Health Survey for England, 2021 part 2

Cholesterol is a fatty substance (also referred to as a lipid) found in the blood and is needed by the body to function. There are different types of cholesterol including LDL (low density lipoprotein) cholesterol, VLDL (very low density lipoprotein) cholesterol, and HDL (high density lipoprotein) cholesterol.

HDL cholesterol is beneficial, as it carries cholesterol away from the arteries back to the liver, where it can be excreted. Too much non-HDL cholesterol is harmful as it can clog blood vessels, causing them to become stiff and narrow, reducing blood flow. High cholesterol is a significant risk factor for CVD, including narrowing of the arteries (atherosclerosis), heart attack (Peters et al, 2016) and stroke (Law, Wald and Rudnicka, 2003).

In HSE, cholesterol levels were measured via blood samples taken at the nurse visit.

Full details of the HSE blood sample protocols, analytical methods and equipment can be found in the HSE 2021 Methods report.

Raised total cholesterol is defined as total cholesterol equal to or greater than 5mmol/L. No distinction is made between different types of cholesterol.

In 2021, the prevalence of raised total cholesterol was 59%.

The overall difference in prevalence between men (56%) and women (61%) was not statistically significant. Though some differences are apparent between men and women in different age groups, these are in different directions and therefore make the figures for all ages combined closer.

The prevalence of raised cholesterol differed by age and was highest among those aged between 45 and 64 (72%).

Among adults aged 16 to 44, men (53%) were more likely than women (46%) to have raised cholesterol. In older age groups, the prevalence of raised cholesterol was higher among women. 77% of women aged 45 to 64 and 65% aged 65 and over had raised cholesterol. Among men, 67% aged 45 to 64 and 48% of those aged 65 and over had raised cholesterol.

For more information: Table 8

The proportions of adults with raised cholesterol were similar across equivalised household income tertiles.

For more information: Table 9

The proportions of adults with raised cholesterol were similar across the IMD quintiles.

For more information: Table 10

The proportion of adults with raised total cholesterol declined from 1998 to 2019, from 66% to 40% among men, and from 67% to 45% among women.

In 2021, the prevalence of raised cholesterol was 56% among men and 61% among women, higher than in recent years. It is not possible to determine how much this reflects real change in the prevalence of raised cholesterol. It may be influenced by the lower response rates in 2021 to different stages of the HSE. In 2021, valid blood samples were obtained from 16% of adults taking part in the survey, compared with 35% in 2019.

There is evidence to suggest some, at least, of this difference is due to real change in the population. The period between the two surveys included the COVID-19 pandemic, during which access to GPs, particularly access in person, was severely restricted. This may have had implications for the number of people tested for raised cholesterol, including those eligible for NHS Health Checks. These are offered every five years to adults aged 40 to 74 who do not have a range of pre-existing conditions, such as heart disease, diabetes or hypertension.

According to data published by the Office for Health Improvement and Disparities (OHID), the number of individuals receiving NHS Health Checks was 1.2 million or more each year between 2013/14 and 2019/20. In 2020/21, 190,712 adults received an NHS Health Check, increasing to 551,293 eligible adults in 2021/22.

An analysis of initial prescriptions of lipid-lowering drugs for the period March 2020 to July 2021 shows that new prescriptions for lipid-lowering drugs fell during the period when compared with the pre-pandemic period. In England, Scotland and Wales, 316,018 fewer first prescriptions were recorded overall, an average of 16,744 cases a month (Dale et al, 2023).

For more information: Table 11