High Cholesterol in London 2026. Which Numbers Matter, Whether You Need a Statin and the Tests That Settle It
Around half of UK adults have a total cholesterol above the commonly used threshold, which makes a raised result on its own almost meaningless, and it is the reason so many people are left uncertain whether to start a statin. The number that decides treatment is not your cholesterol. It is your overall 10-year cardiovascular risk.
Key points
QRISK3, calculated from age, sex, family background, blood pressure, smoking, diabetes, family history and cholesterol ratio, is what NICE guideline NG238 actually uses, advising a statin where 10-year risk is 10% or more.
Apolipoprotein B counts the particles that actually enter artery walls, and a considerable share of people have an acceptable LDL alongside a high particle count, particularly with central weight gain or raised triglycerides.
Lipoprotein little a is inherited, raised in around 20% of people, unaffected by diet or exercise, and missing from QRISK3 entirely, so someone with a high level can be told their risk is low.
A coronary artery calcium score shows whether plaque is already present, and a score of 0 can justify holding off on lifelong medication where risk is uncertain.
Not sure whether you need a statin? Ask a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
What do the numbers on a cholesterol test mean
Total cholesterol is the least useful figure on the report, because it combines the cholesterol you want lower with the cholesterol that protects you. LDL cholesterol is the main target of treatment. HDL cholesterol is protective, and the ratio of total to HDL is what QRISK3 uses. Non-HDL cholesterol, meaning total minus HDL, captures all the atherogenic cholesterol and is the target NICE uses for treatment response, with a reduction of more than 40% the aim on a statin.
Triglycerides rise with refined carbohydrate, alcohol, excess weight and insulin resistance, and a high level alongside low HDL is a signature of metabolic risk. Fasting is not required for most cholesterol testing, although it matters where triglycerides are very high.
The problem with all of these is that they measure the cholesterol carried inside particles rather than the particles themselves. That is what apolipoprotein B corrects.
A total cholesterol above 7.5, or an LDL above around 4.9, particularly with a family history of early heart disease, raises the possibility of familial hypercholesterolaemia, an inherited condition affecting around 1 in 250 people, most of whom are undiagnosed. It needs identifying because it causes heart disease decades early and because relatives should be tested.
Why apolipoprotein B and lipoprotein little a change the answer
Each atherogenic particle carries exactly 1 molecule of apolipoprotein B, so measuring it counts the particles directly. Ference and colleagues, writing the European Atherosclerosis Society consensus in the European Heart Journal, established that these particles cause atherosclerosis, and Sniderman and colleagues in JAMA Cardiology showed apolipoprotein B outperforms LDL cholesterol as a risk marker.
The practical consequence is discordance. People with central weight gain, raised triglycerides, prediabetes or fatty liver commonly carry an acceptable LDL cholesterol and a high particle count, and their standard report reassures them when their risk does not justify it.
Lipoprotein little a is the second omission and the more striking. It is set by inheritance, largely unaffected by lifestyle and statins, raised in around 20% of people, and causally linked to heart attack, stroke and aortic valve narrowing. Because the level is genetic it needs measuring only once in a lifetime. QRISK3 does not include it, so somebody with a high level can be classified as low risk while carrying a substantial inherited risk. European guidance recommends measuring it at least once in every adult.
A raised lipoprotein little a does not currently have a licensed targeted treatment in routine use, but it changes how aggressively every other risk factor is managed, which is exactly how it is used.
Ask whether these tests would help you. Message us on WhatsApp.
Do I need a statin
The decision rests on overall risk rather than cholesterol alone. NICE guideline NG238 advises offering a statin where 10-year cardiovascular risk calculated by QRISK3 is 10% or more, and to people with established cardiovascular disease, chronic kidney disease, type 1 diabetes above defined thresholds, or familial hypercholesterolaemia regardless of the score.
The evidence for benefit is large. The Cholesterol Treatment Trialists' Collaboration, pooling data from over 170,000 people across randomised trials, found that each 1 mmol/L reduction in LDL cholesterol reduces major vascular events by around 22%, with benefit proportional to the reduction achieved and to the level of baseline risk.
The side effect picture is widely misunderstood. Muscle aches are commonly attributed to statins, yet blinded n-of-1 trials, including the SAMSON study published in the New England Journal of Medicine, found that most symptoms reported on statins occurred equally on placebo. Genuine muscle problems exist and are managed by changing the drug or dose rather than stopping altogether.
Where risk sits in the uncertain middle band, the extra tests earn their place. A raised apolipoprotein B or lipoprotein little a moves the decision towards treatment. A coronary artery calcium score of 0 in someone at intermediate risk moves it away, since the absence of calcified plaque is associated with a low event rate over the following years.
Where statins are not tolerated or not enough, ezetimibe, bempedoic acid and injectable PCSK9-targeting treatments are further options, used according to NICE criteria.
What actually lowers cholesterol without medication
Diet makes a measurable difference, typically lowering LDL cholesterol by 5% to 15%. Replacing saturated fat with unsaturated fat is the change with the strongest evidence. Soluble fibre from oats, barley, beans and lentils lowers LDL modestly. Plant sterols add a further small reduction.
