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More and more people are having their cholesterol levels checked but tests can be misleading. New drugs reduce cholesterol effectively but have most benefit for those at high risk of heart attack.

Should I get my cholesterol level tested?

High blood cholesterol increases risk of heart attack but other factors - such as smoking, diabetes, high blood pressure and obesity - are more serious risks. Most heart attack victims have average or low cholesterol, so tests on their own are not useful predictors of a problem. A test is worthwhile if you have a family history of heart disease or several other risk factors.

Are checks reliable?

Laboratory tests are not always accurate. One study found laboratories overestimated cholesterol, so half the people recommended for treatment did not need it. Tests offered in chemists and health food shops have been found to be even less accurate.

So what should I do if I have high cholesterol?

Attempting to change to a low-fat diet is generally ineffective at reducing cholesterol or heart attacks for most of us - probably because diets are hard to stick to. New cholesterol-lowering drugs produced in the past few years, called statins, are extremely effective. Trials show they reduce cholesterol by more than one-fifth and the risk of a fatal heart attack by a quarter. Older-style drugs, such as fibrates, work less well and have other medical risks.

So should everyone with high cholesterol take statins?

Drug manufacturers are marketing statins heavily for everyone with high cholesterol and prescriptions are rising at huge cost to the NHS. But heart experts argue that statins should only be given to people with high cholesterol if they also have a high risk of heart attack. This covers people who have already had one attack, have symptoms of heart disease, have a strong family history, or are at risk from several other factors such as diabetes and smoking.

If you have high cholesterol but otherwise low heart attack risk, statins are still effective but you may end up taking them for decades for relatively marginal difference. No trials have yet tested long-term effects. You should weigh up the potential benefit against the disadvantage of taking a life-long drug. Side-effects include stomach upsets and there is rare risk of muscular problems. Stopping smoking would more effectively reduce your heart attack risk.

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