High Cholesterol & Dyslipidaemia:
Causes, Risk & Modern Treatment

1. What is high cholesterol?

Cholesterol is a vital component of every body cell. The body produces most of it itself, with some taken in via food. The problem arises when LDL cholesterol (colloquially: "bad cholesterol") is persistently elevated — because LDL accumulates in blood vessel walls and promotes atherosclerosis.^¹

Elevated LDL cholesterol is one of the most important modifiable risk factors for heart attack, stroke and other cardiovascular diseases. The evidence is clear: the lower the LDL cholesterol, the lower the risk — the ESC/EAS guideline (Focused Update 2025) frames this as a fundamental principle.^¹

2. LDL, HDL, triglycerides — what do the values mean?

• LDL cholesterol: Carries cholesterol into blood vessels and deposits it there. Elevated values promote atherosclerosis. The most important treatment target.^¹
• HDL cholesterol: Transports excess cholesterol back to the liver (protective function). Low values are considered a risk factor. However, currently no medication has been shown to reduce cardiovascular risk by raising HDL.
• Triglycerides: Blood fats that rise with excess energy intake (especially sugar, alcohol, overweight). Significantly elevated triglycerides can increase cardiovascular risk and, in rare cases, trigger acute pancreatitis.
• Total cholesterol: The sum of LDL, HDL and VLDL. Often measured but less informative than LDL cholesterol alone.
• Lipoprotein(a) (Lp(a)): A genetically determined risk factor included as a risk modifier in the ESC/EAS Update 2025. Should typically be measured once in a lifetime. Currently cannot be effectively treated with medication — new therapies are in development.

3. Causes and risk factors

• Diet: A high proportion of saturated fats (fatty meat, sausage, cheese, butter, coconut oil) and trans fats (fried foods, baked goods, processed products) can raise LDL.
• Lack of exercise: sedentary lifestyle.
• Overweight: obesity typically raises LDL and triglycerides and lowers HDL.
• Genetics: Familial hypercholesterolaemia (FH) is a common genetic condition leading to markedly elevated LDL from a young age. It is often unrecognised (see separate section below).
• Other conditions: hypothyroidism, chronic kidney disease, type 2 diabetes, liver disease.
• Medications: Certain medications can affect lipid metabolism (e.g. corticosteroids, beta-blockers, thiazide diuretics, immunosuppressants).

4. Symptoms

With very markedly elevated values (especially in familial hypercholesterolaemia), visible signs can appear:

• Xanthomas: cholesterol deposits in tendons or under the skin
• Xanthelasmas: yellowish deposits on the eyelids
• Arcus lipoides: a whitish ring around the cornea

These signs are rare but diagnostically pointing — they should raise suspicion of a familial form.

5. Diagnosis and risk assessment

• Lipid profile: total cholesterol, LDL, HDL, triglycerides — typically fasting or non-fasting (results are comparable for most values). LDL is the decisive target.
• Risk assessment: The ESC/EAS guideline recommends individual risk assessment — in the 2025 update with SCORE2 (for ages 40–69) and SCORE2-OP (for ages 70–89). Total risk determines LDL targets and treatment intensity.^¹
• LDL targets (ESC/EAS 2025): Depend on individual cardiovascular risk. The higher the risk, the lower the target. For people with established cardiovascular disease or very high risk, the lowest targets typically apply.^¹
• Lipoprotein(a): Recommended in the 2025 Update as a risk modifier — should typically be measured once in a lifetime.

6. Treatment: lifestyle

Lifestyle changes are the foundation of every cholesterol therapy — regardless of whether medications are used.^¹

• Reduce saturated fats — less fatty meat, sausage, cheese, butter, coconut oil; instead choose unsaturated fats (olive oil, nuts, avocado, oily fish)
• Avoid trans fats — fried foods, industrial baked goods, processed products
• Increase fibre — wholegrains, vegetables, pulses, fruit
• Normalise weight if overweight
• Regular exercise — can lower LDL and raise HDL
• Stop smoking — smoking damages blood vessels independently of cholesterol
• Reduce alcohol — can lower triglycerides

7. Treatment: medications

When lifestyle changes alone are not enough to reach individual LDL targets, medications are used. The decision is based on overall risk.^¹

8. Familial hypercholesterolaemia

Familial hypercholesterolaemia (FH) is a common genetic condition that leads to markedly elevated LDL values — already from a young age and independent of lifestyle. The heterozygous form affects approximately one in several hundred people by current estimates, but is typically substantially underdiagnosed.^¹

• Suspect with markedly elevated LDL (particularly at a younger age), positive family history (heart attack or stroke in relatives before age 55 (men) or 60 (women)), xanthomas
• Diagnosis: clinical scoring systems (e.g. Dutch Lipid Clinic Network Score) and/or genetic testing
• Treatment: early and consistent LDL lowering (statins + ezetimibe, plus PCSK9 inhibitors when needed); lifestyle changes alone are typically insufficient for FH
• Cascade screening: first-degree relatives should also be tested

How brite helps you with high cholesterol

Statin in the evening, ezetimibe alongside, a new LDL result every three months and the question of whether the target has been reached — and in the background blood pressure and diabetes too. Cholesterol therapy is often part of a bigger cardiovascular plan. brite keeps it organised.

• Intake reminder — statin in the evening, ezetimibe or bempedoic acid in the morning: brite reminds you on time. Particularly because statins are taken for life, routine helps.
• Drug interaction check — statin plus grapefruit juice? Plus macrolide antibiotics? Plus certain antifungals? brite shows when statin levels can rise unintentionally — and with them the risk of muscle side effects.
• Health journal — track LDL, HDL, triglycerides and total cholesterol over time. So you can see clearly whether therapy is reaching the LDL target — or whether escalation might make sense.
• Digital medication plan — all medications clearly organised for cardiology, GP and lipid clinic. Particularly helpful when blood pressure medications and antidiabetics come into the picture too.

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