Healthy cholesterol levels for adults, according to the NHS, are a total cholesterol below 5mmol/L, a non-HDL ("bad") cholesterol below 4mmol/L, and an HDL ("good") cholesterol above 1.0mmol/L for men or above 1.2mmol/L for women. Many labs in Pakistan report results in a different unit (mg/dL), so always compare your numbers with the reference range printed on your own lab report. Your doctor will look at your results together with your age, blood pressure and other health conditions.
If you have just collected a lipid profile from a lab and are looking at a page full of numbers, this guide will help you understand what they mean. It uses only information from the NHS and MedlinePlus.
What is cholesterol?
According to MedlinePlus, cholesterol is a waxy, fat-like substance found in all the cells in your body. Your body needs some cholesterol to make hormones, vitamin D and substances that help you digest food. Your body makes all the cholesterol it needs, and cholesterol is also found in foods from animal sources, such as egg yolks, meat and cheese.
The problem starts when there is too much of it in your blood. MedlinePlus explains that extra cholesterol can combine with other substances in the blood to form plaque, which sticks to the walls of your arteries. This build-up is called atherosclerosis. It can lead to coronary artery disease, where the arteries that supply the heart become narrow or even blocked.
The NHS overview of high cholesterol puts it simply: too much cholesterol can block your blood vessels and makes you more likely to have heart problems or a stroke.
HDL, LDL, non-HDL and triglycerides: the parts of your report
Cholesterol travels around the blood attached to proteins. MedlinePlus says these combinations of fat (lipid) and protein are called lipoproteins, and different types do different jobs.
- HDL (high-density lipoprotein) is often called "good" cholesterol. MedlinePlus says it helps your body get rid of cholesterol by carrying it back to your liver, which removes it from your body.
- LDL (low-density lipoprotein) is often called "bad" cholesterol, because a high LDL level leads to the build-up of plaque in your arteries.
- VLDL (very low-density lipoprotein) also contributes to plaque build-up. MedlinePlus explains that VLDL mainly carries triglycerides, while LDL mainly carries cholesterol.
- Total cholesterol is the overall amount of cholesterol in your blood, according to the NHS.
- Non-HDL cholesterol is the difference between your total cholesterol and your HDL. The NHS calls this "bad cholesterol".
Your report may also list LDL and triglycerides separately. The NHS table below does not give healthy figures for LDL or triglycerides, so for these results, check the reference range printed next to each one and ask your doctor what yours mean.
What a cholesterol test involves
The NHS page on getting tested says high cholesterol does not usually cause symptoms, and you can only find out if you have it from a blood test. There are two ways to have the test:
- Blood from your arm: a sample is taken with a needle and sent to a lab. The NHS says you should get the result in a few days. In Pakistan, this is usually what happens when your doctor writes "lipid profile" and you go to a local lab.
- Finger-prick test: a drop of blood is put on a strip and read by a machine that checks your cholesterol in a few minutes.
Do I need to fast before a cholesterol test?
The NHS says you might be asked not to eat anything for up to 12 hours before the test, but most people do not need to fast. It also says it does not make much difference to the healthy levels below whether you have eaten before your test or not. Follow whatever instructions your doctor or lab gives you.
Who should get tested, and how often
The NHS suggests asking for a cholesterol test if you have not had one before and you are over 40, overweight, or high cholesterol or heart problems run in your family. Your doctor may also suggest a test because of your age, your weight or a condition such as high blood pressure or diabetes.
MedlinePlus says how often you should be tested depends on your age, risk factors and family history, and gives these general recommendations:
- Age 19 or younger: first test between ages 9 and 11, then every 5 years. Some children may be tested from age 2 if there is a family history of high cholesterol, heart attack or stroke.
- Ages 20 to 65: younger adults every 5 years. Men aged 45 to 65 and women aged 55 to 65 every 1 to 2 years.
- Over 65: every year.
How to read your cholesterol levels
The NHS guide to cholesterol levels gives these healthy levels for healthy adults:
| Result | Healthy level (NHS, mmol/L) |
|---|---|
| Total cholesterol | Below 5mmol/L |
| HDL (good cholesterol) | Above 1.0mmol/L for men, above 1.2mmol/L for women |
| Non-HDL (bad cholesterol) | Below 4mmol/L |
A few important points about this table:
- These are a guide for healthy adults. The NHS says a good target level for you depends on your age, any health conditions and your risk of heart and circulation disease (cardiovascular disease).
- Some things can change your results. The NHS says your levels may be lower or higher if you have been ill, are taking some medicines, or have recently had a baby.
- Read the direction carefully. The healthy HDL level is above a number, while total and non-HDL cholesterol should be below a number.
mmol/L or mg/dL? Check your own report
The NHS figures above are in mmol/L. Many labs in Pakistan report cholesterol in mg/dL instead, so the numbers on your report will not match the table and cannot be compared with it directly. Do not try to convert them yourself. Every lab report shows its own reference range next to each result, and your doctor can explain how your numbers compare.
How your doctor uses the results
Your cholesterol is only one part of the picture. The NHS says doctors use your cholesterol levels along with other factors, such as your age, blood pressure and health conditions, to estimate your risk of cardiovascular disease, and may work out your risk of having a heart attack or stroke over the next 10 years. Since blood pressure is part of this picture, you may also find our guide to blood pressure numbers helpful.
What causes high cholesterol?
