Cholesterol travels through the blood attached to a protein. This cholesterol-protein package is called a lipoprotein. Lipoprotein analysis (lipoprotein profile or lipid profile) measures blood levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
- Cholesterol. The body uses cholesterol to help build cells and produce hormones. Too much cholesterol in the blood can build up inside arteries, forming what is known as plaque. Large amounts of plaque increase your chances of having a heart attack or stroke.
- HDL (high-density lipoprotein) helps move cholesterol out of the body. HDL does this by binding with cholesterol in the bloodstream and carrying it back to the liver for disposal. HDL may also reduce inflammation. A high HDL level is linked with a lower risk of heart disease.
- LDL (low-density lipoprotein) carries mostly fat and only a small amount of protein from the liver to other parts of the body. A certain level of LDL in your blood is normal and healthy because LDL moves cholesterol to the parts of your body that need it. But it is sometimes called "bad cholesterol" because a high level may increase your chances of developing heart disease.
- VLDL: (very low-density lipoprotein) contains very little protein. The main purpose of VLDL is to distribute the triglyceride produced by your liver. A high VLDL cholesterol level can cause the buildup of cholesterol in your arteries and increases your risk of heart disease and stroke.
- Triglycerides are a type of fat the body uses to store energy and give energy to muscles. Only small amounts are found in the blood. Having a high triglyceride level along with a high LDL cholesterol may increase your chances of having heart disease more than having only a high LDL cholesterol level.
Cholesterol screening is often available in supermarkets, pharmacies, shopping malls, and other public places. Home cholesterol testing kits also are available. The results of tests done outside a doctor's office or lab may not be accurate. If you have cholesterol screening done outside your doctor's office, talk with your doctor about the accuracy of the results.
Why It Is Done
Cholesterol and triglyceride testing is done:
- As part of a routine physical examination to screen for a lipid disorder.
- To check your response to medicines used to treat lipid disorders.
- To help determine your chances of having of heart disease, especially if you have other risk factors for heart disease or symptoms that suggest heart disease is present.
- If you have unusual symptoms, such as yellow fatty deposits in the skin (xanthomas), which may be caused by a rare genetic disease that causes very high cholesterol levels.
Cholesterol and triglyceride screening
Some health organizations recommend that everyone older than age 20 be checked for high cholesterol.
Some health organizations recommend that everyone age 20 and older be checked for high cholesterol.footnote 1 The Canadian Cardiovascular Society recommends cholesterol tests based on age and risk factors for heart disease. footnote 2
Talk to your doctor about when you should get a cholesterol test.
For more information, see When to Have a Cholesterol Test.
How To Prepare
Preparation may depend on the type of test you are having. You may or may not have to fast.
- If your doctor tells you to fast before your test, do not eat or drink anything except water for 9 to 12 hours before having your blood drawn. Usually, you are allowed to take your medicines with water the morning of the test. Fasting is not always necessary, but it may be recommended.
- Do not eat high-fat foods the night before the test.
- Do not drink alcohol or exercise strenuously before the test.
Many medicines may affect the results of this test. Be sure to tell your doctor about all the non-prescription and prescription medicines and natural health products you take.
Tell your doctor if you have had a test such as a thyroid or bone scan that uses a radioactive substance within the last 7 days.
Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .
How It Is Done
The health professional taking a sample of your blood will:
- Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
- Clean the needle site with alcohol.
- Put the needle into the vein. More than one needle stick may be needed.
- Attach a tube to the needle to fill it with blood.
- Remove the band from your arm when enough blood is collected.
- Put a gauze pad or cotton ball over the needle site as the needle is removed.
- Put pressure on the site and then put on a bandage.
How It Feels
The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.
There is very little chance of a problem from having blood sample taken from a vein.
- You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
- In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
- Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your health professional before your blood sample is taken.
Results are usually available within 24 hours.
