What is total cholesterol, and how do I calculate it?

Six out of ten adults have raised cholesterol and many people are completely unaware they have it. That’s because it tends not to cause any symptoms. But it can put you at risk for serious health conditions like heart disease and stroke.  

It’s useful to know what total cholesterol is as well as how different types of cholesterol impact your health.   

In this article, we cover:  

• What is total cholesterol? 
• How is total cholesterol calculated? 
• How often should I check my cholesterol? 
• What should my cholesterol levels be?
• What are the risks of high total cholesterol? 
• How can I lower my cholesterol? 

What is total cholesterol?

Cholesterol is an essential part of our bodies. There are different types of cholesterol - 'good' and 'bad'.  

Total cholesterol is the overall amount of cholesterol in your blood including both good and bad cholesterol.

You can learn more about the different types of cholesterol in our blog.

How is total cholesterol calculated?
 

You might be wondering how to calculate your total cholesterol.

The first thing to do is take a lipid panel. This can be a simple finger prick cholesterol test, like our Cholesterol Blood Test, and find out your levels of HDL cholesterol, LDL cholesterol, and triglycerides.

If you're calculating your total cholesterol in the UK, that's actually all the steps, as we calculate your total cholesterol for you.

You can also estimate your ten-year risk of having a heart attack or stroke by using the QRISK3 tool. For a more accurate estimate, you'll need a recent blood pressure reading.

How often should I check my cholesterol?

The only way to check your cholesterol levels is with a blood test.  

It’s generally a good idea to check your cholesterol every few years or more frequently if you are known to have high cholesterol or another condition that puts you at increased risk of heart disease. Some people may like to check their cholesterol more often, especially if they are making lifestyle changes and want to track their progress. 

You’ll usually be offered a cholesterol test if you: 

• Are aged between 40 and 74 — it’s included every five years with the NHS health check 
• Are at high risk of heart disease — e.g., if you have a family history, you’re overweight, you smoke, or you have diabetes 
• Have been diagnosed with heart disease or other related illnesses like stroke or peripheral vascular disease 
• Are taking medicines to lower your cholesterol — it’s usually tested every year 
• Have a close relative with familial hypercholesterolaemia 

For an in-depth look at cholesterol and other heart disease biomarkers, try an Advanced Heart Disease Risk Blood Test.

What is a normal cholesterol range?

The following cholesterol targets are given as a guide [1]:  

If you're at an increased risk of heart disease, your doctor may set specific targets for you.

*In December 2023, NICE issued new guidelines recommending an LDL cholesterol goal of less than or equal to ≤2 mmol/L and a non-HDL cholesterol goal of less than or equal to ≤2.6 mmol/L for individuals with a higher risk of cardiovascular disease [2]. This means that more people are likely to be offered statins or lipid-lowering therapy to prevent further disease. 

Total cholesterol to HDL ratio 

Another useful measurement is your ratio of total cholesterol to HDL cholesterol ratio (TC:HDL). This is because HDLs can somewhat counter the negative effects of bad cholesterol. A higher ratio means a higher risk of heart disease.  

The ideal total cholesterol to HDL ratio is less than 4.  

What are the risks of high total cholesterol?

If you have high cholesterol, it can build up in the artery walls, restricting the blood flow to your heart, brain, and the rest of your body. These fatty deposits, known as plaques, can rupture and encourage the blood to clot. If a clot travels to the heart or brain it can cause a heart attack or stroke.  

Raised cholesterol increases your risk of:  

• Angina 
• Heart attacks 
• Stroke 
• Transient ischaemic attacks (TIA) — often known as a mini-stroke 
• Peripheral vascular disease (PVD) — pain, ulcers, and numbness in the legs and feet 

PVD, if left untreated, can lead to serious and potentially fatal problems.   

How can I lower my cholesterol?

Fortunately, in most cases, cholesterol can be lowered by making changes to your diet and lifestyle.  

For people with inherited conditions, like familial hypercholesterolaemia, it may be difficult to lower cholesterol levels into the normal range with lifestyle changes alone. You may be advised to take cholesterol-lowering medication. However, many of these suggestions will still be beneficial to overall health alongside any medication.  

Four top tips to reduce cholesterol:  

1. Eat less fatty food — include plenty of fresh fruit and vegetables and switch to healthier fats that can raise your HDLs (you could even try something like the Mediterranean diet)
2. Exercise regularly — aim for at least 150 minutes of moderate exercise a week 
3. Stop smoking — smoking can raise your cholesterol and significantly increase your risk of heart disease and stroke 
4. Cut back on alcohol — try to avoid drinking more than 14 units a week 

Try the following meal substitutions to lower your cholesterol:  

References