A cholesterol result means little on its own. What matters is your total 10 year risk and the particles carrying the cholesterol, which is what ApoB and lipoprotein(a) measure. Every 1 mmol per litre fall in LDL cuts major vascular events by around a fifth. The Core panel is £350.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Cholesterol is carried through the blood inside particles. The ones that deposit in artery walls all carry a protein called apolipoprotein B, and the number of those particles predicts risk better than the amount of cholesterol inside them.European Heart Journal EAS consensus, 2022
A raised level causes no symptoms. The exceptions are the inherited disorders, which can show as yellow deposits around the eyes or thickened tendons, and those are the cases where treatment matters most and starts earliest.NICE NG238, 2023
Diet, weight, alcohol and inactivity account for a large part of it. An underactive thyroid, kidney disease, liver disease and some medicines all raise lipids, and those are checked before a lifelong treatment is started for something reversible.NICE NG145, 2019
Familial hypercholesterolaemia affects roughly 1 in 250 people and is substantially underdiagnosed. A total cholesterol above 9, or a first degree relative with premature heart disease, is what should trigger the question.NICE NG238, 2023
Send us what you are seeing and we will tell you what it is likely to be.
A full lipid profile does not require fasting. Total cholesterol, HDL, non HDL and triglycerides are measured, and non HDL cholesterol is now the working number rather than LDL calculated by formula.NICE NG238, 2023
ApoB counts the particles rather than the cholesterol they carry, and it is the more accurate measure where triglycerides are high or someone has metabolic syndrome. Lipoprotein(a) is measured once, because it is inherited and does not change.European Heart Journal EAS consensus, 2022
HbA1c goes in the same draw. Raised blood sugar and raised lipids travel together, and the combination changes both the calculated risk and the treatment target.World Health Organization WHO/NMH/CHP/CPM/11.1, 2011
Blood pressure is measured at the same visit, because the risk calculation needs it and because treating one arm of the same risk and not the other is the commonest way this goes wrong.NICE NG136, 2023
Thyroid, kidney, liver function and HbA1c go in the same draw, because a secondary cause changes the treatment and treating the lipid while missing the thyroid treats the wrong thing.NICE NG145, 2019
Diet and weight
Replacing saturated fat rather than simply removing it, more soluble fibre, and weight loss where there is weight to lose. Typically moves LDL by 5 to 15%, which is real and is less than medication.European Heart Journal ESC guideline, 2021
Doing nothing, with the number known
Where the calculated 10 year risk is low, a mildly raised cholesterol is a reason to recheck in a few years rather than to treat. That is the majority outcome in people under 45.NICE NG238, 2023
Statin treatment
The best evidenced option. A meta analysis of over 170,000 people found that each 1 mmol per litre reduction in LDL cut major vascular events by around a fifth for each year of treatment, and the absolute benefit depends on your starting risk.The Lancet Baigent, 2010
Adding a second agent
Where a statin alone has not reached target, or is not tolerated, a second class is added rather than the first abandoned. Combination is usual rather than a failure.NICE NG238, 2023
Specialist referral for inherited disorders
Suspected familial hypercholesterolaemia goes to a lipid clinic, and family members are then tested. Finding one case usually finds more.NICE NG238, 2023
Lipid treatment reaches most of its effect within 4 to 6 weeks and is rechecked at 3 months. The target is a percentage fall from your own baseline rather than a single number, so the before value matters as much as the after.NICE NG238, 2023
The inconvenient half. Muscle aches are reported by a meaningful proportion of people taking a statin, and in blinded trials most of those symptoms occurred just as often on placebo. That does not make anyone’s symptom imaginary, and it does mean a rechallenge or a change of agent is usually worth trying before treatment is abandoned.The Lancet Baigent, 2010
Lipoprotein(a) does not respond to any of this. Where it is raised, the response is to treat everything else harder rather than to keep retesting it.European Heart Journal EAS consensus, 2022