The values listed here are for adult cholesterol levels.footnote 3
Target cholesterol and triglyceride levels vary according to your risk for having a heart attack. The cholesterol levels given in the following table are for people at low risk for having a heart attack in the next ten years. If you are at moderate or high risk for having a heart attack, your target cholesterol levels may be different. For your actual target levels, talk to your doctor.
Less than 5.2 millimoles per litre (mmol/L)
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Higher than 6.2 mmol/L
1.6 mmol/L or higher
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Less than 1.0 mmol/L
Less than 2.6 mmol/L (less than 2.0 mmol/L for people at high risk for a heart attack)
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Higher than 4.9 mmol/L
0.78 mmol/L or less
Less than 1.7 mmol/L
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Higher than 5.6 mmol/L
- An HDL level of 1.5 mmol/L or higher is linked with a lower risk of heart disease.
- An HDL cholesterol level less than 1.0 mmol/L raises your risk for developing heart disease, especially if you also have high total cholesterol levels.
- The ratio of total cholesterol to "good" (HDL) cholesterol may be important, especially if total cholesterol is high.
- Very high cholesterol and triglyceride levels may be caused by an inherited form of high cholesterol (hypercholesterolemia or hyperlipidemia).
- Talk with your doctor about other things that raise your risk of heart problems. Your doctor may change your goals for cholesterol levels if you have other risk factors for coronary artery disease, such as:
- High blood pressure.
- Family history of early CAD.
- You are a man and older than 40, or you are a woman and older than 50.
- If you have a very high risk of having a heart attack, your doctor may want your LDL level to be less than 2.0 mmol/L.
What Affects the Test
Many conditions can affect cholesterol and triglyceride levels, including:
- Medicines, such as diuretics, corticosteroids, male sex hormones (androgens), tranquillizers, estrogen, birth control pills, antibiotics, and niacin (vitamin B3).
- Physical stress, such as infection, heart attack, surgery.
- Other conditions, such as hypothyroidism, diabetes, or kidney or liver disease.
- Alcohol use disorder.
- Liver disease (such as cirrhosis or hepatitis), malnutrition, or hyperthyroidism.
- Pregnancy. Values are the highest during the third trimester and usually return to the pre-pregnancy levels after delivery of the baby.
Your doctor will talk with you about any abnormal results that may be related to your other health problems.
What To Think About
- Chylomicrons are another type of lipoprotein that are measured in a different test. Chylomicrons are in the blood and carry fat from your intestine to your liver. They carry triglycerides to your muscles for immediate use. Or they carry triglycerides to fat tissue for storage.
- Having a high cholesterol level increases your chances of having a heart attack. The higher your cholesterol, the greater your chances. An elevated total cholesterol level in younger people is particularly significant, since the narrowing of the coronary arteries usually takes many years to develop.
- Lifestyle changes may help lower blood cholesterol levels and increase HDL ("good") cholesterol. Some people have better responses to diet and lifestyle changes than do others. Lifestyle changes might include:
- Quitting smoking.
- Eating healthier by reducing saturated (animal) fats and cholesterol in the diet while increasing fibre and complex carbohydrate.
- Losing weight. An improvement may occur if you lose as little as 2.5 kg (5 lb) to 5 kg (10 lb).
- Being active on most, preferably all, days of the week.
- Grundy SM, et al. (2018). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Journal of the American College of Cardiology, published online November 8, 2018: S0735. DOI: 10.1016/j.jacc.2018.11.003. Accessed January 28, 2019.
- Anderson TJ, et al. (2016). 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Canadian Journal of Cardiology, 32(11): 1263–1282. DOI: 10.1016/j.cjca.2016.07.510. Accessed October 20, 2018.
- Grundy S, et al. (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NIH Publication No. 02–5215). Bethesda, MD: National Institutes of Health. Also available online: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf.
Other Works Consulted
- Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
- Miller M, et al. (2011). Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 123(20): 2292–2333.
Current as of: December 16, 2019
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Brian D. O'Brien MD - Internal Medicine
Adam Husney MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Current as of: December 16, 2019