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Doctor's Assessment Included

Every result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

Cardiovascular

Cholesterol levels: what do they tell you about your cardiovascular health?

Total cholesterol is a starting point for lipid assessment. Athletes should look at the full panel including HDL, LDL, and triglycerides for complete cardiovascular insight.

Reference Ranges

Male
mmol/l
Normal < 5 High
Female
mmol/l
Normal < 5 High

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

What It Measures

This test measures the total cholesterol level in your blood, expressed in millimoles per litre (mmol/L). The desirable value is below 5.0 mmol/L. Total cholesterol is the sum of LDL cholesterol, HDL cholesterol, and a fraction of triglycerides.

Total cholesterol alone is of limited informative value. A value of 5.5 mmol/L can be favourable if it consists largely of HDL, but risky if it is mainly LDL. Therefore, cholesterol is preferably measured as part of a complete lipid profile, including LDL, HDL, and triglycerides.

For an optimal lipid profile, fasting blood is generally drawn (10–12 hours fasting), although recent guidelines indicate that non-fasting cholesterol is also usable for most assessments.

Why It Matters

Cardiovascular disease is the leading cause of death in the Netherlands. Elevated cholesterol — particularly LDL — is one of the best-established risk factors. The process of atherosclerosis progresses gradually over decades and causes no symptoms for a long time, until a heart attack or stroke occurs.

The cholesterol level does not stand alone. Cardiovascular risk is determined by the interplay of cholesterol, blood pressure, age, smoking, diabetes, and family history. A cholesterol of 6.0 mmol/L in an otherwise healthy 30-year-old has a different meaning than the same value in a 60-year-old smoker with diabetes.

Early detection and treatment of elevated cholesterol — through lifestyle and medication if needed — can significantly reduce the risk of cardiovascular disease.

When to Test

A cholesterol test is recommended for everyone over 40, and earlier if you have risk factors: a family history of cardiovascular disease (especially if a parent or sibling had a heart attack or stroke before age 60), smoking, obesity, diabetes, or high blood pressure.

When using cholesterol-lowering medication (statins), periodic monitoring is necessary to assess the medication's effect. Fasting (10–12 hours) is recommended if LDL, HDL, and triglycerides are also being measured, although this is not strictly necessary for total cholesterol alone.

Symptoms

Low Levels

Low cholesterol (below 3.5 mmol/L) is usually not problematic. There are rare situations where very low cholesterol may be associated with nutritional deficiencies, liver conditions, or hyperthyroidism. For most people, low cholesterol is favourable.

High Levels

Elevated cholesterol itself causes no direct symptoms. The risk lies in the silent accumulation of plaque in blood vessels (atherosclerosis), which can lead to heart attack, stroke, or peripheral vascular disease over decades. Sometimes there are visible signs of long-term significantly elevated cholesterol, such as xanthelasma (yellow fat deposits around the eyes) or arcus cornealis (white ring around the iris). These are mainly seen in familial hypercholesterolaemia.

Lifestyle Tips

Diet has a measurable effect on your cholesterol. Limit saturated fat (full-fat dairy, red meat, pastries) and avoid trans fats. Replace these with unsaturated fats (olive oil, nuts, avocado, oily fish). Increase your fibre intake through whole grain products, vegetables, and fruit — soluble fibre binds cholesterol in the gut.

Regular physical activity raises HDL cholesterol. Even thirty minutes of moderate exercise per day makes a difference. Stopping smoking improves the HDL/LDL ratio. Moderate alcohol consumption (maximum one glass per day) appears to slightly raise HDL, but the risks of alcohol do not outweigh this benefit.

With familial hypercholesterolaemia or significantly elevated cardiovascular risk, lifestyle measures are often insufficient and medication (statins) is indicated.

Frequently Asked Questions

What is a normal cholesterol level?
The desirable value for total cholesterol is below 5.0 mmol/L. But total cholesterol does not tell the whole story — the ratio between LDL (bad) and HDL (good) cholesterol is more clinically important. A total cholesterol of 5.5 with high HDL can be more favourable than 4.5 with low HDL.
What is the difference between LDL and HDL?
LDL cholesterol deposits in blood vessel walls and increases the risk of atherosclerosis. HDL cholesterol transports cholesterol back to the liver for breakdown and has a protective effect. You want low LDL and high HDL.
Do I need to fast before a cholesterol test?
Fasting is not strictly required for total cholesterol. But if LDL, HDL, and triglycerides are also being measured (a complete lipid profile), 10–12 hours fasting is recommended for the most accurate triglyceride value.
Is cholesterol always bad?
No, cholesterol is essential for your body. It is needed for cell membranes, hormone synthesis, and vitamin D production. The problem arises when LDL cholesterol is chronically too high and accumulates in blood vessels.
Can I lower my cholesterol without medication?
Yes, with moderately elevated cholesterol without additional risk factors, lifestyle changes can be effective: less saturated fat, more fibre, regular exercise, and stopping smoking. With hereditary elevated cholesterol or high cardiovascular risk, statins are usually necessary.
How often should I have my cholesterol checked?
Without risk factors, a check every five years is sufficient from age 40. With known risk factors, family history, or when using cholesterol-lowering medication, annual monitoring is usual.