High Cholesterol: Understanding Your Levels and Treatment Options
%20Medium.jpeg)
Cholesterol is a waxy, fat-like substance that the body needs to function. It plays an essential role in building cell membranes, producing hormones (including oestrogen and testosterone), and manufacturing vitamin D. The liver produces most of the cholesterol the body requires, while a smaller portion comes from dietary sources.
Cholesterol travels through the bloodstream attached to proteins, forming particles called lipoproteins. The two main types are:
- LDL (low-density lipoprotein), often referred to as "bad" cholesterol. LDL carries cholesterol from the liver to the arteries, where excess amounts can accumulate in the artery walls and form plaque. Over time, this plaque narrows and hardens the arteries, a process known as atherosclerosis, which increases the risk of heart attack and stroke.
- HDL (high-density lipoprotein), commonly called "good" cholesterol. HDL helps transport cholesterol away from the arteries and back to the liver, where it is broken down and removed from the body. Higher HDL levels are generally associated with a lower cardiovascular risk.
There is also a third component that matters: triglycerides. These are a type of fat found in the blood that the body uses for energy. Elevated triglyceride levels, particularly when combined with high LDL and low HDL, can compound cardiovascular risk.
High cholesterol, or hypercholesterolaemia, occurs when levels of LDL cholesterol or total cholesterol are higher than what is considered healthy. The challenge is that elevated cholesterol does not produce noticeable symptoms. There is no pain, no fatigue, and no outward sign. The only reliable way to know where cholesterol levels sit is through a blood test, which is why regular health checks matter so much.
A standard cholesterol test in Australia is called a lipid panel or lipid profile. It is a simple blood test, typically taken after fasting for 10 to 12 hours, that measures four key values.
Total Cholesterol
This is the overall measure of cholesterol in the blood. The Heart Foundation of Australia considers a total cholesterol level below 5.5 mmol/L to be desirable for most adults. However, total cholesterol alone does not tell the full story, because it does not distinguish between LDL and HDL.
LDL Cholesterol
For most adults without pre-existing cardiovascular conditions, an LDL level below 2.0 mmol/L is considered optimal, though individual targets vary depending on overall cardiovascular risk. The RACGP recommends that LDL targets be set in the context of a person's absolute cardiovascular risk rather than treated as a standalone number.
HDL Cholesterol
Higher HDL levels are generally protective. The Heart Foundation suggests that an HDL level above 1.0 mmol/L for men and above 1.2 mmol/L for women is desirable.
Triglycerides
A fasting triglyceride level below 2.0 mmol/L is generally considered normal. Elevated triglycerides can be influenced by diet, alcohol intake, weight, and certain medical conditions including diabetes and hypothyroidism.
The Bigger Picture: Absolute Cardiovascular Risk
One of the most important things to understand about cholesterol numbers is that they do not exist in isolation. A GP will typically assess cholesterol results alongside other factors, including age, sex, blood pressure, smoking status, family history, and whether conditions like diabetes are present. This combined assessment is called absolute cardiovascular risk.
The RACGP and the National Vascular Disease Prevention Alliance recommend using the Australian absolute cardiovascular risk calculator to guide treatment decisions. Two people with the same LDL level may receive quite different recommendations depending on their overall risk profile. This is why a cholesterol result should always be interpreted by a GP in context.
Some risk factors for high cholesterol can be modified through lifestyle changes or medical treatment. Others, like age and genetics, cannot be changed but are important to be aware of.
Non-Modifiable Risk Factors
- Age and sex: Cholesterol levels tend to rise with age. Before menopause, women generally have lower total cholesterol levels than men. After menopause, LDL cholesterol levels in women often increase due to the decline in oestrogen.
- Family history: A family history of high cholesterol or premature cardiovascular disease significantly increases risk. Familial hypercholesterolaemia (FH) is a genetic condition affecting an estimated one in 250 Australians, according to the Heart Foundation.
