Total Cholesterol
Total Cholesterol
What this test measures
Cholesterol is a fatty substance in your blood. Your body needs some cholesterol to work properly, but too much can clog your arteries and increase your risk of heart disease and stroke. This test measures all the cholesterol in your blood.
Understanding the numbers
Typical range: Below 5 mmol/L
If you have heart disease or diabetes, your doctor may want it below 4 mmol/L.
- Desirable: 2–5 mmol/L
- Borderline: 5–6.5 mmol/L
- High: 6.5–12 mmol/L
Key numbers
- 5.0 mmol/L — General target
- 7.5 mmol/L — Consider familial hypercholesterolaemia screen
- 9.0 mmol/L — Very high — strong case for specialist review
5 mmol/L is the general UK population target; under 4 mmol/L is the typical target after heart disease or diabetes (NICE NG181). 7.5 mmol/L is a Simon Broome / NICE flag for familial hypercholesterolaemia screening. The 9 mmol/L marker is clinician guidance for very raised levels.
Ranges can vary slightly between laboratories — your report may show slightly different numbers. This page does not read or interpret your result; your GP looks at it alongside your history and other tests.
What a higher-than-normal result can mean
- You have more cholesterol than is healthy
- This increases your risk of heart disease and stroke
- You may need to change your diet and exercise more
- Some people may need medicine called statins
Questions you could ask your GP
- What is my overall heart disease risk based on this and other factors?
- Should I have a full lipid profile to check my HDL and LDL levels?
- Would dietary changes alone help, or do I need to consider statins?
- How often should I have my cholesterol rechecked?
Example stories
These are made-up examples to show how results are talked about in real appointments. They are not real patients.
Routine QRISK calculation
James had his cholesterol checked as part of an NHS health check. Total cholesterol was 4.6 mmol/L — within the desirable range. His 10-year heart disease risk (QRISK3) was 6%.
What the GP said: “Your cholesterol is fine and your overall heart risk is low. No action is needed now — we'll review again in about five years or sooner if your circumstances change.”
Total cholesterol on its own doesn't tell the whole story. Your GP looks at your HDL, LDL, age, sex, blood pressure, smoking and family history together (QRISK3) to decide whether treatment is needed.
Raised cholesterol, post-menopause
Aruna had a total cholesterol of 6.4 mmol/L two years after menopause. Her LDL was 4.2, HDL 1.5. Her QRISK3 was 12%.
What the GP said: “Your cholesterol has drifted up since menopause — that's common. Your 10-year risk of a heart event is 12%, which crosses the NICE threshold to discuss statins. We can try lifestyle first or start a low-dose statin — it's your choice.”
What happened next: Aruna chose to try lifestyle first: Mediterranean diet, 150 minutes of walking a week, and she cut back on ghee. Six months later her cholesterol was 5.6. She then agreed to a low-dose statin and dropped to 4.2.
A borderline cholesterol isn't an automatic statin prescription. NICE asks your GP to calculate your overall 10-year risk first (QRISK3). If risk is 10% or more, statins are offered — but it's a conversation, not a rule.
After a heart attack
Devraj had a heart attack last year. He was started on a high-dose statin (atorvastatin 80 mg). His total cholesterol a year later was 3.7 and his LDL was 1.7 — both well below target.
What the GP said: “This is exactly what we want after a heart attack. Your LDL has more than halved. Keep taking the statin and we'll check again in 12 months.”
What happened next: Devraj stayed on treatment, completed cardiac rehab, and hasn't had another event.
After a heart attack or stroke, targets are stricter — the aim is typically LDL below 2 and total cholesterol below 4. A low total cholesterol on a statin isn't 'too low' — it's the treatment working.
Family history of early heart attacks
Lakshmi's father had a heart attack at 42. Her cholesterol was 8.9 mmol/L with an LDL of 6.1 — much too high for her age.
What the GP said: “This pattern — very high cholesterol and a strong family history — makes me think of familial hypercholesterolaemia, an inherited condition. I'd like to refer you to the lipid clinic for genetic testing and to plan treatment.”
What happened next: Lakshmi was found to carry an LDLR gene mutation. She started a statin plus ezetimibe and her siblings and children were offered cascade screening.
A very high cholesterol in a young adult, especially with early heart disease in the family, is a red flag for familial hypercholesterolaemia (FH). FH affects about 1 in 250 people in the UK — and once identified, treatment is highly effective and close family should be screened.
Before you act on anything here
This page is general information, written to help you understand — it is not personal medical advice and it cannot tell you what is right for you. Talk to your own GP, pharmacist or nurse about your own health.
- Need help now but it's not an emergency? Call NHS 111 or use 111.nhs.uk.
- Emergency? Call 999 or go to A&E.