To screen for risk of developing cardiovascular disease (heart disease, stroke and related diseases) and to monitor treatment.
 

Cholesterol testing is recommended when you have established heart disease (angina, heart attack), or if there is a family history of high cholesterol, or of heart disease at an early age; if you are less than 45 years of age and have risk factors which put you at an increased chance of developing heart disease, such as diabetes, high blood pressure, chronic renal failure or renal transplantation, Aboriginal or Torres Strait Islander, overweight or you are a smoker. In addition, cholesterol testing is performed if you are following a recommended diet or taking drugs to lower your cholesterol level, to monitor your response to treatment. Total cholesterol may be measured alone or in combination with other tests including HDL, LDL, and triglycerides - often called a lipid profile.

Lipid Profile – cholesterol (total, HDL and LDL) & triglycerides

The lipid profile is a group of tests used to assess your risk of cardiovascular diseases (heart disease, stroke and related diseases). It checks total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol. The results are considered along with other important factors such as your age, gender, ethnicity and blood pressure and whether you have diabetes or smoke.
 
If you’ve had test results for cholesterol and triglycerides, this example form may help you understand them.
 
It is important to realise that the format and look of reports often differ between laboratories so your results form may not look exactly like this.
  Comment: LDL-Cholesterol ≥ 6.4 mmol/L:
Familial hypercholesterolaemia, an autosomal dominant cause of premature cardiovascular disease is highly likely (risk greater than I in 2).
Recommend http://www.athero.org.au/calculator to calculate diagnostic score and http://www. athero.org.au/fh/health-professionals/what-is-familial-hypercholesterolaemia-fh/ to assist with diagnosis and management, if required.

Who prepares your test results report?

In this report, four tests have been performed as a group. They each measure a different substance in the blood that can indicate a possible health problem if levels are shown to be too high or too low.
 
In this example case, the purpose of the first test was to check the lipid profile (cholesterol, triglycerides plus HDL and LDL) of this relatively young man.  Normally, this would not be done unless the person has known risk factors. In this case, Paul has a strong family history of early heart disease. His grandfather and two uncles have all died some years ago from heart attacks and recently, his 53-year old father has also had a fatal heart attack. His father had always been apparently healthy and had not had blood tests to check his lipids.   
 
What the results mean?
Two sets of results are shown from tests that have been performed just over two weeks apart.
 

• In the first column of results, showing tests performed on the 28th of February Paul was found to have very high total cholesterol and LDL cholesterol.
• The current results (16th March) have been done to confirm the initial results because they were so abnormal and because Paul had been drinking quite heavily prior to the first test. The second set of results are very similar to the first and have not changed after two weeks without alcohol.
• The comment on the report states that Paul has a high probability of having familial hypercholesterolaemia. This is an inherited condition in which people have a very high risk of developing early coronary artery disease. They need to have treatment.
• The results have been compared to a reference interval. This is shown on the far right (column 5).
• The reference intervals represent the levels of cholesterol and triglycerides which would be considered ‘healthy’ for the general population.  (Note that for these two substances, the range given is not the same as most ‘normal’ ranges which are derived from the results for most healthy people. In this case they are derived from studies showing the levels at which the risk of developing early coronary artery or other atherosclerotic disease is acceptably low. Because our modern diet and lifestyle are not ideal, the statistical ‘normal’ ranges would be higher than is desirable.)
• If your results are outside this range and flagged with an H (high) or L (low) this is just to draw your attention to them. If the total cholesterol, LDL cholesterol or triglyceride levels are flagged as high this suggests that you and your doctor should discuss strategies to reduce the levels.
• Your results need to be interpreted by your doctor who will consider them in the context of your whole medical history, as well as the results of any other investigations you have had.
• There are a number of other causes of high cholesterol results and also high triglyceride results. You should also look at the entry for lipid profile.

 
Who prepares your test results report?
 
Your tests will have been performed by scientists and/or pathologists (who are medical doctors).  The pathologist-in-charge who specialises in interpreting test results and observing and evaluating biological changes to make a diagnosis, will be responsible for your report. The pathologist is also available to discuss your results with your doctor.



 

The cholesterol level measured in your blood will be considered along with other risk factors for heart disease (high blood pressure, smoking etc.) when assessing your overall risk of developing heart disease. This overall assessment is what will be used to decide whether or not you require further treatment in the form of lifestyle changes such as diet, exercise or drugs to lower your cholesterol level. 

A total cholesterol level of greater than 7.5 mmol/L is considered high risk. And also this level should be reviewed for family history and clinical features of familial hypercholesterolaemia which is an inherited condition.

If you are taking medication to lower your cholesterol, the target is to get your total cholesterol to a value less than 4.0 mmol/L.

About Reference Intervals

Cholesterol testing is recommended as a screening test to be done for all adults with no risk factors for heart disease at least once every four to six years. It is frequently done in conjunction with a routine physical examination. 

Blood cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like surgery or accident). You should wait at least 6 weeks after any illness to have cholesterol measured.

There is some debate about whether very low cholesterol is bad. Low cholesterol is often seen when there is an existing problem like malnutrition, liver disease, or cancer. However there is no evidence that low cholesterol causes any of these problems.

Cholesterol is high during pregnancy. Women should wait at least six weeks after the baby is born to have cholesterol measured.

Some drugs that are known to increase cholesterol levels to a moderate extent, include oral corticosteroids, beta blockers, oral contraceptives, thiazide diuretics, oral retinoids and phenytoin. 

Familial hypercholesterolaemia (FH) is a severe form of elevated cholesterol levels that runs in families. It is often undetected until damage is done and the person develops cardiovascular disease. It can be easily screened for and treated early in life. Information about FH can be found at the FH Australia network site. Individual risk of having FH can be determined using their online calculator.
 

• If you already know you have heart disease (angina, heart attack)
• If there is a family history of high cholesterol or of heart disease at an early age
• If you are less than 45 years old and have risk factors which put you at an increased chance of developing heart disease, such as diabetes, high blood pressure, chronic renal failure or renal transplantation, Aboriginal or Torres Strait Islander, overweight or you are a smoker
• If you are taking drugs to lower your cholesterol level
• If you are over 45 years old.

High cholesterol may be the result of an inherited disease or it may result from an unhealthy diet (high in saturated and trans fats, and cholesterol) and lack of exercise. For many people it is caused by a combination of these modifiable factors and an inherited tendency towards high cholesterol.

Lifestyle factors should be managed at all risk levels. Healthy diet and other positive lifestyle changes, e.g. increased physical activity, smoking cessation, weight reduction, are quite important. Very high and resistant cholesterol levels need medication. Sometimes two different drugs are used together to treat people with extremely high cholesterol levels. The drug of choice differs for different people. There are several classes of drugs that are commonly used. These include bile acid sequestrants, niacin, HMG-CoA reductase inhibitors (statins) and fibrates. Your doctor will need to take into account your individual situation before prescribing any cholesterol-lowering drug.

High cholesterol increases your risk of a heart attack. The higher the cholesterol, the higher the risk. However, many other factors also affect your risk of a heart attack, such as gender, smoking, diabetes, age, and high blood pressure. Charts to allow you to assess your risk of a heart attack are available from the National Heart Foundation.

Cholesterol levels fluctuate over time. The measured cholesterol level may differ by as much as 10% from one month to another. It may go up sometimes or it may go down sometimes. These changes are called biological variation and they represent normal variability inherent in human metabolism.

Cholesterol levels fluctuate over time. A single measurement of cholesterol may not always reflect the ‘usual’ cholesterol level. For this reason, it is advisable to have at least two different measurements several weeks to several months apart before beginning any kind of treatment.