Is my cholesterol high?
Yes, if it’s 5 or more. The NHS healthy level is below 5, so 5.2, 6.1 and 7.1 are all above it. But two people on 6.1 can get different advice. One line shows why.
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Is a cholesterol of 5, 6 or 7 high?
Yes. The NHS says a healthy total for adults is below 5 mmol/L. So any result of 5 or more is outside it.
Picture 5 as a 50 mph limit. A 5.8 is doing 58 and a 7.1 is doing 71.
Going over doesn’t mean you’ll crash, but it makes a crash more likely. The NHS says too much cholesterol makes you more likely to have heart problems or a stroke.
To see how likely that is for you, your GP may work out your 10-year risk of a heart or circulation problem.
- Below 5 mmol/LHealthy for adults.
- 5 up to 7.5 mmol/LAbove healthy. Your GP may work out your 10-year risk.
- Above 7.5 up to 9 mmol/LNICE: think about an inherited cause (FH).
- Above 9 mmol/LNICE: specialist check.
Sources: NHS; NICE CG71; NICE NG238
On 7.1? You’re close to 7.5. Above that, NICE says to suspect familial hypercholesterolaemia (FH).
The same goes at any level if you or a parent, brother, sister or child had heart disease before 60. FH is inherited and affects about 1 in 250 people. HEART UK says fewer than 10% are diagnosed.
Just over 5? Your total can move about 5% from day to day, even in healthy people. So a 5.2 may come from a usual level just under 5.
Ask your GP whether a repeat test is worth it.
How to read your cholesterol results
| Line | Healthy level (mmol/L) | What it is |
|---|---|---|
| Total cholesterol | Below 5 | All your cholesterol added together. |
| Non-HDL | Below 4 | Total minus HDL. The NHS calls it bad cholesterol. |
| HDL | Above 1.0 (men) or above 1.2 (women) | The NHS calls it good cholesterol. |
| LDL | Below 3.0 | One part of non-HDL. Usually worked out, not measured. |
| Triglycerides | Below 1.7 fasting, below 2.0 non-fasting | Another blood fat. It swings most from day to day. |
Sources: NHS; HEART UK; NICE NG238; EFLM
Only see a total? Ask your doctor or nurse for your HDL and non-HDL as well.
Ate before the test? For these levels it makes little difference. Triglycerides are the exception, so HEART UK gives two levels.
Ill lately, on some medicines or had a baby? Your levels may read higher or lower. HEART UK advises against testing in pregnancy and suggests waiting at least 6 to 8 weeks after birth, or until you stop breastfeeding.
More on each line: non-HDL, HDL, LDL and triglycerides.
Why can two people on 6.1 get different advice?
A total is like weighing a shopping bag. The scales can’t tell you how much is fruit (good HDL) and how much is junk (bad non-HDL).
Source: NHS
That line is your HDL. Take it from your total and you get your bad cholesterol.
NICE says to measure total and HDL together for the best estimate of heart risk. So Person B may get a higher risk score and a different next step.
- Below 4 mmol/LHealthy for adults.
- 4 up to 7.5 mmol/LAbove healthy. Your GP may work out your 10-year risk.
- Above 7.5 mmol/LNICE: specialist check.
Sources: NHS; NICE NG238
No non-HDL on your sheet? Take your HDL away from your total. Or ask for a full lipid profile, which works it out for you.
What will my GP do after a high result?
What usually happens after a high total
- 1
Full results
Total, HDL and triglycerides. Usually no need to fast.
- 2
Risk score
QRISK3 gives your 10-year risk, if you’re 25 to 84 without heart or circulation disease.
- 3
Lifestyle first
Food, exercise, smoking and alcohol.
- 4
Statin talk
Offered at a score of 10% or more, if changes aren’t enough.
Sources: NICE NG238; NHS
A risk score is a forecast, like a 10% chance of rain. It gives the odds over 10 years, not what will happen to you.
Under 10%? NICE says don’t rule out a statin just for that, if you’d prefer one after talking it through or your score may be too low.
Scores can read too low for some people. Tell your GP if you:
- are being treated for HIV
- already take medicines for heart risks, such as blood pressure tablets
- stopped smoking recently
- take medicines that can upset blood fats, such as medicines that calm the immune system
- have a severe mental illness
- have a condition where your immune system attacks your own body, or another long-term inflammatory condition
- have triglycerides of 4.5 to 9.9
If you take a statin to prevent a first heart attack or stroke, NICE aims for a fall of more than 40% in non-HDL. It’s retested 2 to 3 months after you start.
Never stop or change a prescribed medicine without your prescriber. See blood tests on statins.
How can I lower my cholesterol?
Six NHS changes to start this week
- Swap butter, lard and ghee for olive or rapeseed oil, or spreads made from them.
- Have oily fish, like salmon or mackerel, in place of pies, sausages or fatty meat.
- Choose wholegrain bread, brown rice and wholewheat pasta.
- Reach for nuts, seeds and fruit instead of cakes and biscuits.
- Build up to 150 minutes of moderate exercise a week, such as brisk walking.
- Stop smoking, and drink no more than 14 units a week, spread over 3 or more days.
Oats help a little. At least 3 g a day of beta-glucan, the fibre in oats, has been shown to lower cholesterol. Across 58 trials, 3.5 g a day cut LDL by about 4%.
Spreads and yoghurt drinks with added plant sterols or stanols help more. At 1.5 to 3 g a day, they’ve been shown to cut cholesterol by 7% to 12.5% within 2 to 3 weeks. Skip them if you’re pregnant or breastfeeding, and don’t give them to under-5s.
There’s not enough long-term evidence that sterols cut heart attacks or strokes. NICE doesn’t advise them to prevent heart disease.
For meals and more detail, see how to lower cholesterol, high-fibre foods and plant sterols.
When to speak to a GP
High cholesterol does not usually cause symptoms. Only a blood test can show it. Book an appointment if:
- Your total is above 7.5, or you or a parent, brother, sister or child had heart disease before 60. NICE says to check for FH.
- Your total is above 9, or your non-HDL is above 7.5. NICE advises a specialist check.
- Your triglycerides are 10 or more. NICE advises a repeat fasting test, and urgent specialist review above 20 if alcohol or poorly controlled diabetes doesn’t explain it.
- You’re over 40, overweight or heart problems run in your family, and you’ve never had a test.
Aged 40 to 74 and living in England? You should be invited to a free NHS Health Check every 5 years, unless you have certain conditions. It includes a cholesterol test.
See also cholesterol levels by age and signs of high cholesterol.