Cholesterol is a fatty substance found naturally in the blood and in every cell of the body. While it is essential for many bodily functions, having too much of certain types of cholesterol increases your risk of heart disease and stroke. The good news is that cholesterol levels are largely manageable with the right combination of lifestyle changes and, when needed, medication.
Understanding Cholesterol
Cholesterol travels through the bloodstream attached to proteins called lipoproteins. The main types are:
LDL Cholesterol – “Bad” Cholesterol
Low-density lipoprotein (LDL) carries cholesterol from the liver to the rest of the body. High levels of LDL cause fatty deposits (plaques) to build up in artery walls, narrowing them and increasing the risk of heart attack and stroke. Keeping LDL low is a key goal of cardiovascular risk management.
HDL Cholesterol – “Good” Cholesterol
High-density lipoprotein (HDL) carries cholesterol away from the arteries back to the liver, where it is broken down. Higher HDL levels are generally associated with a lower risk of heart disease.
Triglycerides
Triglycerides are another type of fat in the blood. Elevated triglyceride levels – often caused by excess sugar, alcohol, refined carbohydrates, and excess body weight – also contribute to cardiovascular risk.
Target Levels
Your cardiologist will set personalised targets based on your overall cardiovascular risk. General reference ranges for Australian adults are:
- Total cholesterol: less than 5.5 mmol/L (lower is preferred if you have existing heart disease)
- LDL cholesterol: less than 2.0 mmol/L for people at high risk; less than 1.4 mmol/L after a heart attack or for very high-risk patients
- HDL cholesterol: above 1.0 mmol/L for men; above 1.2 mmol/L for women
- Triglycerides: less than 1.7 mmol/L
Note: These targets are guidelines. Your doctor will consider your full medical history and risk profile when determining appropriate goals for you.
Lifestyle Changes That Help
Dietary and lifestyle modifications can significantly reduce LDL cholesterol and triglycerides, and raise HDL:
Eat a Heart-Healthy Diet
- Increase fibre intake – oats, legumes, fruit, nuts, seeds, and vegetables help lower LDL
- Choose healthy unsaturated fats found in olive oil, avocado, nuts, and oily fish
- Limit saturated fats found in fatty meats, full-fat dairy, butter, and fried foods
- Avoid trans fats found in many processed and packaged foods
- Reduce sugar and refined carbohydrates, which raise triglycerides and can cause obesity
Exercise Regularly
Aerobic exercise (such as brisk walking, cycling, or swimming) for at least 150 minutes per week has been shown to raise HDL cholesterol, lower triglycerides, and improve overall cardiovascular health.
Other Key Lifestyle Factors
- Quit smoking – smoking lowers HDL and damages artery walls
- Limit alcohol – excessive intake raises triglycerides
- Achieve and maintain a healthy body weight
Medications for High Cholesterol
In many individuals, cholesterol levels are genetically determined rather than being the consequence of lifestyle. When lifestyle changes are insufficient, your cardiologist may recommend medication. The most commonly prescribed class is statins, which reduce the liver’s production of cholesterol and have a well-established evidence base for preventing heart attacks and strokes.
Statins
Examples include atorvastatin, rosuvastatin, and pravastatin. They are generally well tolerated. Some people experience muscle aches, which should be discussed with your doctor. Rarely, statins can affect liver function, so periodic blood tests may be recommended.
Other Medications
- Ezetimibe – reduces cholesterol absorption in the intestine; often used alongside a statin
- PCSK9 inhibitors – injectable medications that significantly lower LDL; used for high-risk patients or those who cannot tolerate statins
- Fibrates and omega-3 fatty acid supplements – primarily used to lower triglycerides
Important: Never stop or adjust your cholesterol medication without speaking to your cardiologist first, even if your levels have improved. Medication often plays a long-term protective role beyond just lowering numbers.
Monitoring Your Levels
A fasting lipid panel blood test is used to measure your cholesterol and triglyceride levels. Depending on your risk profile and treatment, your cardiologist will advise how often testing is needed, typically every 6 to 12 months once levels are stable.