Cholesterol isn't the enemy. Your liver makes around 80% of it for your cell walls, your hormones and vitamin D. It only becomes a risk when your LDL cholesterol stays too high for too long, because it can then contribute to arterial plaque. Here's what your cholesterol values mean and what you can do about them.
What is cholesterol?
Cholesterol is a fatty substance your body needs to build cells, hormones and vitamin D. It travels through your blood in packages called lipoproteins. The two best known are LDL and HDL, and the ratio between them often says more than your total cholesterol alone.
- LDL: the "bad" cholesterol. High LDL particles are a direct cause of plaque in your artery walls (Ference et al., 2017).
- HDL: the "good" cholesterol. HDL helps carry excess cholesterol back to your liver (Rosenson et al., 2012).
We cover the difference in detail in our guide to LDL and HDL cholesterol.
Normal cholesterol values
Targets depend on your personal risk, but these are the general reference values, measured fasting in mmol/L:
- Total cholesterol: below 5.0
- LDL: below 3.0, lower if your risk is higher
- HDL: men above 1.0, women above 1.3
- Triglycerides: below 1.7
- Total/HDL ratio: below 5, lower is better
Which value says what about your heart risk?
Not every value carries the same weight. This aid shows what each marker may indicate and which vitalcheck test covers it. It stays a guide, not a diagnosis.
- LDL: may point to a higher risk of arterial plaque (lipid profile)
- HDL: a low value may be unfavourable (lipid profile)
- Non-HDL: sums up all your "bad" cholesterol (lipid profile)
- Triglycerides: may relate to lifestyle and insulin resistance (lipid profile)
- ApoB: counts the actual number of harmful particles (extended health checkup)
- hs-CRP: may say something about vascular inflammation (extended health checkup)
- Homocysteine: sometimes linked to vascular damage (extended health checkup)
We wrote a separate piece on the lesser-known markers: ApoB, hs-CRP and homocysteine.
What is high cholesterol?
High cholesterol usually means your LDL or total cholesterol sits above target. You often won't feel a thing, which is why it can go unnoticed for years. Common causes include saturated fat, overweight, smoking, age and heredity. Familial hypercholesterolaemia affects roughly 1 in 250 people (Nordestgaard et al., 2013). More in high cholesterol.
How to lower your cholesterol
For most people it starts with lifestyle. Replace saturated fat with unsaturated, eat more fibre, move regularly, stop smoking and watch your triglycerides. Our full approach is in lowering cholesterol without medication. If lifestyle isn't enough, your doctor may consider statins, which can lower LDL by 30 to 50%.
How and when to test
Cholesterol is measured with a simple blood draw, ideally fasting. Some people choose to test periodically to stay informed, especially when high cholesterol runs in the family. At vitalcheck you can test with a lipid profile, without a GP referral.
Frequently asked questions
Do I need to fast?
For reliable LDL and triglyceride values, 8 to 12 hours of fasting is advised. Water is fine.
Can cholesterol be too low?
Very low cholesterol is rare and usually linked to undernutrition or liver disease.
Eggs and cholesterol?
Dietary cholesterol has less impact than once thought. Saturated and trans fats matter more.
The bottom line
My advice: don't fixate on total cholesterol. The LDL/HDL ratio, your triglycerides and your other risk factors tell the real story together. Tested already? Discuss your values with your GP, especially if high cholesterol runs in your family. Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
References
- Ference BA, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. Eur Heart J. 2017. PMID: 28444290.
- Rosenson RS, et al. Cholesterol efflux and atheroprotection. Circulation. 2012. PMID: 22508840.
- Nordestgaard BG, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated. Eur Heart J. 2013. PMID: 23956253.
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