Cholesterol and Lipid Panel: What Your Numbers Mean

What Is a Lipid Panel?

A lipid panel (also called a lipid profile or cholesterol test) is a blood test that measures the fats and fatty substances circulating in your blood. Cholesterol is essential for building cell membranes, producing hormones, and making vitamin D, but when levels are too high, fatty deposits build up in your arteries, increasing the risk of heart attack and stroke.

Cardiovascular disease (CVD) is the leading cause of death worldwide and one of the top causes in the UK. High cholesterol is a major modifiable risk factor, which is why the NHS Health Check programme offers cholesterol testing to everyone aged 40 to 74 in England.

Total Cholesterol

Total cholesterol is the overall amount of cholesterol in your blood, including both "good" and "bad" types. It is a useful headline number but does not tell the full story on its own.

• Below 5 mmol/L — Ideal for healthy adults (NHS recommended target).
• 5 to 6.4 mmol/L — Mildly raised. Lifestyle changes recommended.
• 6.5 to 7.8 mmol/L — Moderately raised. May warrant treatment depending on overall risk.
• Above 7.8 mmol/L — Significantly raised. Familial hypercholesterolaemia should be considered.

HDL Cholesterol ("Good Cholesterol")

High-density lipoprotein (HDL) carries cholesterol away from the arteries and back to the liver for disposal. Higher HDL levels are protective against cardiovascular disease.

• Above 1.0 mmol/L (men) or 1.2 mmol/L (women) — Desirable.
• Above 1.6 mmol/L — Considered very protective.
• Below 1.0 mmol/L (men) or 1.2 mmol/L (women) — Low. Associated with increased cardiovascular risk.

HDL can be raised through regular exercise, maintaining a healthy weight, moderate alcohol consumption, and eating unsaturated fats (such as olive oil, nuts, and oily fish).

LDL Cholesterol ("Bad Cholesterol")

Low-density lipoprotein (LDL) carries cholesterol to the arteries, where it can accumulate as plaque, narrowing the vessels and increasing the risk of heart attack and stroke.

• Below 3 mmol/L — Ideal for healthy adults.
• Below 2 mmol/L — Target for people at high cardiovascular risk or on statins.
• Below 1.8 mmol/L — Target for people with established CVD or very high risk (NICE CG181).

LDL is the primary target for statin therapy. NICE recommends aiming for a greater than 40% reduction in non-HDL cholesterol (which includes LDL and other atherogenic lipoproteins) within 3 months of starting a statin.

Triglycerides

Triglycerides are a type of fat used by the body for energy. They come from the food you eat, and the liver also produces them. Raised triglycerides are associated with increased cardiovascular risk and are often seen alongside high LDL and low HDL (a pattern sometimes called "atherogenic dyslipidaemia").

• Below 1.7 mmol/L (fasting) — Normal.
• 1.7 to 2.3 mmol/L — Mildly raised.
• 2.3 to 10 mmol/L — Moderately raised.
• Above 10 mmol/L — Severely raised. Risk of acute pancreatitis.

Triglycerides are more affected by recent food intake than other lipids, which is why fasting was traditionally recommended. However, non-fasting triglycerides up to 2.3 mmol/L are now considered acceptable for screening purposes.

TC:HDL Ratio

The total cholesterol to HDL ratio (TC:HDL) is calculated by dividing your total cholesterol by your HDL. It provides a useful summary of cardiovascular risk.

• Below 4 — Low cardiovascular risk.
• 4 to 6 — Moderate risk.
• Above 6 — High risk.

QRISK3: Your 10-Year Cardiovascular Risk

Your cholesterol results are most meaningful when combined with other risk factors using a tool called QRISK3. This estimates your percentage risk of having a heart attack or stroke within the next 10 years. It considers age, sex, ethnicity, blood pressure, cholesterol, smoking status, BMI, family history, diabetes, kidney disease, and other factors.

NICE recommends offering statin therapy to anyone with a QRISK3 score of 10% or higher. This means even someone with modestly elevated cholesterol may benefit from treatment if their overall risk profile is high.

Do You Need to Fast?

Traditionally, patients were asked to fast for 10 to 14 hours before a lipid panel. However, NICE now states that a fasting sample is not required for cardiovascular risk assessment in most cases. A non-fasting sample is acceptable because total cholesterol and HDL are not significantly affected by food. However, if triglycerides are raised on a non-fasting sample, your GP may request a fasting test to get a more accurate reading.

Statin Monitoring

If you are started on a statin, NICE recommends the following blood tests:

• Lipid profile at 3 months — To check whether non-HDL cholesterol has fallen by at least 40%. If not, discuss adherence, lifestyle, and consider dose increase.
• Liver function tests (LFTs) — At baseline and again at 3 months. Statins can occasionally cause elevated liver enzymes, though serious liver damage is very rare.
• Annual lipid profile — Once stable, to ensure targets continue to be met.

Lifestyle Factors

While medication is important for those at high risk, lifestyle changes can significantly improve your lipid profile:

• Replace saturated fats with unsaturated fats (olive oil, avocado, nuts, oily fish).
• Increase dietary fibre (oats, beans, lentils, fruits, vegetables).
• Maintain a healthy weight.
• Exercise for at least 150 minutes per week at moderate intensity.
• Stop smoking — this raises HDL and reduces overall cardiovascular risk.
• Limit alcohol intake.

Getting Tested at Home

A cholesterol check is one of the simplest blood tests you can have. A mobile phlebotomist from Lola Dispatch can visit your home, collect the blood sample, and send it to an accredited laboratory. If a fasting sample is needed, an early-morning appointment makes this easy.

Book a home blood test to check your cholesterol and take control of your cardiovascular health without the hassle of a GP waiting room.