High Cholesterol

High cholesterol is one of the most important — and most treatable — causes of heart attack and stroke. Like high blood pressure, it causes no symptoms: the first sign is too often a cardiac event that could have been prevented. Modern cholesterol management has advanced enormously, with treatment now personalised to your individual risk and a far wider range of options than statins alone.

Cholesterol is a fatty substance carried in the blood. Your body needs it, but the balance matters:

• LDL cholesterol ("bad" cholesterol) — deposits cholesterol in artery walls, driving the build-up of plaque (atherosclerosis). The higher your LDL, and the longer it stays high, the greater your lifetime risk of heart attack and stroke
• HDL cholesterol ("good" cholesterol) — helps remove cholesterol from the circulation
• Triglycerides — another blood fat linked to cardiovascular risk, often raised with weight, diabetes and alcohol
• Lipoprotein(a), or Lp(a) — a largely inherited particle that independently increases risk. It is not included in standard cholesterol tests, yet around 1 in 5 people have raised levels. Everyone should have it measured at least once

Crucially, there is no single "normal" cholesterol number for everyone. The level that is acceptable for a healthy 35-year-old is very different from the target for someone with diabetes, a strong family history, or existing artery disease. Cholesterol should always be interpreted in the context of your overall risk.

Raised LDL cholesterol is a direct cause of coronary artery disease — the evidence for this is among the most robust in medicine. Over years, cholesterol deposits narrow the heart's arteries and can trigger heart attacks when plaques rupture.

The corollary is powerful: lowering LDL cholesterol reliably lowers risk, and the earlier and longer it is lowered, the greater the benefit. Modern treatment can reduce LDL to levels at which plaque progression stops — and in some cases partially reverses.

Your first appointment lasts around 30 minutes and includes:

1. A full review of your cholesterol history — previous results, treatments tried, and any side effects experienced
2. A comprehensive cardiovascular risk assessment — blood pressure, diabetes, smoking, weight, family history and lifestyle, brought together into your personal risk estimate
3. A physical examination and resting ECG performed in clinic
4. A personalised plan — advanced lipid testing where needed, artery imaging where it would change management, and a clear treatment recommendation with specific targets

Cholesterol management is most effective when guided by complete information. I can arrange rapid access to:

• Advanced lipid profile — LDL, HDL, triglycerides, non-HDL cholesterol and Lp(a), which standard NHS panels usually omit
• Coronary artery calcium score — a quick CT scan quantifying calcified plaque in your heart arteries. For many people with borderline risk, this single test settles the statin question: a score of zero is reassuring; a raised score confirms treatment will genuinely benefit you
• CT coronary angiogram — detailed non-invasive imaging of the artery walls where symptoms or risk warrant it
• Other dedicated non-invasive imaging test - these will be tailored to your risk profile.
• Blood tests — diabetes screening, thyroid, kidney and liver function
• Genetic testing — where familial hypercholesterolaemia is suspected

This "treat the arteries, not just the number" approach means treatment decisions rest on evidence about your arteries, not population averages.

Lifestyle measures form the foundation: a Mediterranean-style diet, regular activity, weight management and stopping smoking all improve the lipid profile and overall risk. For some people with modestly raised cholesterol and low overall risk, lifestyle alone is appropriate.

Statins remain the first-line medication — among the most studied drugs in history, effective and safe for the great majority. Concerns about side effects are common; genuine intolerance is much rarer than believed, and often resolved with a change of statin, dose or dosing pattern.

Beyond statins, the options have expanded significantly:

• Ezetimibe — a well-tolerated tablet that adds meaningful LDL reduction
• Bempedoic acid — an alternative for statin-intolerant patients
• PCSK9 inhibitors (injectable therapies) — powerful LDL-lowering injections every two to four weeks, for high-risk patients or where tablets are insufficient
• Inclisiran — a twice-yearly injection offering sustained LDL reduction

If you have struggled with statins, or your cholesterol remains high despite treatment, there is almost always an effective route forward.

• Consultant Interventional Cardiologist — I treat the consequences of cholesterol every week in the catheter lab, and bring that perspective to preventing them
• Beyond the basic test — Lp(a) measurement, advanced lipid profiling and artery imaging to base decisions on your actual arteries, not just a number
• Full range of modern therapies — including PCSK9 inhibitors and inclisiran for patients who need more than statins
• PhD from King's College London and over 100 peer-reviewed publications
• Rapid access — same-week appointments at Heart Health Welbeck London (Marylebone), Cromwell Hospital (Kensington), The Wellington Hospital (St John's Wood), Bupa Health Care Canary Wharf, The Essex Cardiothoracic Centre (Basildon)
• Consultations in English and Turkish
• Recognised by all major private medical insurers; self-paying patients welcome

High cholesterol is silent — but its consequences are preventable with the right assessment and treatment, started early. Contact my practice team to arrange a consultation at one of my London or Essex locations.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.