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There is good evidence that if you have high cholesterol or another lipid disorder you have a greater chance of getting heart disease. This is because your risk of getting atherosclerosis (narrowing of the arteries) is also increased.

If you have atherosclerosis, fatty deposits can build up inside your blood vessels, and this increases your risk of having a heart attack or a stroke. The more bad cholesterol (also known as low-density lipoprotein or LDL cholesterol) you have in your blood and the less good cholesterol you have (also known as high-density lipoprotein or HDL cholesterol), the higher your risk.^{1 2}

Many things besides the level of lipids in your blood affect whether or not you get heart disease. These are called risk factors.

When your doctor decides whether you need treatment for high cholesterol, he or she also looks at what other risk factors you have. Only when all these things have been considered can he or she estimate whether your chances of having a heart attack or a stroke are raised and whether you need treatment.

The people at the greatest risk of having a heart attack or a stroke are those who already have signs of heart disease as well as high cholesterol. So if you've got angina (a pain in your chest that you get when you exercise or do something strenuous) or if you've already had a heart attack or a stroke, your chances of having another are higher than average. Your doctor will pay extra attention to the levels of cholesterol and other lipids in your blood. You will definitely be considered for treatment.

If you don't already have heart disease, it's more complicated to figure out whether or not you need treatment for high cholesterol. It depends on what other risk factors you have.

Here are the other risk factors that mean you have a higher chance of having a heart attack or a stroke.³

• Someone in your family had heart disease early. Early means that your father or uncle had a heart attack or died suddenly from heart disease before they were 55 or your mother or another female relative had a heart attack before they were 65.
• You have high blood pressure (sometimes called hypertension).
• You have diabetes.
• You smoke.
• You are a man over 45.
• You are a woman over 55.
• You are a woman who had menopause early.
• Your good (HDL) cholesterol is under 35 mg/dL. (See How do doctors diagnose high cholesterol?)
• You already have atherosclerosis (narrowing of the arteries).

If your good (HDL) cholesterol count is above 60 mg/dL this means you are less likely to get heart disease. This is like having one less risk factor, and it should be subtracted from the total number of risk factors that you have. So, if you have three of the risk factors listed but your HDL cholesterol is above 60mg/dL, you should count yourself as having only two risk factors. You have a higher chance of getting heart disease if:³

• You have two of the risk factors listed above plus a bad (LDL) cholesterol number that is higher than 130 mg/dL
• You have less than two of the risk factors but your bad (LDL) cholesterol is higher than 160 mg/dL.

If you fall into one of these groups your doctor may advise you to change what you eat or treat you with medication, or both.

If you have familial combined hyperlipidemia (the most common type of inherited lipid disorder) you are 70 percent more likely to have a heart attack than people with normal lipid levels.⁴

If you have familial hypertriglyceridemia your risk of having a heart attack may be similar to people who have familial combined hyperlipidemia. But in the big study that we looked at, there weren't enough families with this disorder to let us say for sure.³

You will probably be offered drug treatments if you have either of these conditions.

For more information, see Inherited lipid disorders

If you have a lipid disorder, you can lower your risk of heart disease no matter what your age, your medical condition or your sex. You can do this by taking steps to lower the levels of harmful lipids (LDL cholesterol or triglycerides) in your blood and raise the level of good ones (HDL cholesterol).

For every 1 percent increase in good (HDL) cholesterol or 1 percent decrease in bad (LDL) cholesterol, your risk of having a heart attack or stroke drops by 2 percent.⁵ If your total cholesterol level lowers by 0.6 mmol/l, your risk of having a stroke is reduced by half.⁶ This fall in cholesterol also lowers the risk of having a heart attack by one-fifth.⁶

For more information, see More about cholesterol and triglycerides.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.