Lipid Panel & Cholesterol Test: Understanding Your Heart Health Numbers

Introduction: Understanding Your Cholesterol Numbers

Heart disease is Australia's biggest killer, claiming one life every 27 minutes according to the Heart Foundation. Yet many Australians don't understand their cholesterol numbers or what they mean for heart health. A lipid panel (also called a cholesterol test or lipid profile) is your first line of defense in preventing heart attacks and strokes.

This comprehensive guide will help you understand every component of your lipid panel – from "good" HDL cholesterol to "bad" LDL cholesterol and triglycerides. We'll explain what the numbers mean in plain English, what puts you at risk, and how lifestyle changes can dramatically improve your heart health outcomes.

Whether you've just received your first lipid panel results or you're monitoring cardiovascular disease, this guide will empower you to take control of your heart health.

What Is a Lipid Panel?

A lipid panel is a blood test that measures the fats (lipids) in your blood. These fats are essential for many body functions, but too much of certain types can clog your arteries and dramatically increase your risk of heart attack and stroke.

The test typically measures four key values:

• Total Cholesterol – The total amount of cholesterol in your blood
• LDL Cholesterol – "Bad" cholesterol that clogs arteries
• HDL Cholesterol – "Good" cholesterol that removes bad cholesterol
• Triglycerides – Another type of fat that increases heart disease risk

Your doctor may also calculate additional ratios like the Total Cholesterol/HDL ratio or non-HDL cholesterol, which provide additional insights into your cardiovascular risk.

Why Is a Lipid Panel Important?

High cholesterol has no symptoms. You can feel perfectly healthy while dangerous plaque builds up in your arteries. By the time symptoms appear – chest pain, shortness of breath, or worse, a heart attack – significant damage may have already occurred.

A lipid panel allows you to:

• Assess your heart disease risk before problems develop
• Make informed lifestyle changes that can prevent heart attacks and strokes
• Determine if you need medication like statins to lower cholesterol
• Monitor the effectiveness of diet, exercise, or medication changes
• Screen for familial hypercholesterolemia – a genetic condition affecting 1 in 250 Australians

The Heart Foundation recommends all Australians have their cholesterol checked from age 45, or from age 30 if you're Aboriginal or Torres Strait Islander, or have risk factors like family history, diabetes, or high blood pressure.

Understanding Total Cholesterol

Your total cholesterol is simply the sum of all the cholesterol in your blood – HDL, LDL, and a portion of your triglycerides.

Australian Heart Foundation Target: Less than 5.5 mmol/L

However, total cholesterol alone doesn't tell the complete story. You could have high total cholesterol but also very high HDL (good cholesterol), which is actually protective. Or you could have "normal" total cholesterol with very low HDL and high LDL – a dangerous combination.

This is why doctors look at the complete lipid panel, not just total cholesterol.

What affects total cholesterol:

• Diet high in saturated fats and trans fats
• Being overweight or obese
• Physical inactivity
• Smoking
• Genetics (family history of high cholesterol)
• Age (cholesterol typically rises with age)
• Certain medical conditions (diabetes, hypothyroidism, kidney disease)

LDL Cholesterol: The "Bad" Cholesterol

Low-Density Lipoprotein (LDL) cholesterol is called "bad" cholesterol because high levels lead to plaque buildup in your arteries (atherosclerosis). This narrows the arteries and increases the risk of heart attack and stroke.

Think of LDL as delivery trucks dropping off cholesterol at artery walls. Too many trucks cause traffic jams and blockages.

Australian Target Levels (for people without heart disease):

• Optimal: Less than 2.0 mmol/L
• Near optimal: 2.0-2.5 mmol/L
• Borderline high: 2.6-3.3 mmol/L
• High: 3.4-4.1 mmol/L
• Very high: Above 4.1 mmol/L

For people with existing heart disease, diabetes, or very high risk, the target is much lower: Less than 1.8 mmol/L, and sometimes even lower (below 1.4 mmol/L) for very high-risk individuals.

Types of LDL: Small Dense vs Large Buoyant

Not all LDL particles are equal. Some advanced lipid tests measure LDL particle size:

• Small, dense LDL particles – These penetrate artery walls more easily and are more dangerous
• Large, buoyant LDL particles – These are less likely to cause atherosclerosis

If you have high LDL, your doctor may recommend an advanced lipid panel to determine your particle size and better assess your true cardiovascular risk.

