Cholesterol numbers explained: how to read a lipid panel

Ask Australians whether they have high cholesterol and 8.4% say yes. Measure their blood and the picture changes: 30.2% of adults have a total cholesterol of 5.5 mmol/L or more. Both figures come from the Australian Bureau of Statistics. The first is from its 2022 National Health Survey, which records what people report about themselves. The second is from the National Health Measures Survey 2022–24, which took blood samples.

The surveys are not a perfect match: the self-reported figure covers all ages and the measured one adults only. The age bands point the same way, though. Among people aged 45–54, 8.8% reported high cholesterol, while 41.7% of men that age had a high result on testing. At 55–64, 19.0% reported it. Among women of that age, 53.5% measured high.

One reason for the gap is easy to find. The Heart Foundation points out that high cholesterol generally has no obvious symptoms. Without a blood test there is nothing to notice and nothing to report.

What the four numbers measure

Cholesterol is a waxy, fat-like substance. The body makes its own and uses it to produce hormones and to help digest food, and some also comes from what we eat. The blood test that measures it is called a lipid panel or lipid profile, and it normally reports four results.

• Total cholesterol. The overall amount in the blood. The ABS survey counted 5.5 mmol/L or more as abnormally high.
• LDL cholesterol. Low-density lipoprotein, often called bad cholesterol. The Heart Foundation explains that it makes up most of the body's cholesterol and can stick to artery walls, causing the fatty build-up known as plaque. The ABS cut-off was 3.5 mmol/L or more, and 27.8% of adults were at or above it.
• HDL cholesterol. High-density lipoprotein, the so-called good cholesterol, which carries LDL away from the arteries and back to the liver. Here the concern is a low reading. The ABS counted below 1.0 mmol/L for men and below 1.3 mmol/L for women as abnormally low, which applied to 14.9% of adults.
• Triglycerides. The most common fat in the body. The Heart Foundation says levels can rise with excess weight, a lot of high-fat and sugary food, or too much alcohol. The ABS cut-off was 2.0 mmol/L or more, met by 14.5% of adults and by more men (18.3%) than women (10.8%).

Put the four together and the picture broadens. The ABS classed 58.9% of adults as having dyslipidaemia, meaning at least one abnormal result or current use of a lipid-lowering medicine. Of that group, three in ten (30.5%) were taking a cholesterol-lowering medicine.

Cut-offs are not personal targets

The thresholds above are the ones statisticians used to describe a population. They are not a pass mark for an individual. The Heart Foundation's advice to the public is that target cholesterol levels vary with factors such as age and family history, and that people should ask their doctor which levels are right for them.

The 2023 Australian guideline for assessing and managing cardiovascular disease risk, published at cvdcheck.org.au, starts from the position set out in a peer-reviewed summary for clinicians: a person's risk depends on the combined effect of several factors, so assessment and treatment should be based on overall risk.

In practice a GP enters a set of details into the Australian CVD risk calculator. These include age, sex, smoking status, systolic blood pressure, diabetes status and the ratio of total cholesterol to HDL cholesterol. The calculator returns a percentage: the estimated chance of dying or being hospitalised because of a cardiovascular event, such as a heart attack or stroke, within the next five years. That figure is sorted into three bands: low (under 5%), intermediate (5% to under 10%) and high (10% or more).

So the same LDL result can lead to different advice for two people. For someone in the high-risk band, the guideline recommends both blood pressure-lowering and lipid-modifying medicines. For intermediate risk, medicines are something to consider. For everyone, the primary focus is support for healthy lifestyle choices, with or without medicine. Reassessment is advised after five years for people at low risk and after two for those at intermediate risk.

There are exceptions where one number does carry the decision. The guideline summary gives a total cholesterol above 7.5 mmol/L as an example of a level that warrants preventive medicine whatever the calculator says. People with a confirmed diagnosis of familial hypercholesterolaemia are treated as high risk without using the calculator.

Getting checked

The guideline recommends a risk assessment for all people aged 45 to 79 without known cardiovascular disease, from 35 for people with diabetes and from 30 for First Nations people. The Heart Foundation calls the appointment a Heart Health Check and describes it as a 20-minute visit to a GP. It has been covered by Medicare since April 2019 and is free at practices that bulk bill the service.

What the Heart Foundation suggests eating

The Heart Foundation describes a heart-healthy eating pattern with five parts.

• Plenty of vegetables, fruit and wholegrains. Wholegrains such as oats and brown rice are high in fibre, which the Heart Foundation says can help lower cholesterol.
• Protein mostly from legumes, nuts, seeds, fish and seafood, with smaller amounts of eggs and lean poultry. For people who eat fish, two to three times a week is suggested. Lean red meat is limited to one to three times a week.
• Unflavoured milk, yoghurt and cheese. People with high cholesterol or heart disease are advised to choose reduced-fat versions.
• Fats from avocados, olives, nuts and seeds, and cooking oils such as olive, canola, sunflower, peanut and soybean.
• Herbs and spices to flavour food in place of salt.

Water is the recommended drink. For people with heart disease, high LDL cholesterol or type 2 diabetes, the Heart Foundation recommends no more than seven eggs a week.

Movement is part of the same advice: the Heart Foundation recommends working up to 30 to 60 minutes of moderate-intensity physical activity on most days of the week.

Reading your own results

A lipid panel is one input among several. The more useful thing to ask a GP is which risk band the whole picture adds up to.

For people already prescribed a cholesterol-lowering medicine, the Heart Foundation's advice is to take it exactly as directed and not to stop because they feel better. Any change is a decision to make with the doctor who prescribed it.

For anyone aged 45 or older who has not had a cholesterol test, or 30 or older for Aboriginal and Torres Strait Islander people, the Heart Foundation's advice is to see a doctor for one.

Sources

1. Australian Bureau of Statistics, High cholesterol, 2022.
2. Australian Bureau of Statistics, National Health Measures Survey, 2022–24.
3. Heart Foundation, Blood cholesterol.
4. Heart Foundation, Time to book a Heart Health Check?.
5. Heart Foundation, How to follow a heart healthy eating pattern.
6. Australian Chronic Disease Prevention Alliance and Australian Government Department of Health and Aged Care, Assessing and managing cardiovascular disease risk: 2023 Australian guideline and calculator.
7. Jennings G, Raffoul N, Nelson M and others, Australian Prescriber (2024), via PubMed Central, Assessing, communicating and managing cardiovascular disease risk: a practical summary of the 2023 guideline.