Cholesterol

The cholesterol test measures total blood cholesterol, the sum of cholesterol in all the particles that transport it through the blood. It is used to assess the risk of heart attack and stroke and to monitor treatment. Total cholesterol alone, however, says little: decisions are based on LDL and HDL cholesterol, triglycerides and your overall risk.

Who the test is for

• adults as part of cardiovascular risk assessment and preventive examination, as recommended by a doctor;
• smokers and people with high blood pressure, diabetes, kidney disease or excess body weight;
• people whose close relatives had high cholesterol or a heart attack or stroke at a younger age;
• people taking statins or other lipid-lowering medicines, to monitor treatment.

What cholesterol is and what the test shows

Cholesterol is a fatty substance the body needs for cell structure and to produce certain hormones, vitamin D and bile acids. Most cholesterol is produced by the liver, with a smaller amount obtained from food. Because it does not dissolve in blood, it travels in particles called lipoproteins:

• LDL cholesterol, “bad” cholesterol: its excess accumulates in artery walls over the years and forms atherosclerotic deposits;
• HDL cholesterol, “good” cholesterol: it carries excess cholesterol from tissues to the liver;
• non-HDL cholesterol: total cholesterol minus HDL, covering all particles that can damage blood vessels.

A person with high HDL and low LDL can have the same total cholesterol as someone with the reverse ratio, but their risks are not equal. Cholesterol is therefore almost always measured in the Lipid profile panel, alongside HDL and LDL cholesterol and triglycerides.

Panels including this test

Test Cholesterol is also included in these panels.

Lipid profile panelcholesterol, HDL and LDL cholesterol, triglycerides11.50€Details ›General preventive panelCBC, glucose, cholesterol, HDL and LDL cholesterol, triglycerides and 430.00€Details ›

All panels including Cholesterol (8) ›

Preparation and sample

Cholesterol is measured in blood from a vein. Come fasting, for about 12 hours without food and with water only, as for the other blood lipids. Total cholesterol changes little after a meal, but triglycerides, which are usually measured alongside it, rise, and fasting results are easier to compare with earlier ones.

Avoid alcohol and a large, fatty meal the day before. Take lipid-lowering medicines as usual unless your doctor tells you otherwise. Values change temporarily after acute illness or surgery and during pregnancy, so a doctor assesses when results are representative.

How to interpret the result

Cholesterol is expressed in mmol/L. The reference interval is printed on the report, and in adults a total cholesterol level below 5,0 mmol/L is usually considered desirable. That is not enough to decide on treatment. A doctor assesses your overall risk according to age, sex, blood pressure, smoking, diabetes, kidney function and family history, then determines your individual LDL cholesterol target. The higher the risk, the lower the target. We describe targets according to European guidelines and the role of LDL in atherosclerosis in the article on the Lipid profile panel.

High cholesterol

It most often results from a combination of heredity, a diet rich in saturated fat, excess body weight and insufficient physical activity. It rises with age, particularly after menopause in women. An underactive thyroid, nephrotic syndrome, liver disease with cholestasis, pregnancy and some medicines such as corticosteroids can also raise it. A doctor therefore often also checks TSH.

Very high cholesterol, particularly when LDL is above 5 mmol/L and there is early heart disease in the family, may indicate hereditary (familial) hypercholesterolaemia. Early treatment and examination of close relatives are then important.

Low cholesterol

Low cholesterol is rarely a problem in itself and is expected with cholesterol-lowering medicines. Without medicines, it can be lowered by an overactive thyroid, severe liver disease, malnutrition or reduced food absorption, severe acute illness or infection, and rarely inherited disorders. A doctor assesses whether further investigation is needed.

Total cholesterol is not enough to assess risk

With raised triglycerides, diabetes or obesity, LDL cholesterol may underestimate risk. A doctor may then request apolipoprotein B, which reflects the number of particles harmful to blood vessels. Read more in the articles ApoB and ApoA1 and Why is cholesterol alone no longer enough?

How to arrange testing

You can have blood taken without an appointment or referral at one of our branches across Croatia (listed under Contact). Prices for all tests and panels are available in the service price list. Total cholesterol is most informative as part of the Lipid profile panel, which also includes HDL and LDL cholesterol and triglycerides from the same blood collection.

Frequently asked questions

What should the cholesterol level be?

In adults, total cholesterol below 5,0 mmol/L is usually considered desirable, but LDL cholesterol is more important, with a target determined by your risk. The same result may be satisfactory for one person but too high for another, for example after a heart attack. A doctor therefore interprets the result.

Do I need to fast for cholesterol testing?

Yes. For cholesterol and the lipid profile, come fasting, for about 12 hours without food and with water only. Cholesterol changes little after a meal, but triglycerides rise, so a fasting result is more reliable and easier to compare with earlier results.

Do eggs raise cholesterol?

In most people, dietary cholesterol raises blood cholesterol less than saturated and trans fats, found in fatty meat, full-fat dairy products and cakes. Eggs in moderate amounts can form part of a balanced diet. If you have raised LDL or diabetes, agree your diet with a doctor.

Can a young, slim person have high cholesterol?

Yes. Cholesterol levels depend heavily on heredity, so young people of normal weight can also have high LDL cholesterol, particularly with a family history of familial hypercholesterolaemia. Tell your doctor if close relatives had an early heart attack or stroke.