High cholesterol: risk factors
Risk factors for high cholesterol include:
- Diet - a high intake of saturated fats or trans fats is associated with raised blood cholesterol levels. However, recent research suggests that saturated fats may increase cardiovascular disease risk through mechanisms unrelated to cholesterol (Maki et al, 2021). A 2022 review by Fernandez & Murillo found no association between dietary cholesterol and blood cholesterol levels.
- Genetics - some inherited conditions, such as familial hypercholesterolaemia, limit the ability of the liver to remove low-density lipoprotein (LDL), also known as “bad” cholesterol, from the blood. This condition affects over 10,000 people in Scotland and, left untreated, can cause stroke or heart attack at a young age (British Heart Foundation [BHF], 2025).
- Other conditions such as diabetes, high blood pressure, liver disease, kidney disease and underactive thyroid can all contribute to an increase in blood cholesterol levels.
- Lack of exercise - physical activity tends to increase the level of high-density lipoprotein (HDL), also known as “good” cholesterol, which in turn aids in the removal of LDL from the blood.
- Weight – being overweight can raise the level of LDL, lower HDL, and raise total cholesterol levels
- Getting older – blood cholesterol gradually increases with age (National Health Service [NHS], 2022).
- Drinking alcohol to excess - the metabolism of alcohol feeds into pathways of fat metabolism (Heart UK, 2025).
- Ethnic group - People who are of Indian, Pakistani, Bangladeshi or Sri Lankan descent have an increased risk of high blood cholesterol
High cholesterol should not be considered as a cardiovascular risk factor in isolation but needs to be assessed in the context of global cardiovascular risk, which is affected by age and sex, blood pressure, smoking, family history of cardiovascular disease, socioeconomic status and the presence of other conditions such as chronic kidney disease or diabetes.
