High Cholesterol: Understanding Your Levels and Treatment Options
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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 such as meat, dairy, and eggs.
Cholesterol travels through the bloodstream attached to proteins, forming particles called lipoproteins. The two main types that appear on a standard lipid panel 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 that anything is wrong. 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. Understanding what each number means can help people engage more meaningfully with their GP about what the results suggest.
Total Cholesterol
This is the overall measure of cholesterol in the blood, combining LDL, HDL, and a portion of triglycerides. 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. A person could have a high total cholesterol reading driven largely by a high HDL level, which changes the risk picture considerably.
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. People with existing heart disease, diabetes, or multiple risk factors may be advised by their GP to aim for even lower LDL levels. The Royal Australian College of General Practitioners (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. HDL acts as a kind of cleanup crew in the arteries, and lower levels of it are associated with increased risk.
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. When triglycerides are high alongside unfavourable LDL and HDL levels, the combined effect on cardiovascular risk is greater than any single measurement alone.
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, and it gives a more accurate picture of someone's likelihood of experiencing a heart attack or stroke within the next five years.
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, not judged in isolation against a number on a chart.
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 because they influence how proactively cholesterol should be monitored and managed.
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 of the same age. After menopause, LDL cholesterol levels in women often increase, partly due to the decline in oestrogen, which has a protective effect on lipid levels.
- Family history: A family history of high cholesterol or premature cardiovascular disease (heart attack or stroke in a first-degree male relative before age 55 or female relative before age 65) significantly increases risk. Familial hypercholesterolaemia (FH) is a genetic condition that causes very high LDL cholesterol from birth and affects 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, which makes cholesterol monitoring particularly important.
Modifiable Risk Factors
- Diet: Diets high in saturated fats and trans fats can raise LDL cholesterol levels. Saturated fats are found in foods such as fatty meats, full-fat dairy, butter, and many processed snack foods. Trans fats, while now less common in Australian food products due to industry reformulation, still appear in some commercially baked and fried foods.
- Physical inactivity: Regular physical activity can help raise HDL cholesterol and lower LDL and triglycerides. A sedentary lifestyle has the opposite effect.
- Weight: Carrying excess weight, particularly around the abdomen, is associated with higher LDL and triglyceride levels and lower HDL. Even modest weight reduction may help improve lipid profiles.
- Smoking: Smoking lowers HDL cholesterol and damages the lining of blood vessels, making it easier for LDL cholesterol to accumulate in artery walls. Stopping smoking can improve HDL levels within weeks.
- Alcohol: While moderate alcohol consumption has historically been discussed in the context of heart health, current evidence suggests there is no safe level of alcohol consumption when it comes to overall health. 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. Managing these conditions effectively is an important part of managing lipid levels.
For many people, lifestyle modifications are the first line of approach for managing high cholesterol, and the evidence behind them is solid. Depending on the degree of elevation and overall cardiovascular risk, a GP may recommend lifestyle changes alone or alongside medication.
Dietary Adjustments
The Heart Foundation of Australia provides evidence-based dietary guidance for managing cholesterol, with several practical recommendations:
- 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. This does not mean eliminating all fat from the diet. It means shifting the balance toward healthier fat sources.
- 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. Healthdirect Australia notes that aiming for 25 to 30 grams of total dietary fibre per day is a reasonable target for most adults.
- Include plant sterols: Plant sterols (also called phytosterols) can reduce LDL cholesterol by blocking its absorption in the intestine. They are found naturally in small amounts in grains, vegetables, and nuts, and are also available in fortified foods such as margarine and milk. The Heart Foundation notes that 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 and support overall heart health. Two to three serves of oily fish per week is a commonly recommended target.
- Limit processed foods and added sugars: Processed foods tend to be high in both saturated fats and refined carbohydrates, which can contribute to unfavourable lipid profiles and weight gain.
Physical Activity
The Australian Government's Physical Activity and Sedentary Behaviour Guidelines recommend that adults aim for at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes of vigorous-intensity activity, along with muscle-strengthening activities on at least two days. Regular exercise has been shown to raise HDL cholesterol, lower triglycerides, and support modest reductions in LDL. It does not need to be complicated. Walking, swimming, cycling, and gardening all count.
Weight Management
For individuals carrying excess weight, even a 5 to 10 per cent reduction in body weight can produce meaningful improvements in cholesterol levels. This is supported by data from Healthdirect Australia and aligns with RACGP clinical guidance on cardiovascular risk reduction. 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 a person can make for cardiovascular health. HDL cholesterol levels can begin to improve within weeks of stopping, and the risk of heart disease drops substantially over the following years. Support is available through the Quitline (13 7848) and through GPs who can discuss nicotine replacement therapy and other cessation aids.
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. The decision to start cholesterol-lowering medication is based on the overall risk picture, not solely on a single blood test result.
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 depending on the type and dose.
Commonly prescribed statins in Australia include atorvastatin, rosuvastatin, simvastatin, and pravastatin. Several of these are available on the Pharmaceutical Benefits Scheme (PBS), making them more affordable for eligible patients.
Statins have a strong evidence base. 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. They are considered a cornerstone of cardiovascular prevention.
Like all medications, statins can have side effects. 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. Any concerns about side effects should be discussed with a GP, who can help weigh the benefits against any experienced symptoms.
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 people who need additional LDL lowering beyond what a statin alone achieves, or as an alternative for those who cannot tolerate statins. Research published in the New England Journal of Medicine (the IMPROVE-IT trial) demonstrated that combining ezetimibe with a statin provided additional cardiovascular benefit compared with statin therapy alone.
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 who have not achieved adequate LDL reduction with statins and ezetimibe. Access in Australia is available through the PBS for eligible patients, subject to specific criteria. These medications require specialist involvement and are not a first-line treatment.
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. Omega-3 fatty acid supplements at prescription-strength doses have also been studied for triglyceride reduction, though their role in reducing cardiovascular events remains a topic of ongoing research.
All cholesterol medications require a prescription and a conversation with a GP about the benefits, risks, and monitoring requirements specific to each individual. There is no substitute for that clinical relationship.
Need a cholesterol check?
Cholesterol management is rarely a one-and-done conversation. It typically involves an initial assessment, a treatment plan (whether lifestyle-focused, medication-based, or both), and then regular follow-up to track progress, adjust targets, and address any concerns that arise along the way. For many Australians, particularly those living in regional and remote areas, fitting these ongoing appointments into daily life can be genuinely difficult.
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 across the care network reflects this: three in four patients choose to see the same doctor again.
For something like 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 than one seeing the patient for the first time.
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, so the time spent together is focused on what matters most.
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, though a GP will advise on the appropriate interval based on individual circumstances.
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 such as increased physical activity and weight management. However, the extent of improvement varies between individuals, and some people, especially those with familial hypercholesterolaemia or very high baseline levels, may need medication alongside lifestyle changes to reach their target levels. A GP can help determine the right approach.
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. People with existing cardiovascular disease or diabetes should discuss their specific dietary needs with a GP or dietitian.
What are the signs of high cholesterol? High cholesterol typically does not cause any noticeable symptoms. In rare cases of very high cholesterol, particularly familial hypercholesterolaemia, physical signs such as xanthomas (yellowish deposits of fat under the skin, often around the eyes or on tendons) may be visible. For the vast majority of people, the only way to detect high cholesterol is through a blood test, which underscores the importance of regular health checks.
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 with a valid Medicare card. Prescriptions and pathology referrals can be arranged during the consultation where clinically appropriate.
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