What Raises LDL Cholesterol

• Saturated fats: Found in fatty meat, full-fat dairy, butter, coconut oil, palm oil
• Trans fats: Found in some processed foods, baked goods, and fried foods (largely banned in Australia but still present in some imported foods)
• Excess dietary cholesterol: From egg yolks, organ meats, and shellfish (though dietary cholesterol has less impact than once thought)
• Being overweight – Especially excess abdominal fat
• Sedentary lifestyle – Lack of physical activity
• Smoking – Damages artery walls and lowers HDL
• Genetics – Familial hypercholesterolemia causes very high LDL

HDL Cholesterol: The "Good" Cholesterol

High-Density Lipoprotein (HDL) cholesterol is called "good" cholesterol because it acts like a garbage truck, picking up excess cholesterol from your artery walls and taking it back to your liver for disposal.

Higher HDL levels are protective against heart disease. Studies show that for every 1 mmol/L increase in HDL, your heart attack risk decreases by 2-3%.

Australian Target Levels:

• Men: Above 1.0 mmol/L (optimal: above 1.3 mmol/L)
• Women: Above 1.3 mmol/L (optimal: above 1.5 mmol/L)

Women typically have higher HDL levels than men due to estrogen, which raises HDL. This is one reason why heart disease risk increases for women after menopause, when estrogen levels drop.

What Lowers HDL (Bad for Your Heart)

• Smoking – Perhaps the single worst thing you can do to your HDL
• Being overweight or obese
• Physical inactivity
• Type 2 diabetes
• High triglycerides
• Certain medications (beta-blockers, benzodiazepines, anabolic steroids)
• Genetic factors

What Raises HDL (Good for Your Heart)

• Regular aerobic exercise – Even 30 minutes of brisk walking most days can raise HDL by 5-10%
• Weight loss – Losing excess weight, especially abdominal fat
• Quitting smoking – HDL increases within weeks of quitting
• Moderate alcohol consumption – One drink per day for women, two for men (but other health risks may outweigh benefits)
• Healthy fats – Olive oil, avocados, nuts, and fatty fish
• Foods high in omega-3s – Salmon, mackerel, sardines, walnuts, flaxseeds
• Purple and red foods – Anthocyanins in berries, red grapes, and eggplant may boost HDL

Triglycerides: The Often-Overlooked Risk Factor

Triglycerides are the most common type of fat in your body. Your body converts calories it doesn't need immediately into triglycerides, which are stored in fat cells and released for energy between meals.

High triglycerides are strongly linked to heart disease, especially when combined with low HDL or high LDL. Very high triglycerides (above 10 mmol/L) can also cause pancreatitis, a dangerous inflammation of the pancreas.

Australian Target Levels:

• Normal: Less than 1.7 mmol/L
• Borderline high: 1.7-2.2 mmol/L
• High: 2.3-5.6 mmol/L
• Very high: Above 5.6 mmol/L

What Raises Triglycerides

• Excess calories – Especially from sugar and refined carbohydrates
• Alcohol – Even moderate amounts can significantly raise triglycerides
• Sugary foods and drinks – Soft drinks, fruit juice, lollies, biscuits, cakes
• Refined carbohydrates – White bread, white rice, pasta, pastries
• Saturated fats – From fatty meats and full-fat dairy
• Being overweight – Especially with excess abdominal fat
• Physical inactivity
• Type 2 diabetes – Especially if poorly controlled
• Hypothyroidism – Low thyroid function
• Kidney disease
• Certain medications – Steroids, some blood pressure drugs, estrogen
• Genetics – Familial hypertriglyceridemia

How to Lower Triglycerides

The good news is that triglycerides respond very well to lifestyle changes:

• Lose excess weight – Even 5-10% weight loss can significantly lower triglycerides
• Limit sugar – Cut back on sugary drinks, sweets, and refined carbohydrates
• Choose healthy fats – Replace saturated fats with unsaturated fats from olive oil, avocados, nuts
• Eat more omega-3 fatty acids – Fatty fish (salmon, mackerel, sardines) at least twice weekly, or fish oil supplements
• Limit alcohol – Alcohol has a potent effect on triglycerides
• Exercise regularly – Aim for at least 150 minutes of moderate activity weekly
• Avoid trans fats – Check food labels for "partially hydrogenated" oils

Important Cholesterol Ratios

Total Cholesterol/HDL Ratio

This ratio divides your total cholesterol by your HDL cholesterol. It's a powerful predictor of heart disease risk.

