High Cholesterol
High cholesterol (hypercholesterolaemia) is a major modifiable risk factor for cardiovascular disease, including heart attack and stroke. It is usually symptomless until a cardiac event occurs. LDL (low-density lipoprotein) cholesterol is the primary therapeutic target; HDL and triglycerides provide additional risk context. Familial hypercholesterolaemia (FH) — present in 1 in 250 adults — requires early identification and aggressive treatment.
What it is
High cholesterol (hypercholesterolaemia) is a major modifiable risk factor for cardiovascular disease, including heart attack and stroke. It is usually symptomless until a cardiac event occurs. LDL (low-density lipoprotein) cholesterol is the primary therapeutic target; HDL and triglycerides provide additional risk context. Familial hypercholesterolaemia (FH) — present in 1 in 250 adults — requires early identification and aggressive treatment.
Symptoms and signs
- High cholesterol has no symptoms — it is diagnosed by a blood test.
- Xanthelasmas (yellow deposits around the eyes) or xanthomas (fatty deposits on tendons) may be visible in familial hypercholesterolaemia.
- Corneal arcus (grey ring around the iris) in patients under 45 may suggest FH.
- Cardiovascular symptoms — chest pain, breathlessness or stroke symptoms — may be the first presentation in untreated high cholesterol.
How we investigate
Fasting lipid profile (total cholesterol, LDL, HDL, triglycerides, non-HDL). HbA1c. NT-proBNP and high-sensitivity CRP for cardiovascular risk stratification. Q-Risk3 score calculation. Thyroid function (secondary dyslipidaemia). In suspected FH: Dutch Lipid Score or Simon Broome criteria applied; cascade family testing recommended.
Treatment options at The Vesey
- Dietary modification — reduced saturated fat, increased plant sterols, soluble fibre and omega-3 intake.
- High-intensity statins — atorvastatin 40–80 mg or rosuvastatin 20–40 mg; first-line for all high-risk patients.
- Ezetimibe — added when statin alone does not achieve LDL target; well-tolerated.
- PCSK9 inhibitors — evolocumab or alirocumab for FH, statin intolerance or very high-risk patients not at target.
- Bempedoic acid — oral non-statin option for statin-intolerant patients.
When to see a specialist
- Total cholesterol above 7.5 mmol/L or LDL above 5.0 mmol/L at any age
- Strong family history of early heart attack or high cholesterol (FH screening)
- Statin intolerance or muscle symptoms requiring medication review
- High Q-Risk3 score (≥10%) requiring structured cardiovascular risk management
- Cardiovascular event in the past with LDL above target despite treatment
See a cardiology specialist within 7 days. No GP referral required. Learn more →
Frequently asked questions
Do I need a GP referral to see a specialist about high cholesterol at The Vesey? +
No. You can self-refer directly to Dr Sunil Nadar, Consultant Cardiologist, without a GP letter.
How much does a cholesterol assessment cost? +
Lipid profile blood test £45. Full cardiovascular risk assessment (lipids + HbA1c + NT-proBNP) £250 with Dr Sunil Nadar. See /specialty/cardiology.
How quickly can I be seen? +
Same-week cardiology appointments are typical. Same-day blood tests available. Urgent presentations are prioritised.
Will my health insurance cover cholesterol management? +
BUPA, Vitality, AXA, WPA, Cigna, Aviva and Healix typically cover consultant cardiology and cardiovascular risk assessment. We pre-authorise at booking.
What is familial hypercholesterolaemia (FH)? +
An inherited condition causing very high LDL cholesterol from birth, significantly increasing heart attack risk. Affects 1 in 250 UK adults. Diagnosed by blood test + Simon Broome criteria or Dutch Lipid score.
What are the NICE targets for LDL cholesterol? +
In high cardiovascular risk patients: LDL below 2.0 mmol/L. In very high risk (prior heart attack, FH): below 1.4 mmol/L. Standard population: below 3.0 mmol/L.
What medications lower cholesterol? +
Statins (atorvastatin, rosuvastatin — first-line); ezetimibe (second-line); PCSK9 inhibitors (evolocumab, alirocumab — for FH or statin intolerance); bempedoic acid (for statin-intolerant).
How much does a cholesterol assessment cost? +
Lipid profile blood test £45. Full cardiovascular risk assessment (lipids + HbA1c + NT-proBNP) £250 with Dr Sunil Nadar. See /specialty/cardiology.
Book an appointment
When to see a specialist
See a specialist if your total cholesterol is above 7.5 mmol/L, if you have a family history of early heart disease, if you are statin-intolerant, or if you have already had a heart attack or stroke and are not at LDL target.
Cost and pathway
Lipid profile blood test £45. Full cardiovascular risk assessment (lipids + HbA1c + NT-proBNP) £250 with Dr Sunil Nadar. Self-pay and insurance accepted (BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix).
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our cardiology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.88/5 on Doctify from 700+ verified reviews
View our cardiology services →
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727