- Ethnicity: Some population groups, including people of South Asian and Aboriginal and Torres Strait Islander descent, may have higher baseline cardiovascular risk.
Modifiable Risk Factors
- Diet: Diets high in saturated fats and trans fats can raise LDL cholesterol levels. Saturated fats are found in fatty meats, full-fat dairy, butter, and many processed snack foods.
- Physical inactivity: Regular physical activity can help raise HDL cholesterol and lower LDL and triglycerides.
- Weight: Carrying excess weight, particularly around the abdomen, is associated with higher LDL and triglyceride levels and lower HDL.
- Smoking: Smoking lowers HDL cholesterol and damages the lining of blood vessels, making it easier for LDL cholesterol to accumulate.
- Alcohol: Excessive alcohol intake raises triglyceride levels and can contribute to weight gain.
- Other medical conditions: Type 2 diabetes, hypothyroidism, chronic kidney disease, and certain liver conditions can all affect cholesterol levels.
For many people, lifestyle modifications are the first line of approach for managing high cholesterol, and the evidence behind them is solid.
Dietary Adjustments
The Heart Foundation of Australia provides evidence-based dietary guidance:
- Reduce saturated fat intake: Replacing saturated fats with unsaturated fats (found in olive oil, nuts, seeds, avocado, and oily fish) is one of the most effective dietary changes for lowering LDL cholesterol.
- Increase soluble fibre: Foods rich in soluble fibre, such as oats, barley, legumes, fruits, and vegetables, can help reduce the absorption of cholesterol in the gut. Aiming for 25 to 30 grams of total dietary fibre per day is a reasonable target.
- Include plant sterols: Consuming 2 to 3 grams of plant sterols per day can lower LDL cholesterol by approximately 10 per cent.
- Eat more oily fish: Fish such as salmon, mackerel, sardines, and tuna are rich in omega-3 fatty acids, which may help lower triglyceride levels. Two to three serves per week is commonly recommended.
- Limit processed foods and added sugars: Processed foods tend to be high in both saturated fats and refined carbohydrates.
Physical Activity
The Australian Government's guidelines recommend at least 150 minutes of moderate-intensity physical activity per week. Regular exercise has been shown to raise HDL cholesterol, lower triglycerides, and support modest reductions in LDL.
Weight Management
Even a 5 to 10 per cent reduction in body weight can produce meaningful improvements in cholesterol levels. Sustainable, gradual changes tend to be more effective than drastic short-term approaches.
Smoking Cessation
Quitting smoking is one of the single most impactful changes for cardiovascular health. HDL cholesterol levels can begin to improve within weeks of stopping. Support is available through the Quitline (13 7848) and through GPs.
When lifestyle changes alone are not sufficient to bring cholesterol to target levels, or when a person's absolute cardiovascular risk is high, a GP may recommend medication.
Statins
Statins are the most commonly prescribed cholesterol-lowering medications in Australia and globally. They work by inhibiting an enzyme in the liver called HMG-CoA reductase, which plays a central role in cholesterol production. By reducing the liver's output of cholesterol, statins lower LDL levels in the bloodstream, typically by 30 to 50 per cent.
Commonly prescribed statins in Australia include atorvastatin, rosuvastatin, simvastatin, and pravastatin. Several of these are available on the Pharmaceutical Benefits Scheme (PBS).
Large-scale clinical trials and meta-analyses, including those reviewed by the National Heart Foundation of Australia, have consistently demonstrated that statins reduce the risk of major cardiovascular events such as heart attack and stroke in people at elevated risk.
Muscle pain or weakness is the most commonly reported concern. Most people tolerate statins well, and when side effects do occur, switching to a different statin or adjusting the dose often resolves the issue.