Optimal: Below 4.0
Acceptable: 4.0-5.0
High risk: Above 5.0

For example, if your total cholesterol is 5.5 mmol/L and your HDL is 1.5 mmol/L, your ratio is 5.5 ÷ 1.5 = 3.67 (optimal).

Non-HDL Cholesterol

This is calculated by subtracting HDL from total cholesterol. It represents all the "bad" cholesterol particles – LDL plus others like VLDL (which carries triglycerides).

Target: Less than 3.5 mmol/L for people without heart disease
High risk target: Less than 2.6 mmol/L

Non-HDL cholesterol is increasingly recognized as a better predictor of heart disease than LDL alone, especially in people with high triglycerides.

Preparing for Your Lipid Panel Test

For the most accurate results, particularly for triglycerides:

• Fast for 9-12 hours before the test (water is allowed)
• Avoid alcohol for at least 24 hours before testing
• Maintain your usual diet in the days before testing (don't suddenly eat ultra-healthy or you won't get accurate baseline results)
• Tell your doctor about all medications you're taking, as some can affect results
• Schedule morning appointments since fasting overnight is easier

Note: Some newer guidelines suggest fasting may not be necessary for initial screening tests in people without diabetes or very high triglycerides, but always follow your doctor's instructions.

Understanding Your Risk: Beyond the Numbers

Your lipid panel is just one piece of your cardiovascular risk puzzle. Doctors also consider:

• Age – Risk increases with age (men 45+, women 55+)
• Family history – Heart disease in close relatives, especially before age 55 (men) or 65 (women)
• Smoking status – Current or former smoker
• Blood pressure – High blood pressure damages arteries
• Diabetes – Dramatically increases cardiovascular risk
• Weight – Especially abdominal obesity (waist circumference over 94cm for men, 80cm for women)
• Physical activity – Sedentary lifestyle increases risk
• Diet quality – Mediterranean-style diet is protective
• Chronic kidney disease
• Inflammatory markers – Like high-sensitivity C-reactive protein (hs-CRP)

In Australia, doctors often use the Australian Cardiovascular Risk Calculator to estimate your risk of having a heart attack or stroke in the next 5 years. This calculator combines your lipid panel results with other risk factors to give a comprehensive risk assessment.

Lifestyle Changes to Improve Your Lipid Profile

Diet: The Mediterranean Approach

Multiple studies show the Mediterranean diet is one of the best for heart health:

• Eat more: Vegetables, fruits, whole grains, legumes, nuts, seeds
• Choose healthy fats: Extra virgin olive oil as primary fat source
• Eat fish regularly: Fatty fish at least twice weekly
• Limit red meat: Choose chicken, turkey, or plant proteins more often
• Include dairy: Preferably low-fat yogurt and cheese in moderation
• Minimize: Processed foods, added sugars, refined grains

Specific foods that improve cholesterol:

• Oats and barley: Beta-glucan fiber lowers LDL by 5-10%
• Nuts: Almonds, walnuts (about 30g daily) lower LDL
• Legumes: Beans, lentils, chickpeas reduce LDL
• Avocados: Monounsaturated fats lower LDL, raise HDL
• Fatty fish: Salmon, mackerel, sardines – omega-3s lower triglycerides
• Plant sterols/stanols: Found in fortified margarine (like Flora Pro-Activ) can lower LDL by up to 10%

Exercise: Move Your Body

Physical activity improves all components of your lipid panel:

• Aim for 150-300 minutes of moderate-intensity aerobic activity weekly
• Include strength training at least twice weekly
• Break up sitting time – even short activity breaks help
• Find activities you enjoy – walking, swimming, cycling, dancing, tennis

Exercise can:

• Raise HDL by 5-10%
• Lower triglycerides by 20-30%
• Modestly lower LDL
• Improve LDL particle size (fewer small dense particles)

Weight Management

If you're overweight, losing just 5-10% of your body weight can:

• Lower LDL cholesterol
• Raise HDL cholesterol
• Significantly reduce triglycerides
• Lower blood pressure
• Reduce diabetes risk

Quit Smoking

Smoking is devastating for your lipid profile and cardiovascular health:

• Lowers HDL cholesterol
• Damages artery walls, making them more susceptible to cholesterol deposits
• Increases inflammation
• Promotes blood clots

The good news: HDL levels improve within weeks of quitting, and after one year, your heart disease risk drops by 50%.

