Genetics are the main driver of high LDL cholesterol levels, not weight alone, according to a professor of cardiometabolic medicine at the University of Glasgow.
Lean people can still have high cholesterol due to genetics or diet
Naveed Sattar explains that diets high in saturated fat — found in cakes, biscuits, chocolate and ultra-processed foods — can raise LDL levels regardless of total calorie intake or body weight. So someone who is not overweight may still develop elevated LDL cholesterol, which builds up in arteries and increases the risk of heart attack and stroke.
Obesity affects other blood lipids more than LDL cholesterol
Even as obesity has minimal direct effect on LDL cholesterol, it is strongly linked to higher triglycerides and remnant cholesterol, both of which contribute to cardiovascular disease risk. Excess body fat also increases the likelihood of type 2 diabetes and high blood pressure, which can amplify the harm caused by LDL cholesterol.
NHS health checks from age 40 include cholesterol testing
In the UK, people aged 40 and over are eligible for a free NHS health check that assesses overall cardiovascular risk, including cholesterol levels. Sattar advises that those under 40 with a family history of early heart disease should consider earlier testing, as genetics play a significant role in lipid profiles.
Can thin people have high cholesterol?
Yes, genetics and dietary patterns high in saturated fat can lead to high LDL cholesterol even in individuals who are not overweight.
Does obesity directly raise LDL cholesterol?
Obesity has minimal effect on LDL cholesterol levels but increases triglycerides, remnant cholesterol, diabetes and blood pressure, which together raise cardiovascular risk.
When should people get their cholesterol checked?
In the UK, NHS health checks offering cholesterol tests are available from age 40; earlier testing is advised for those with a family history of early heart disease.