Reducing refined carbohydrate, sugar and alcohol lowers triglycerides substantially, often more than any other change, and weight loss improves the whole profile including HDL.
Regular exercise raises HDL and lowers triglycerides, and it reduces cardiovascular risk through many routes beyond cholesterol, including blood pressure, insulin sensitivity and fitness, which is itself one of the strongest predictors of survival.
Stopping smoking produces a larger reduction in cardiovascular risk than almost anything else on this page.
None of this changes lipoprotein little a, which is why knowing your level matters. Where it is high, lifestyle measures remain worthwhile because they lower the other risks sitting alongside it.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What cholesterol assessment costs
Consultant cardiology and lipid clinic appointments in the Harley Street district run £250 to £500 for a first consultation, with tests and imaging charged separately. Coronary artery calcium scoring runs £250 to £500. Advanced lipid panels including apolipoprotein B and lipoprotein little a sell at £150 to £400 without interpretation.
At The Wellness the testing, the risk calculation and the decision are made together. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Heart Health programme with echocardiography, carotid Doppler, aortic assessment, a cardiometabolic panel and review, from £3,495.
Complete Biomarker Assessment, over 100 markers including a full lipid profile, apolipoprotein B, lipoprotein little a, HbA1c with fasting insulin, liver and kidney function and thyroid, with extended review, from £1,400.
Comprehensive Blood Panel including full lipids with consultation and interpretation, from £495. Targeted lipid panel from £295.
Extended 45-minute consultation with QRISK3 calculation, statin decision and a written plan, from £395.
In-person consultation from £220. Same-day video consultation for reviewing existing results, from £150. Mini consultation from £59.
Coronary artery calcium scoring, familial hypercholesterolaemia genetic testing and lipid clinic referral to a named consultant arranged at specialist centres.
Appointments within the week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for cholesterol assessment
Because the decision is made on risk rather than a number. QRISK3 is calculated with you, and the uncertain middle band is resolved with the tests that answer it rather than with a coin toss.
Because the 2 markers most panels omit are measured. Apolipoprotein B identifies the people whose standard report reassures them wrongly, and lipoprotein little a identifies inherited risk that QRISK3 cannot see, measured once and never again.
Because coronary artery calcium scoring is arranged where it will change the decision, at a specialist centre with consultant reporting, and a score of 0 can justify holding off on lifelong medication.
Because statin side effects are discussed honestly, including the evidence that most reported symptoms occur equally on placebo, and genuine intolerance is managed by adjusting the drug rather than abandoning treatment.
And because familial hypercholesterolaemia is looked for, since it affects around 1 in 250 people, is mostly undiagnosed, and means your relatives need testing too.
Related reading
Biomarker screening covers apolipoprotein B and lipoprotein little a in depth, high blood pressure covers the other major modifiable risk, heart health screening covers the cardiac assessment, and fatty liver and prediabetes cover the metabolic conditions that travel with raised triglycerides.
Book a cholesterol assessment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about high cholesterol and statins
Do I need a statin for high cholesterol?
It depends on overall risk rather than cholesterol alone. NICE guideline NG238 advises offering a statin where 10-year cardiovascular risk calculated by QRISK3 is 10% or more, and to people with established cardiovascular disease, chronic kidney disease or familial hypercholesterolaemia. Where risk is borderline, apolipoprotein B, lipoprotein little a and a coronary calcium score help decide.
What is apolipoprotein B?
A protein carried by every atherogenic particle, so measuring it counts the particles that enter artery walls. It outperforms LDL cholesterol as a risk marker and identifies people with an acceptable LDL but a high particle count, commonly those with central weight gain, raised triglycerides or prediabetes.
What is lipoprotein little a?
An inherited lipoprotein, raised in around 20% of people, largely unaffected by diet, exercise or statins, and causally linked to heart attack, stroke and aortic valve narrowing. It needs measuring once in a lifetime, and QRISK3 does not include it.
Do statins cause muscle pain?
Less often than people believe. Blinded trials including the SAMSON study found most symptoms reported on statins occurred equally on placebo. Genuine muscle problems do occur and are managed by changing the drug or dose rather than stopping treatment altogether.
How much do statins reduce risk?
The Cholesterol Treatment Trialists' Collaboration, pooling over 170,000 people, found each 1 mmol/L reduction in LDL cholesterol reduces major vascular events by around 22%, with benefit proportional to the reduction achieved and the baseline risk.
Can I lower cholesterol without medication?
Often by 5% to 15%, by replacing saturated fat with unsaturated fat, adding soluble fibre and plant sterols, reducing refined carbohydrate and alcohol, losing weight and exercising regularly. None of this changes lipoprotein little a, which is why knowing your level matters.
This article is for information and does not replace personal medical advice. Any medicine is prescribed only following a consultation and clinical assessment. Chest pain, breathlessness or collapse needs 999. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
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