Cholesterol is a fat-like substance present normally in the blood, and in every cell of the body. However the level at which it is present in the blood varies, and the higher the cholesterol level in individuals in a population, the greater the risk of coronary heart disease and stroke. A raised cholesterol level is therefore a risk factor for these diseases, and is especially important when other risk factors are also present.

There is some evidence that there is no cut-off point for cholesterol becoming a risk factor. In other words there is virtually no lower limit at which further lowering of cholesterol does not decrease risk. In the UK the consensus is that 6.5 mmol/L is a useful as the point at which cholesterol level becomes 'raised'. A report from the World Health

Organisation has defined an 'optimal' cholesterol level as 3.8 mmol/L). Serum total cholesterol alone is a poor predictor of individual CHD risk which is much increased if multiple risk factors are present.

Cholesterol is found in the blood in different forms. It is found in lipoproteins. High density lipoprotein (HDL) is thought to transport cholesterol away from tissues and arteries and into the liver, and a high level in the blood is therefore protective against diseases of the heart and arteries. Cholesterol in this form is known as 'good' cholesterol'. Low density lipoprotein (LDL) however is thought to have the opposite function, and cholesterol in this form is thought of as 'bad'. Although this difference exists, within this section total blood cholesterol is considered.

High cholesterol is related to the intake of saturated fat in the diet rather than cholesterol intake.

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