MedlinePlus says the most common cause of high cholesterol is an unhealthy lifestyle, including:
- eating lots of saturated fat, found in red meat, full-fat dairy products, chocolate, some baked goods and many deep-fried and processed foods
- lack of physical activity, with lots of sitting and little exercise
- smoking, which lowers HDL and raises LDL
- stress, which may raise hormones that make your body produce more cholesterol
- drinking too much alcohol
Other things raise your risk too:
- Age: cholesterol levels tend to rise as you get older (MedlinePlus). The NHS says you are more likely to have high cholesterol if you are over 50.
- Sex and menopause: the NHS says men, and women who have been through the menopause, are more likely to have high cholesterol.
- Ethnicity: the NHS says people of South Asian origin are more likely to get high cholesterol, which matters for families in Pakistan.
- Family history and genes: high cholesterol can run in families. MedlinePlus describes an inherited condition called familial hypercholesterolemia that causes very high levels.
- Weight and other conditions: being overweight, and conditions such as diabetes and chronic kidney disease, can raise your risk.
- Certain medicines: MedlinePlus lists steroids among the medicines that can affect cholesterol.
How to lower your cholesterol
The NHS advice on lowering cholesterol focuses on four things.
Eat less fatty food
Cut down on fatty food, especially food with saturated fat. You can still have foods with healthier unsaturated fat. The NHS suggests:
| Try to eat more | Try to eat less |
|---|---|
| Oily fish, nuts and seeds | Fatty meat, sausages and meat pies |
| Olive oil, rapeseed oil and spreads made from them | Butter, lard and ghee |
| Brown rice, wholegrain bread and wholewheat pasta | Cream and cheese |
| Fruits and vegetables | Cakes, biscuits and food with coconut or palm oil |
For many Pakistani households, this can mean using less ghee and butter in cooking, choosing less fatty meat, and adding more vegetables, fruit, nuts and whole grains.
Exercise more
The NHS says aim for at least 150 minutes (2.5 hours) of moderate exercise or 75 minutes of vigorous activity a week. Fast walking, swimming and cycling are good places to start. Pick something you enjoy, because you are more likely to keep doing it.
Stop smoking
Smoking can raise your cholesterol and make you more likely to have heart attacks, strokes and cancer, according to the NHS. Your doctor can help you quit.
Cut down on alcohol
The NHS advises not regularly drinking more than 14 units a week and having several drink-free days.
Medicines such as statins are a doctor's decision
The NHS page on medicines for high cholesterol says you might need medicine if your cholesterol has not gone down after changing your diet and lifestyle, or if you are at high risk of a heart attack or stroke. Statins are the most common medicine for high cholesterol and reduce the amount of cholesterol your body makes. Other tablets or injections may be used if statins do not work or you cannot take them.
Whether you need medicine, and which one, is for your doctor to decide. MedlinePlus adds that if you do take cholesterol medicine, you should still continue with the lifestyle changes.
When to see a doctor
See your doctor if:
- your lab report shows results outside the reference range
- you are over 40 and have never had a cholesterol test
- you are overweight, or high cholesterol or heart problems run in your family
- you have diabetes or high blood pressure and have not had your cholesterol checked
- you have started lifestyle changes and want to know whether they are working
Know the emergency signs
High cholesterol itself has no symptoms, but MedlinePlus explains that plaque in the arteries can lead to angina (chest pain), a heart attack or a stroke. If you or someone with you suddenly has chest pain, or signs of a heart attack or stroke, call 1122 or go to the nearest emergency department straight away.
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Sources
- NHS — High cholesterol
- NHS — High cholesterol: getting tested
- NHS — Cholesterol levels
- NHS — How to lower your cholesterol
- NHS — Medicines for high cholesterol
- MedlinePlus — Cholesterol
Medical note: This guide is for general information and is not a substitute for advice from a doctor who can examine you.
Frequently asked questions
- What is a normal cholesterol level?
- The NHS gives these healthy levels for healthy adults: total cholesterol below 5mmol/L, non-HDL cholesterol below 4mmol/L, and HDL cholesterol above 1.0mmol/L for men or above 1.2mmol/L for women. Your own target may be different depending on your age, health conditions and heart risk. If your lab reports in mg/dL, use the reference range printed on your report.
- Do I need to fast before a cholesterol test?
- The NHS says most people do not need to fast, although you might be asked not to eat for up to 12 hours before the test. It also says eating before the test does not make much difference to the healthy levels. Follow the instructions your doctor or lab gives you.
- What is the difference between HDL and LDL cholesterol?
- HDL is often called good cholesterol because it carries cholesterol back to the liver, which removes it from the body. LDL is often called bad cholesterol because a high LDL level leads to plaque building up in the arteries. Plaque can narrow or block the arteries that supply the heart.
- Why is my cholesterol report in mg/dL instead of mmol/L?
- Many labs in Pakistan report cholesterol in mg/dL, while NHS guidance uses mmol/L, so the numbers cannot be compared directly. Do not try to convert them yourself. Use the reference range printed next to each result on your lab report, and ask your doctor to explain your numbers.
- Does high cholesterol cause any symptoms?
- High cholesterol does not usually cause symptoms, according to the NHS, and the only way to find out is a blood test. Over time, too much cholesterol can block blood vessels and make heart problems or a stroke more likely. That is why testing matters if you are at higher risk.
- Can I lower my cholesterol without medicine?
- The NHS says eating less fatty food, exercising more, stopping smoking and cutting down on alcohol can help lower cholesterol. Some people still need medicine, such as statins, if their levels do not come down or their heart risk is high. Your doctor decides whether you need medicine and which one.
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