Conditions
Cholesterol explained: LDL, HDL and triglycerides
What cholesterol numbers mean, how often to get tested, what raises and lowers cholesterol, and when medicines such as statins are recommended.
Key takeaways
- High cholesterol causes no symptoms; a blood test is the only way to know.
- LDL is the main target: lower is generally better for heart health.
- Diet, activity and not smoking help; medicine is recommended when overall heart risk is high.
Cholesterol is a fatty substance your body needs to build cells and make hormones. Problems arise when too much of the wrong type builds up in artery walls, narrowing them and raising the risk of heart attack and stroke.
The numbers on a lipid panel
- LDL cholesterol (“bad”): the main contributor to artery plaque. Lower is better.
- HDL cholesterol (“good”): helps carry cholesterol away from arteries.
- Triglycerides: another type of blood fat, raised by excess calories, sugar and alcohol.
- Non-HDL cholesterol: total cholesterol minus HDL — a useful overall measure.
There is no single “normal” LDL for everyone. Your clinician sets a target based on your overall risk, which includes age, blood pressure, diabetes, smoking and family history. See how blood tests are interpreted in our guide to common blood tests.
How often to test
The CDC advises that most healthy adults have their cholesterol checked every 4 to 6 years, and more often if you have heart disease, diabetes or a family history of high cholesterol. Children should usually be tested once between ages 9 and 11 and again between 17 and 21.
Inherited high cholesterol
Familial hypercholesterolaemia affects roughly 1 in 250 people and causes very high LDL from childhood. If a close relative had a heart attack or stroke at a young age, or has very high cholesterol, ask about testing.
What lowers cholesterol
- Swap saturated fats (fatty meats, butter, coconut and palm oil) for unsaturated fats (olive and canola oils, nuts, seeds, oily fish).
- Eat more soluble fibre from oats, barley, beans, lentils and fruit.
- Move regularly — at least 150 minutes of moderate activity a week.
- Reach a healthier weight, limit alcohol and stop smoking (which also raises HDL).
Medicines
Statins are the most widely used and studied cholesterol-lowering medicines and reduce the risk of heart attacks and strokes in people at higher risk. Other options include ezetimibe and newer injectable medicines. Muscle aches are the most commonly reported side effect; talk to your clinician rather than stopping on your own.
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