Why do I need a cholesterol test?
Having too much of certain types of cholesterol, which GPs and nurses often call high Cholesterol or hyperlipidaemia, can increase your risk of having a heart attack or a stroke.
To find out whether you’re at risk of this happening, we carry out a blood test to measure the different types of cholesterol in your body.
West Street Surgery will contact you when we need to check your cholesterol levels. You may be offered a finger-prick cholesterol test or a blood test depending on risk factors and family history.
If you have had a heart attack or stroke, or have coronary heart disease (CHD), we will be regularly checking your cholesterol levels.
What does a cholesterol test measure?
Millimoles per litre (mmol/L) is the unit used to measure cholesterol levels in the blood.
A cholesterol test usually measures:
– your good cholesterol called HDL cholesterol
– your bad cholesterol called non-HDL cholesterol
– another type of fat in your blood (lipid) called triglyceride.
If your GP says you have high cholesterol, this may mean your level of bad cholesterol is too high.
Explaining the different cholesterol levels
Your cholesterol test will tell you if the different types of cholesterol in your blood are at a healthy level.
Your cholesterol test results may be hard to understand. If you’re not sure what your results mean, you can speak to a member of our clinical team who will explain them.
Here are the different types of cholesterol that you may see on your cholesterol test results and what your results may mean.
Non-HDL cholesterol (bad cholesterol) level
This is the amount of bad cholesterol in your blood.
This type of cholesterol is called bad cholesterol because it can cause the build-up of fatty material in your arteries.
Below 4.0mmol/L is a healthy level of bad cholesterol. After a heart attack or stroke, below 2.6mmol/L is a healthy level.
HDL cholesterol (good cholesterol) level
This is the level of good cholesterol in your blood. It’s called good cholesterol because it helps to get rid of bad cholesterol from your blood.
Above 1.0mmol/L is a healthy level for men and above 1.2mmol/L is a healthy level for women.
LDL cholesterol (bad cholesterol) level
Your GP may also test for a specific type of cholesterol, called LDL (low-density lipoprotein) cholesterol. It’s only tested for if your healthcare team think you may need treatment.
Healthy levels are below 3.0mmol/L, or 2.0mmol/L after a heart attack or stroke.
Total cholesterol level
This shows the total amount of cholesterol in your blood. This is your good cholesterol and bad cholesterol together. It’s sometimes called serum cholesterol or TC. For a healthy heart, the aim is to have a high level of HDL (good) cholesterol, and a lower level of non-HDL (bad) cholesterol.
Healthy total levels are below 5.0mmol/L, or 4.0mmol/L if you’ve had a heart attack or stroke.
Total cholesterol: HDL cholesterol ratio
This shows how much good cholesterol you have compared to total cholesterol.
The number should be as low as possible and is looked at alongside your other test results.
Triglycerides
Triglycerides are another type of fat in your blood which can also cause the build-up of fatty material in your arteries.
Knowing your triglyceride levels can tell you more about your health.
There are two tests:
– Non-fasting triglycerides, shows your normal levels of triglycerides. Results can vary depending on what you ate and drank before the test. Healthy levels are below 2.3mmol/L.
Fasting triglycerides, shows levels of triglycerides after you’ve been fasting (not eating) for 10 to 14 hours. It’s more accurate than the non-fasting test and is only done if your non-fasting triglycerides result is high. Healthy levels are below 1.7mmol/L
What are healthy cholesterol and triglyceride levels?
This information about cholesterol results is a general guide for cholesterol and triglyceride levels for healthy adults in the UK. If you have heart disease or diabetes, your target levels will likely be lower as you’re at higher risk of further heart and circulatory diseases.
Here are the healthy levels for different types of cholesterol:
– non-HDL cholesterol, 4mmol/L or below
– HDL cholesterol, 1mmol/L or above for men and 1.2mmol/L or above for women
– LDL cholesterol, 3mmol/L or below
– total cholesterol, 5mmol/L or below
– fasting triglycerides, 1.7mmol/L or below
– non-fasting triglycerides, 2.3mmol/L or below.
What are healthy levels after a heart attack or stroke?
If you’ve had a heart attack or stroke, you may be at a higher risk of having another. Because of this, the recommended cholesterol levels for you are lower. Aiming for lower cholesterol levels helps prevent you from having another heart attack or stroke.
Medication
Treatment for high cholesterol depends on which lipid is elevated (LDL, triglycerides, ApoB, etc.) and your overall cardiovascular risk.
First-line treatments
Lifestyle changes
These are recommended for nearly everyone:
Mediterranean-style diet
Less saturated fat and ultra-processed food
More soluble fibre (oats, beans, psyllium)
Exercise (150+ min/week)
Weight loss if overweight
Reduce alcohol and refined carbs (especially for triglycerides)
Stop smoking
Main medication classes
Statins (most common and strongest evidence)
Examples:
Atorvastatin
Rosuvastatin
Simvastatin
These primarily lower LDL (“bad cholesterol”) and reduce heart attack/stroke risk.
Ezetimibe
Ezetimibe
Blocks cholesterol absorption in the intestine.
Often added if statins alone are not enough.
PCSK9 inhibitors
Examples:
Evolocumab
Alirocumab
Very effective injectable drugs for:
familial hypercholesterolemia
very high cardiovascular risk
statin intolerance
Bempedoic acid
Bempedoic acid
An oral alternative/add-on, especially for people who cannot tolerate statins well.
Treatments mainly for high triglycerides
Vazkepa (icosapent ethyl)
It is a high-purity EPA omega-3 prescription drug. The most powerful fish oil to be prescribed, achieving amazing results.
It is mainly used for:
elevated triglycerides
reducing cardiovascular risk in selected high-risk patients already on statins
Important point:
Vazkepa is not primarily an LDL-lowering drug. It works best for triglycerides and cardiovascular risk reduction.
FDA-approved uses include:
– triglycerides ≥150 mg/dL with cardiovascular disease or diabetes plus risk factors, despite statin therapy
– severe triglycerides ≥500 mg/dLTypical effects
Fibrates
Examples:
Fenofibrate
Gemfibrozilriglyceridesreventing pancreatitis when triglycerides are extremely highLess evidence for cardiovascular benefit than statins.
How doctors usually choose
High LDL cholesterol
Usually:
1. Statin
2. Add ezetimibe if needed
3. Add PCSK9 inhibitor or bempedoic acid for higher-risk cases
High triglycerides
Usually:
1. Lifestyle + reduce sugar/alcohol
2. Statin if cardiovascular risk is elevated
3. Consider Vazkepa or fibrates depending on triglyceride level and risk profile