Ask for four numbers rather than one. Total cholesterol, HDL, non HDL and triglycerides. Non HDL is the working figure and a total cholesterol on its own cannot be interpreted, which is why a result printed as a single number is close to useless.NICE NG238, 2023
Map the family. Any first degree relative with a heart attack or stroke under 60, and their age at the time. That single fact changes your calculated risk and can be the difference between watching and treating.The BMJ Hippisley Cox, 2017
Try the swap rather than the ban for 8 weeks. Replace saturated fat with unsaturated rather than cutting fat out, and add soluble fibre from oats, beans and pulses. Judged at 8 weeks with a repeat panel, that is worth 5 to 15% off LDL for most people.European Heart Journal ESC guideline, 2021
Do not buy repeat lipoprotein(a) testing. It is genetically determined, it does not move, and once in a lifetime is the right frequency however often it is offered.European Heart Journal EAS consensus, 2022
Do not buy plant sterol drinks and supplements as a substitute for treatment where your risk is high. They lower cholesterol slightly and there is no outcome evidence that they prevent events, and the money is better spent on the appointment that decides whether you need treating at all.NICE NG238, 2023
Step 1
Full lipid profile with thyroid, kidney, liver and HbA1c in one draw, and ApoB and lipoprotein(a) where they change the decision.
Step 2
The same cholesterol means different things at 40 and at 62. The 10 year risk calculation is what turns the result into a decision.
Step 3
Where treatment starts it is rechecked at 3 months against your own baseline. Where it does not, you leave with the year the next panel is due.
Ask before you book if you are not sure this is the right appointment.
There is no single number. The same result means different things depending on your age, blood pressure, smoking status and family history, which is why the 10 year risk calculation matters more than the reading. A total above 9, or premature heart disease in the family, needs specialist assessment.
No. Non fasting samples are used routinely and give results usable for risk calculation. If a fasting sample is needed for a specific reason you are told when you book, so nobody arrives having skipped breakfast unnecessarily.
It counts the particles that deposit in artery walls rather than the cholesterol inside them, and it is more accurate where triglycerides are raised or metabolic syndrome is present. It is included in the Longevity panel at £1,395 and is not needed by everyone.
Muscle aches are commonly reported, and in blinded trials they occurred about as often on placebo as on the drug. That does not make anyone’s symptom imaginary. It does mean a pause and rechallenge, or a change of agent, is usually worth trying before treatment is abandoned.
The Core panel with a full lipid profile, HbA1c, thyroid, kidney and liver is £350. The Longevity panel with ApoB and lipoprotein(a) is £1,395. A 30 minute appointment to read the result against your risk is £150, and the 3 month recheck by telephone is £59.
Diet typically moves LDL by 5 to 15%, which is real and is smaller than medication. Where your calculated risk is low that is often enough. Where it is high, diet is part of the plan rather than the whole of it, and pretending otherwise costs years.
An inherited condition affecting roughly 1 in 250 people that raises cholesterol from birth and is substantially underdiagnosed. A total cholesterol above 9, or a first degree relative with a heart attack under 60, should prompt the question and a lipid clinic referral.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
European Heart Journal, European Atherosclerosis Society
Lipoprotein(a) in atherosclerotic cardiovascular disease, consensus statementEAS consensus, 2022
European Heart Journal, European Society of Cardiology
Guidelines on cardiovascular disease prevention in clinical practiceESC guideline, 2021
NICE
Thyroid disease, assessment and managementNG145, 2019
NICE
Cardiovascular disease, risk assessment and reduction, including lipid modificationNG238, 2023
NICE
The BMJ
Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular diseaseHippisley Cox, 2017
The Lancet
Efficacy and safety of more intensive lowering of LDL cholesterol, Cholesterol Treatment Trialists CollaborationBaigent, 2010
World Health Organization
Use of glycated haemoglobin HbA1c in the diagnosis of diabetes mellitusWHO/NMH/CHP/CPM/11.1, 2011
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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