) on average. If your risk is high or your LDL is 190 mg/dL (4.9 mmol/L) or more, diet alone usually isn't enough.

How long does it take to lower cholesterol with diet?

Blood lipids respond within weeks, but give changes a few months before judging them. NICE recommends offering a new risk assessment after you've tried lifestyle changes. After starting a statin, a repeat test is recommended at 2–3 months (NICE) or 4–12 weeks (2026 ACC/AHA guideline).

What is a dangerous cholesterol level?

An LDL of 190 mg/dL (4.9 mmol/L) or higher is treated as severe hypercholesterolaemia, and NICE recommends specialist assessment if total cholesterol is above 9.0 mmol/L (348 mg/dL) or non-HDL cholesterol above 7.5 mmol/L (290 mg/dL). Below that, how serious a result is depends on your overall heart risk.

What should I ask my doctor if treatment has lowered my cholesterol but not to the target?

Ask whether you're on the right statin dose and taking it consistently, whether a higher-intensity statin would help, and whether adding a medicine such as ezetimibe is appropriate. NICE recommends discussing adherence, continuing diet and lifestyle changes, and considering a higher dose before adding other treatments.

Do I need to fast before a cholesterol test?

Usually not. The NHS says eating beforehand makes little difference, and the 2026 ACC/AHA guideline accepts non-fasting tests, suggesting a fasting test if non-fasting triglycerides are 400 mg/dL (4.5 mmol/L) or higher.

Sources

• NHS: Cholesterol levels and How to lower your cholesterol (reviewed March 2026)
• NICE NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification (December 2023)
• 2026 ACC/AHA/multisociety Guideline on the Management of Dyslipidemia. Journal of the American College of Cardiology. March 2026.
• American Heart Association: Saturated fats
• NHS: Fat, the facts

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