What Is Cholesterol & How Can I Lower It? An Article By Dr Malik

Dr Malik was in the Telegraph again – this time commenting on the best time to get your cholesterol checked. He argues against universal testing at age 30 as there needs to be evidence that this will make a useful difference to the population’s risk of heart attack and stroke. Here’s why.


What is a cholesterol test?

A cholesterol check is a blood test.

It is done at age 40 as part of a health check. Checking earlier MIGHT motivate some people to change, but it would be better to address all the lifestyle issues that affect the Western Middle age population, such as obesity, blood pressure, smoking, lack of exercise, diabetes – rather than a cholesterol number alone. Those with risk factors should certainly be tested. Those without can probably wait until 40.


If you do want to know what your cholesterol is, then lets take a look at the important numbers and what they mean:

Good OK High risk
Total Cholesterol (TC) <4 >5 >6
LDL cholesterol (LDL)  <2 2-3 >3
Ratio TC/HDL  <4 4-5 >6

What types of cholesterol are there?

  • Low-density lipoprotein (LDL) or “bad” cholesterol. Having high levels of LDL cholesterol can lead to plaque buildup in your arteries and result in heart disease or stroke.
  • High-density lipoprotein (HDL) or “good” cholesterol. HDL is known as “good” cholesterol because high levels of it can lower your risk of heart disease and stroke.
  • Triglycerides, (TG). A type of fat in your blood that your body uses for energy. The combination of high levels of triglycerides with low HDL cholesterol or high LDL cholesterol levels can increase your risk for heart attack and stroke.
  • Total cholesterol (TC). The total amount of cholesterol in your blood based on your HDL, LDL, and triglycerides numbers.


How can you lower cholesterol?

Diet & exercise

  • Carbohydrate are more of an enemy to you that saturated fats
  • Take 5 portions of fresh vegetables and fruit a day


Weight loss

  • Walk 10,000 steps a day
  • Try reducing rice/bread/naan/pasta/potatoes/alcohol. These are all carbohydrate calories.
  • Try a diet:
    • Eat less (easy to say!!
    • The 5:2 diet – for a man 1000 calories 2 days of the week, more normal for 5 days; for a woman 600 calories!
    • Intermittent Fasting – eat for ONLY 8 hours of the day, e.g. from Midday to 8pm. No calories outside this!
      • Tea with milk? No
      • Black tea? Yes




  • Well validated and well tolerated
  • They can reduce your LDL cholesterol by around 30%, sometimes even 50% with high doses.



  • Weak on its own, but good in combination.
  • Lower LDL cholesterol (sometimes called ‘bad cholesterol’) by 15-22% when used by itself, or 21-27% if it’s used in combination with a statin.


Bempedoic Acid

  • A newer tablet that works well. Take just once a day.
  • Like statins, bempedoic acid lowers cholesterol in the blood by reducing the production of cholesterol in the liver. Statins block an enzyme known as HMG-CoA reductase. Bempedoic acid works in a similar way, by slowing down a different enzyme in the cholesterol production pathway known as ATP citrate lyase – but only in the liver. This means there are more LDL receptors in the liver, which helps to remove more LDL cholesterol from the blood.
  • They reduce LDL cholesterol by between 17-28% after 12 weeks.. When combined with ezetimibe, bempedoic acid can give up to 38% reduction in LDL cholesterol.
  • Unlike statins, bempedoic acid only works in the liver so it is much less likely to cause side effects affecting the muscles – one of the main reasons some people can’t take statins.


PCSK-9 inhibitors

  • Injectable drugs that you take every 2 weeks.
  • There are currently two PCSK9 inhibitors – Repatha (Evolocumab) and Praluent (Alirocumab). These are monoclonal antibodies.
  • The PCSK9 protein breaks down the LDL receptors, meaning we have less of them and our blood cholesterol rises. PCSK9 inhibitors stop the protein from working so that we have more LDL receptors on our liver cells and less cholesterol in the blood



  • Injectable which you take every 6 months
  • Inclisiran works in a similar way to another treatment called PCSK9 inhibitors (Evolocumab and Alirocumab) because it blocks the action of a protein called PCSK9.
  • Inclisiran is known as an siRNA, also known as small interfering RNA (RNA interference). It works differently from the PCSK9 inhibitors by interrupting the “printing” of PCSK9 protein from the genetic template known as messenger RNA
  • Clinical trial evidence shows that inclisiran can lower LDL cholesterol levels by at least 50%.


How to lower your cholesterol without drugs (telegraph.co.uk)

Discover HEART UK – The Cholesterol Charity


Posted on 06 April 2023
Author: Dr Iqbal Malik
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