High Cholesterol (Hypercholesterolaemia) — NZ Condition Guide | KiwiMeds

What is High Cholesterol?

Cholesterol is a fatty substance in the blood that your body needs to build cells and produce hormones. However, when cholesterol levels are too high, fatty deposits (plaques) can build up in artery walls, increasing the risk of heart attack and stroke. High cholesterol (hypercholesterolaemia) is extremely common — around 50% of New Zealand adults have elevated cholesterol levels. There are two main types: LDL (“bad”) cholesterol that contributes to plaque build-up, and HDL (“good”) cholesterol that helps remove excess cholesterol.

Symptoms

High cholesterol has no symptoms — you can have dangerously high levels without feeling anything. This is why regular blood testing is important. In severe familial hypercholesterolaemia, cholesterol deposits can appear as yellow patches around the eyes (xanthelasma) or tendons (xanthomas), but these are uncommon.

Causes and Risk Factors

High cholesterol is caused by a combination of diet, lifestyle, and genetics. Risk factors include a diet high in saturated and trans fats, lack of physical activity, being overweight, smoking, type 2 diabetes, hypothyroidism, kidney disease, and family history of high cholesterol or early cardiovascular disease. Familial hypercholesterolaemia (FH) is a genetic condition causing very high LDL cholesterol from birth — it affects around 1 in 300 New Zealanders and is often undiagnosed.

Diagnosis

High cholesterol is diagnosed with a fasting lipid panel blood test — checking total cholesterol, LDL, HDL, and triglycerides. In NZ, cholesterol testing is recommended as part of regular cardiovascular risk assessment from age 45 (or earlier if you have risk factors). Your GP will use your full cholesterol profile alongside other risk factors to calculate your 5-year cardiovascular risk using the PREDICT-CVD tool.

Treatment in New Zealand

Lifestyle changes are the first step — reducing saturated fat, increasing soluble fibre, exercising regularly, and quitting smoking. Statins are the most commonly prescribed cholesterol-lowering medicines and have strong evidence for reducing heart attack and stroke. Atorvastatin and simvastatin are fully funded by Pharmac. If statins are not tolerated, ezetimibe is an alternative, also funded. For very high-risk patients or those with familial hypercholesterolaemia, PCSK9 inhibitors (evolocumab) may be considered.

NZ-Specific Information

All first-line cholesterol medications (atorvastatin, simvastatin, ezetimibe) are funded by Pharmac. The NZ Heart Foundation provides dietary guidance for heart health. Familial Hypercholesterolaemia New Zealand (FH NZ) advocates for better screening and access to treatment. PREDICT-CVD, used by NZ GPs for cardiovascular risk assessment, is one of the world’s most advanced tools.

Frequently Asked Questions

If I take a statin, do I still need to watch my diet? Yes — statins work best alongside a healthy diet and lifestyle. Do statins cause muscle problems? Muscle aches are a reported side effect in some people but are uncommon. Serious muscle damage (rhabdomyolysis) is very rare. Can children have high cholesterol? Yes, particularly those with familial hypercholesterolaemia — screening is recommended if a parent has FH.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Plant Sterols/Stanols — Plant sterols and stanols are among the best-evidenced non-pharmaceutical cholesterol-lowering supplements. At 2 g/day (achievable through fortified foods or supplementation), they reduce LDL cholesterol by 8–10% by competitively inhibiting cholesterol absorption in the small intestine.
• Psyllium Husk — A soluble fibre that binds bile acids in the gastrointestinal tract, increasing hepatic cholesterol demand and reducing LDL. Doses of 10–12 g/day have demonstrated LDL reductions of approximately 5–7% in meta-analyses. Also supports glycaemic control.
• Red Yeast Rice — Red yeast rice contains naturally occurring monacolins, including monacolin K (structurally identical to lovastatin), and has demonstrated LDL reductions of 15–25% in trials. Caution: quality and monacolin content vary significantly between products. Should not be combined with statin medications without medical supervision.
• Omega-3 Fatty Acids — While omega-3s have limited direct LDL-lowering effect, they significantly reduce triglycerides (by 20–30% at doses ≥2 g/day) and provide independent cardiovascular protective benefit.
• Coenzyme Q10 (CoQ10) — Statins reduce endogenous CoQ10 production. Supplementation at 100–200 mg/day is commonly recommended alongside statin therapy to mitigate myalgia (muscle aching), though definitive trial evidence for this specific indication remains debated.

Relevant Vaccinations

Individuals living with high cholesterol (hypercholesterolaemia) may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — People with high cholesterol often have concurrent cardiovascular risk factors. Influenza infection can precipitate acute cardiovascular events. Annual vaccination is recommended.
• Pneumococcal — Recommended for adults with cardiovascular risk conditions, including dyslipidaemia.
• COVID-19 — Dyslipidaemia is a marker of increased cardiovascular risk and is associated with worse COVID-19 outcomes. Maintaining vaccination is advised.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of high cholesterol (hypercholesterolaemia). The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Soluble fibre-rich foods (oats, barley, psyllium, legumes) — Soluble fibre is the most evidence-based dietary intervention for LDL cholesterol reduction. Beta-glucan (in oats and barley) reduces LDL by 5–10% at intakes of 3 g/day by increasing bile acid excretion.
• Plant sterols (fortified foods: Proactive margarine, certain yoghurts) — Foods fortified with plant sterols provide a convenient way to achieve the 2 g/day intake associated with meaningful LDL reductions of 8–10%.
• Oily fish — Reduces triglycerides and cardiovascular risk. Recommended at 2–3 servings per week in cardiovascular risk reduction dietary guidelines.
• Tree nuts (almonds, walnuts, pistachios) — Regular nut consumption (30 g/day) is associated with a 4–5% reduction in LDL cholesterol. Walnuts have additional benefit through ALA omega-3 content.
• Olive oil (extra virgin) — Rich in oleic acid (monounsaturated) and polyphenols. Replaces saturated fats in cooking and has demonstrated LDL-reducing and anti-inflammatory cardiovascular benefits in Mediterranean dietary trials.
• Reduce saturated and trans fats (processed meats, full-fat dairy, pastries) — Replacing saturated fat with unsaturated fat is the single most important dietary change for LDL cholesterol reduction. Reducing ultra-processed foods and commercial baked goods is particularly important.

Related Conditions & Medications

Related medications: Atorvastatin. Related conditions: Type 2 Diabetes, Hypertension.