Heart Mark

Like us on Facebook Follow us on Twitter Email Us Email Us


Cholesterol is a soft, waxy, fatty substance in the blood which plays an important role in cell membranes and hormones. Your liver produces all the cholesterol your body needs, but when you eat too many foods that are high in saturated fats and cholesterol (mostly animal foods) it can make your blood cholesterol levels rise.

A high blood cholesterol level can slowly build up in the inner walls of arteries. If left unchecked, it can eventually form plaques - a thick hard deposit that can narrow arteries and make them less flexible. This process is called atherosclerosis. If a clot forms and blocks a narrowed artery that feeds the heart or brain, it can result in a heart attack or stroke. High cholesterol is one of the most important risk factors for cardiovascular disease.

Know your numbers:

Most people with high cholesterol feel perfectly healthy - there are usually no warning signs, which is why it is sometimes called a “silent killer”. The only way to find out is to have a blood test.

For an accurate result, fast (without food, liquids or pills) for at least nine hours before the test. If a total cholesterol level is high, it is important to know what type of cholesterol is high. Aim for a lower LDL (‘bad’ cholesterol) and higher HDL (‘good’ cholesterol) levels.

The target values are:

Lipid Levels


Total cholesterol

< 5.0

LDL cholesterol

< 3.0

HDL cholesterol (women)

> 1.2

HDL cholesterol (men)

> 1.0


< 1.7

NB! People who are at high risk for cardiovascular events will have individualised targets as advised by their doctor or specialist. This includes people who have:

  • coronary artery disease, heart attack, stroke, peripheral vascular disease,
  • Diabetes
  • Familial hypercholesterolaemia (inherited high cholesterol)

What causes high cholesterol?

The most common cause of high cholesterol is too much saturated fat in the diet. Other causes include an underactive thyroid gland, chronic kidney failure or alcohol abuse. Some people have naturally high blood cholesterol levels, due to a rare hereditary condition called familial hypercholesterolaemia (FH).

If one family member is diagnosed with FH, it is vitally important that all members of the family have a full fasting lipogram done to test if they have FH.

How often should cholesterol be tested?

All adults should have a fasting lipogram at least once in young adulthood (from age of 20). If your cholesterol levels are normal, you only need to test them again in a few years. But if your ‘bad’ cholesterol is high or you have a family history of high cholesterol or heart disease, have it checked regularly (every six months). Children don't need to have their levels tested unless they have a family history.

How can cholesterol levels be lowered?

Depending on your risk profile, your healthcare professional may recommend medication. Diet, physical activity and lifestyle changes are critical.

Advice for controlling cholesterol levels

Dietary advice

  • Choose healthier fats:
    • Unhealthy fats like saturated and trans fats can raise cholesterol levels. These can be found in foods such as fatty and processed meats, chicken skin, full-cream dairy products, butter, ghee, cream and hard cheeses, commercially baked goods such as pies, pastries, biscuits and crackers, fast foods and deep-fried potato/slap chips. 
    • It is better to replace these fats with healthier unsaturated fats such as sunflower / canola / olive oil, soft tub margarines, peanut butter, nuts and seeds, avocado or fish. Read more about the butter versus margarine debate at http://www.heartfoundation.co.za/topical-articles/butter-or-margarine%E2%80%A6-which-better
    • Reduce the total amount of fats you eat, especially if you are overweight 
    • Fish, especially naturally oily fish (such as sardines, pilchards, mackerel and salmon) contains healthy omega-3 fats, which can help to improve cholesterol levels. Eating this kind of fish is recommended at least twice a week. (http://www.heartfoundation.co.za/topical-articles/fish-too-beneficial-go-without)
  • Watch your cholesterol intake from certain foods (organ meats, such as liver, brains and kidneys, as well as shellfish, such as prawns, calamari and shrimps) but remember that cholesterol in food does not make a great contribution to your blood cholesterol. It is more important to eat foods low in saturated and trans fats 
  • Eat a high fibre diet (include both soluble and insoluble fibre). Soluble fibre especially helps to lower cholesterol levels (e.g. in oats, oat bran, legumes, vegetables and fruit). Increase daily dietary fibre intake by choosing high fibre whole-grain options 
  • Eat more vegetables and fruit daily 
  • Include a wide variety of legumes (beans, peas, lentils) and soya 
  • Foods high in added sugars such as sweets, chocolates, sweetened soft drinks/fruit juices/flavoured water and milky drinks need to be used sparingly.
  • When used as part of a healthy diet, plant sterols/stanols can help to lower cholesterol levels by up to 10-15%. This could be provided by sterol-enriched foods (e.g. Flora pro-activ)

Other lifestyle changes to control cholesterol levels

  • Quit smoking and avoid second-hand smoke. For advice on quitting smoking, click here
  • Keep a healthy weight for your height 
  • Incorporate regular physical activity into your day (at least 30 minutes five times a week), as it helps increase your HDL (‘good’) cholesterol levels. Read more about how to incorporate physical activity into your day here
  • If you do drink alcohol – drink it in moderation

For more individualised advice, contact the Heart and Stroke Health Line. Call 0860 1 HEART (0860 1 43278) or email heart@heartfoundation.co.za.