When You Need Medication: Statins and Beyond

Lifestyle changes should always come first, but sometimes medication is necessary, especially if you have:

• Very high LDL cholesterol (above 4.9 mmol/L)
• Existing cardiovascular disease
• Diabetes (especially with other risk factors)
• High 5-year cardiovascular risk score
• Familial hypercholesterolemia

Common Cholesterol Medications Available in Australia

Statins (First-Line Treatment)

Examples: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin

Statins work by blocking an enzyme your liver needs to produce cholesterol. They can lower LDL by 20-55%, depending on the dose and which statin you take.

Benefits: Proven to reduce heart attacks, strokes, and cardiovascular death by 25-35%

Side effects: Most people tolerate statins well, but some experience:

• Muscle aches (5-10% of people) – usually mild
• Rarely: Liver enzyme elevation, increased blood sugar

Ezetimibe (Ezetrol)

Blocks cholesterol absorption in your intestines. Lowers LDL by 15-20%. Often combined with statins for additional benefit.

PCSK9 Inhibitors

Examples: Evolocumab (Repatha), Alirocumab (Praluent)

These injectable medications lower LDL by 50-60%. Used for very high-risk people or those who can't tolerate statins. Currently expensive and restricted on the PBS.

Fibrates

Examples: Fenofibrate (Lipidil)

Primarily lower triglycerides (by 30-50%) and raise HDL. Used when triglycerides are very high.

Omega-3 Supplements (High Dose)

Prescription-strength omega-3 (icosapent ethyl) can significantly lower triglycerides.

Special Considerations for Australians

Aboriginal and Torres Strait Islander Peoples

Indigenous Australians face disproportionately high rates of cardiovascular disease, often at younger ages. The Heart Foundation recommends:

• First lipid panel screening from age 30 (or earlier with risk factors)
• More frequent monitoring
• Lower treatment thresholds for starting medication
• Culturally appropriate health education and support

Familial Hypercholesterolemia (FH)

FH is a genetic condition affecting approximately 1 in 250 Australians (100,000 people), making it one of the most common genetic disorders. It causes very high LDL cholesterol from birth.

Signs you might have FH:

• LDL cholesterol above 5 mmol/L (untreated)
• Family history of high cholesterol or early heart disease
• Cholesterol deposits in tendons (tendon xanthomas) or around eyes (xanthelasma)
• Personal history of heart disease before age 55 (men) or 60 (women)

FH requires early, aggressive treatment – usually statins from childhood. If you suspect FH, ask your doctor about genetic testing and specialist referral.

How Often Should You Test?

For healthy adults:

• Age 45+ (30+ for higher risk): Every 5 years
• More frequently if borderline results

If you have cardiovascular disease or are taking medication:

• 4-6 weeks after starting or changing medication
• Every 6-12 months once stable

If you have diabetes:

• Annually or more often if poorly controlled

Resources for Further Reading

Conclusion

Your lipid panel is one of the most important blood tests you'll ever have. Understanding your cholesterol and triglyceride numbers empowers you to take control of your cardiovascular health before problems develop.

Remember, high cholesterol has no symptoms – it silently damages your arteries over years or decades. Regular testing is the only way to know your numbers and your risk.

The encouraging news is that lipid levels respond remarkably well to lifestyle changes. Many Australians can significantly improve their lipid profiles through diet, exercise, weight management, and quitting smoking – without medication. And when medication is necessary, modern treatments are highly effective at reducing your risk of heart attack and stroke.

By tracking your lipid panel results over time with BloodResults, you can see how your lifestyle changes or medications are working. This long-term view helps you and your doctor make the best decisions for your heart health.

Don't wait until you have symptoms. Know your numbers, understand your risk, and take action today for a healthier heart tomorrow.