Cholesterol Blood Test
What a lipid panel reports, why non-HDL is now preferred to LDL, and how the result is used.
Last revised
A blood test reporting several fat fractions. The total figure on its own is close to meaningless; the split between them, and your overall cardiovascular risk, is what a decision is made on.
What is measured
Total cholesterol, HDL, non-HDL or LDL, and triglycerides. HDL carries cholesterol back to the liver and is associated with lower risk. LDL carries it to tissues and is the fraction most strongly linked to arterial disease. Non-HDL is total minus HDL, capturing all the potentially harmful fractions in one figure, which is why UK guidance has largely moved to it.
Fasting is usually unnecessary
Most UK lipid testing no longer requires fasting. Non-fasting samples are acceptable for total cholesterol, HDL and non-HDL, and are more convenient and better tolerated. A fasting sample may still be requested where triglycerides are very high or a specific question is being answered.
How the result is used
Not in isolation. UK practice combines cholesterol with age, sex, blood pressure, smoking status, diabetes, family history and ethnicity in a risk tool such as QRISK to produce a ten-year probability of a cardiovascular event. Statin treatment is generally offered when that risk crosses a threshold, which is why two people with identical cholesterol can reasonably be given different advice.
When very high levels mean something else
Familial hypercholesterolaemia is an inherited condition affecting roughly one in 250 people, producing very high LDL from birth and substantially raised early cardiovascular risk. It is heavily underdiagnosed. Very high cholesterol, particularly with a family history of heart disease before 60, warrants specific assessment rather than dietary advice alone.
At a glance
| Term | Detail |
|---|---|
| Total cholesterol, commonly quoted target | 5mmol/L or below |
| Non-HDL, commonly quoted target | below 4mmol/L |
| LDL, commonly quoted target | below 3mmol/L |
| HDL, men | above 1.0mmol/L |
| HDL, women | above 1.2mmol/L |
| Triglycerides, fasting | below 1.7mmol/L |
| Fasting required | usually not |
| Risk tool used in the UK | QRISK, giving 10-year risk |
When to get help
See a GP if you have a family history of heart attack or stroke before 60, if a close relative has familial hypercholesterolaemia, or if your total cholesterol is very high. Fatty deposits around the eyes or in tendons, particularly at a young age, should be reported. Call 999 for chest pain lasting more than a few minutes or sudden weakness on one side.
Where to go next
Where this comes from
- NICE - Cardiovascular disease: risk assessment and reduction, including lipid modification
- NHS - High cholesterol
- HEART UK - understanding your results
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
