Hypercholesterolaemia (high cholesterol) is a risk factor for atherosclerosis, a major contributor to cardiovascular disease. Much has been written on managing high cholesterol levels including the use of drug therapy and recommendations about beneficial lifestyle changes relating to nutrition and exercise in particular. Despite this, and the need for patients to engage in self management of a condition which may impact invisibly on their health, little is known about how people living with this risk factor actually manage.The purpose of this grounded theory study is to investigate people's process of living with high cholesterol. Eight participants with self reported high cholesterol levels were interviewed and their data analysed using the process of constant comparative analysis, open coding, selective coding and theoretical coding. A substantive theory in the area of patient self-management of high cholesterol levels was generated through the use of this approach. The theory developed was the basic social process of Maintaining Enjoyment of Life, with two supporting categories, Accepting and Getting On With It.Maintaining Enjoyment of Life was central to the participants' process of living with high cholesterol and the recommended health directives. The identification of this basic social process adds to our understanding of the influences on individuals' motivation for behaviour change and adherence to lifestyle changes. The findings of this study provide understanding that issues relating to behaviour change and adherence are not so much about denying that anything is wrong or not taking personal responsibility, but more about trying to hold on to something important, around which the participants' lives revolve. This is Maintaining Enjoyment of Life. By focussing on this basic social process, which is grounded in the participants' data, health professionals could work more effectively towards empowering patients to identify their own individualised strategies for self-management of high cholesterol. In addition, health directives could focus more on process rather than on do(s) and don't(s).