Understanding Cholesterol: Types, Targets, and Treatment

ByFamily Doctor Editorial

A cholesterol test is one of the most common blood tests ordered by Australian GPs. Understanding your results — and what targets apply to you — helps you have a more useful conversation about lifestyle, medication, and long-term cardiovascular risk.

What Is Cholesterol?

Cholesterol is a waxy fat-like substance your body needs for building cells, producing hormones, and making vitamin D. Your liver makes most of it; a smaller amount comes from food. The problem isn’t cholesterol itself — it’s having too much of certain types circulating in your blood, where it contributes to artery narrowing.

The Main Numbers on Your Lipid Panel

LDL cholesterol (“bad”)

Low-density lipoprotein carries cholesterol to tissues. Excess LDL builds up in artery walls, forming plaques that narrow arteries and can rupture to cause heart attacks and strokes. Lower is generally better. Targets depend on your overall cardiovascular risk:

  • Low risk — LDL below 3.0 mmol/L is generally acceptable.
  • Moderate risk — aim for LDL below 2.5 mmol/L.
  • High risk (diabetes, family history, existing heart disease) — aim for LDL below 1.8 mmol/L or lower.
  • Very high risk (prior heart attack or stroke) — aim for LDL below 1.4 mmol/L.

HDL cholesterol (“good”)

High-density lipoprotein carries cholesterol away from tissues back to the liver. Higher HDL is protective. Aim for above 1.0 mmol/L in men and above 1.3 mmol/L in women. Regular exercise, maintaining healthy weight, and moderate unsaturated fat intake all raise HDL.

Triglycerides

Triglycerides are fats circulating after meals and are strongly influenced by what you eat (particularly sugar and alcohol). Target: below 2.0 mmol/L fasting. Very high triglycerides (above 10 mmol/L) can cause pancreatitis and need urgent treatment.

Total cholesterol

An overall number. Less useful on its own — the LDL/HDL breakdown matters more.

Absolute Risk, Not Just the Numbers

Modern practice calculates your absolute cardiovascular risk — the chance of a heart attack or stroke in the next 5 years — based on cholesterol plus age, sex, blood pressure, diabetes, smoking status, and family history. This is more useful than focusing on one number. Your GP uses an online calculator (such as AusCVDRisk) that gives a percentage.

  • Less than 5% — low absolute risk; lifestyle focus.
  • 5-10% — moderate; lifestyle plus consideration of medication.
  • Over 10% — high; medication usually recommended alongside lifestyle.

Lifestyle Changes That Improve Cholesterol

  • Reduce saturated fat — fatty meat, butter, cream, palm oil, coconut oil. Limit to small portions.
  • Eliminate trans fats — found in some processed foods; read labels for “partially hydrogenated oils”.
  • Increase soluble fibre — oats, legumes, flaxseed, apples, barley. Lowers LDL.
  • Plant sterols — found in certain fortified spreads; can lower LDL by around 10%.
  • Oily fish — salmon, mackerel, sardines twice a week — raises HDL, lowers triglycerides.
  • Exercise — 150 minutes of moderate activity weekly raises HDL and lowers triglycerides.
  • Lose weight if overweight — even 5-10% weight loss improves all cholesterol numbers.
  • Limit alcohol — excess raises triglycerides significantly.
  • Quit smoking — raises HDL within weeks of quitting.

Statin Medications

Statins (atorvastatin, rosuvastatin, simvastatin, pravastatin) are the most widely used cholesterol medications. They block an enzyme in the liver, reducing LDL by 30-60% depending on dose.

Statins are strongly recommended when:

  • You’ve had a heart attack, stroke, or stenting — proven to reduce future events.
  • You have diabetes and are over 40 — reduces cardiovascular risk significantly.
  • Your absolute CVD risk exceeds 10% over 5 years.
  • You have familial hypercholesterolaemia (genetically very high LDL).

Common concerns and answers:

  • Muscle aches — affect around 5-10% of users; often resolve with switching statins or lowering dose. True muscle damage is rare.
  • Liver enzymes — mild elevations are common and rarely problematic; your GP monitors.
  • Diabetes risk — a small increase (especially in people already at high diabetes risk); outweighed by cardiovascular benefit for most.
  • Do statins cause dementia? — No. Randomised trials and large observational studies consistently show no increase in dementia risk, and possibly a modest reduction.

Other Cholesterol Medications

  • Ezetimibe — blocks cholesterol absorption; added to statins when further reduction is needed.
  • PCSK9 inhibitors (evolocumab, alirocumab) — injectables for very high-risk patients or statin-intolerant.
  • Bempedoic acid — newer oral option for statin-intolerant patients.
  • Fibrates — primarily for very high triglycerides.

Frequently Asked Questions

Do I need to fast before a cholesterol test?

Traditional guidance was to fast 10-12 hours; newer evidence suggests non-fasting testing is fine for screening. Your GP or pathology request will specify.

Can I lower cholesterol without medication?

Yes, if your LDL isn’t dramatically elevated and you’re at low/moderate risk. Diet, exercise, weight loss, and quitting smoking can make a significant difference. If your LDL is very high or you have diabetes/heart disease, lifestyle alone usually isn’t enough.

How often should I get cholesterol checked?

At minimum every 5 years from age 45, or earlier if you have risk factors. More frequently if you’re on treatment or making changes.

Is low cholesterol dangerous?

Very low cholesterol from medication is safe for most. Very low natural cholesterol can occasionally signal liver disease, thyroid issues, or malnutrition.

Book a Cholesterol Review

If you haven’t had your cholesterol checked in 5+ years — or if you know your numbers are high and want to discuss options — book a GP appointment. Find your nearest Family Doctor clinic.

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