High Cholesterol Result

This page is about reading the numbers on a lipid profile. For food, statins and the treatment ladder, see our high cholesterol fact sheet.

Quick answer: Australian labs flag total cholesterol over 5.5 mmol/L, LDL over 3.0, non-HDL over 4.0, triglycerides over 2.0 and HDL under 1.0 (men) or 1.2 (women). Flags aren’t targets: your 5-year heart attack and stroke risk mostly decides treatment. LDL over 5.0 mmol/L in an adult raises the possibility of familial hypercholesterolaemia.

What the test measures

• LDL cholesterol (“bad”): the main driver of fatty plaque in arteries. It’s usually calculated rather than measured, so it’s less accurate when triglycerides are high.
• HDL cholesterol (“good”): carries cholesterol away from arteries.
• Triglycerides: fats that rise after meals, with alcohol, extra weight and diabetes.
• Non-HDL cholesterol: total minus HDL, covering all the artery-clogging particles. It works on non-fasting samples.
• Total cholesterol, and sometimes a total-to-HDL ratio.

Fasting usually isn’t needed. Your doctor may ask for a fasting sample if triglycerides were high.

Australian lab flags

Australian labs share common flag levels (AACB 2018). They prompt a look at your overall heart risk; they aren’t normal ranges or personal targets.

• Total cholesterol: over 5.5 mmol/L (213 mg/dL)
• LDL: over 3.0 mmol/L (116 mg/dL)
• HDL: under 1.0 mmol/L (39 mg/dL) in men, under 1.2 mmol/L (46 mg/dL) in women
• Non-HDL: over 4.0 mmol/L (155 mg/dL)
• Triglycerides: over 2.0 mmol/L (177 mg/dL)
• To convert cholesterol, multiply mmol/L by 38.67 to get mg/dL. For triglycerides, multiply by 88.57.
• People with heart disease, diabetes or high risk are usually aimed at much lower LDL levels, set with their doctor.

Your heart risk matters more

Australian guidelines combine cholesterol with age, sex, blood pressure, smoking, diabetes and other factors in the Aus CVD Risk Calculator to estimate your chance of a heart attack or stroke in the next 5 years: low under 5%, intermediate 5% to under 10%, high 10% or more. It’s recommended for people aged 45–79, from 35 with diabetes, and from 30 for Aboriginal and Torres Strait Islander people. More calculators are on our tools page.

What a high result usually means

Common causes:

• Genes: many small inherited effects, the commonest reason for a high LDL in people who eat well.
• Food high in saturated and trans fats, extra weight and not moving much.
• High triglycerides: alcohol, extra weight, type 2 diabetes or a non-fasting sample.
• Other conditions: an underactive thyroid, kidney disease (especially with protein in the urine), liver problems and pregnancy.
• Medicines: some steroids, acne retinoids, some antipsychotics and some HIV medicines.

Less common but important:

• Familial hypercholesterolaemia (FH): an inherited condition affecting about 1 in 250 people, causing high LDL from birth and early heart disease if untreated. Fewer than 1 in 10 people with FH have been diagnosed.
• Very high triglycerides (over 10 mmol/L, 886 mg/dL), which raise the risk of pancreatitis. Rare inherited conditions can push them far higher.

Signs of familial hypercholesterolaemia

• LDL over 5.0 mmol/L (193 mg/dL) in an adult not on treatment.
• Thickened tendons from cholesterol deposits (tendon xanthomas), often at the back of the ankle or over the knuckles.
• A pale ring around the coloured part of the eye (corneal arcus) before age 45.
• Heart disease at a young age in you or a close relative: men under 55, women under 60.
• A parent, brother, sister or child with very high cholesterol.

Symptoms

High cholesterol causes no symptoms. The first sign can be angina, a heart attack or a stroke, which is why testing matters. FH can cause the skin, tendon and eye signs above.

What happens next

• Repeat the test if the result is unexpected, fasting if triglycerides were high.
• Check for other causes: thyroid, glucose or HbA1c, kidney and liver tests, and a urine test for protein.
• A heart health check with your GP to work out your 5-year risk.
• Suspected FH: a second LDL test, a Dutch Lipid Clinic Network score, specialist referral and often genetic testing. Close relatives, including children, should then be tested.
• Treatment: lifestyle for everyone; statins and other medicines depending on your risk or an FH diagnosis.

Get urgent help (000 in Australia, or your local emergency number) for chest pain or pressure, or signs of stroke (face drooping, arm weakness, slurred speech), whatever your cholesterol. See a doctor the same day for severe upper tummy pain with high triglycerides, or triglycerides over 20 mmol/L (1771 mg/dL): NICE advises urgent specialist review at this level because of pancreatitis risk. See your GP soon for LDL over 5.0 mmol/L (193 mg/dL), triglycerides over 10 mmol/L, or total cholesterol over 7.5 mmol/L (290 mg/dL) with a close relative who had heart disease young: these can be inherited conditions that run in families.

Practise reading results. Play Panelysis, the daily blood-test puzzle: a fictional patient, a real-looking panel, three guesses. More in medical games.

Evidence and more information

• Pathology Tests Explained (RCPA): Cholesterol
• AACB 2018: Guideline for harmonisation of lipid reporting in Australia (flag levels)
• Medical Journal of Australia 2024: 2023 Australian guideline for assessing and managing cardiovascular disease risk (who to assess, 5-year risk categories)
• Watts et al, Heart, Lung and Circulation 2021: Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia
• NICE NG238: Cardiovascular disease, risk assessment and reduction, including lipid modification (triglyceride and FH referral thresholds)

Updated 8 November 2026. General education, not personal medical advice. Reference ranges differ between laboratories, so use the range printed on your own report and talk to your GP about your result.

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