Ezetimibe
Ezetimibe works differently from statins. Rather than reducing cholesterol production in the liver, it blocks the absorption of cholesterol in the small intestine. It is sometimes prescribed alongside a statin for additional LDL lowering, or as an alternative for those who cannot tolerate statins. The IMPROVE-IT trial demonstrated that combining ezetimibe with a statin provided additional cardiovascular benefit.
PCSK9 Inhibitors
PCSK9 inhibitors are a newer class of cholesterol-lowering medication, administered by injection, that can significantly reduce LDL cholesterol levels. They are typically reserved for people with familial hypercholesterolaemia or those at very high cardiovascular risk. Access in Australia is available through the PBS for eligible patients.
Fibrates and Other Agents
Fibrates, such as fenofibrate, are primarily used to lower triglyceride levels and may modestly increase HDL. They may be prescribed when triglycerides are significantly elevated, particularly in people with type 2 diabetes.
All cholesterol medications require a prescription and a conversation with a GP about the benefits, risks, and monitoring requirements specific to each individual.
Need a cholesterol check?
Cholesterol management is rarely a one-and-done conversation. It typically involves an initial assessment, a treatment plan, and then regular follow-up to track progress, adjust targets, and address any concerns.
This is where an online-first clinic like Abby Health can make a meaningful difference. Abby Health operates 7 days a week, 365 days a year, with over 300 clinicians available through scheduled appointments or the First Available queue. The care network is built around continuity, so patients can see the same GP over time rather than repeating their history at every visit. The 71 per cent rebook rate reflects this: three in four patients choose to see the same doctor again.
For cholesterol management, that continuity matters. A GP who already knows a patient's baseline results, family history, medication tolerability, and lifestyle context is far better placed to make nuanced decisions about treatment adjustments.
Abby AI, our medical AI decision-support tool, supports every consultation by surfacing relevant patient history, previous pathology results, and risk signals ahead of the appointment. It does not diagnose or prescribe. It helps ensure the clinician has the full picture from the moment the consultation begins.
Prescriptions for cholesterol medications, including statins and ezetimibe, can be issued during a consultation where clinically appropriate. Pathology referrals for repeat lipid panels can also be arranged, allowing patients to have blood drawn at a local collection centre and then review the results with their GP in a follow-up appointment.
Consultations are bulk billed for eligible patients with a valid Medicare card, which removes one of the barriers that can prevent people from maintaining the regular follow-up that effective cholesterol management requires.
How often should cholesterol be checked?
The RACGP recommends that adults aged 45 and over (or 35 and over for Aboriginal and Torres Strait Islander peoples) have a cardiovascular risk assessment that includes a lipid panel. For people already diagnosed with high cholesterol or those on medication, follow-up blood tests are typically recommended every 6 to 12 months.
Can high cholesterol be reversed with diet alone?
Dietary changes can produce meaningful reductions in LDL cholesterol for many people, particularly when combined with other lifestyle modifications. However, some people, especially those with familial hypercholesterolaemia, may need medication alongside lifestyle changes to reach their target levels.
Are eggs bad for cholesterol?
For most people, eating eggs in moderation does not significantly raise blood cholesterol levels. The Heart Foundation of Australia advises that eggs can be part of a healthy diet and recommends up to seven eggs per week for the general population. Dietary cholesterol has less impact on blood cholesterol than saturated and trans fats for most individuals.
What are the signs of high cholesterol?
High cholesterol typically does not cause any noticeable symptoms. In rare cases of very high cholesterol, physical signs such as xanthomas (yellowish deposits of fat under the skin) may be visible. The only reliable way to detect high cholesterol is through a blood test.
Can I discuss my cholesterol results with an online GP?
Yes. Reviewing pathology results and discussing cholesterol management are well suited to online consultations. Abby Health provides access to GPs 7 days a week, with bulk billing available for eligible patients. Prescriptions and pathology referrals can be arranged during the consultation where clinically appropriate.
Editorial Standards
Notice something that doesn’t look right? Let us know at support@abbyhealth.app
Authors
.avif)
