Cholesterol

A standard NHS lipid panel reports total cholesterol, HDL ("good"), non-HDL (everything atherogenic), LDL and triglycerides. NICE NG238 now uses non-HDL cholesterol as the main treatment target — it does not require fasting and is a stronger predictor of cardiovascular events than LDL alone.^{[2]NICE NG238}

• Total cholesterol: ideally 5 mmol/L or below
• Non-HDL: below 4 mmol/L
• LDL: below 3 mmol/L (or below 2.6 if at high risk)
• HDL: above 1.0 mmol/L (men) or 1.2 mmol/L (women)

Source: NHS / Heart UK reference values.^{[1]NHS[4]Heart UK}

First-line management is dietary — replacing saturated fat with unsaturated fat, eating oily fish twice a week, increasing soluble fibre (oats, beans, pulses) and losing excess weight. Where 10-year cardiovascular risk (QRISK3) is ≥ 10%, NICE recommends offering atorvastatin 20 mg.^{[2]NICE NG238}

Familial hypercholesterolaemia (FH) is an inherited condition where LDL is very high from birth. Suspect FH if total cholesterol is above 7.5 mmol/L in an adult, or there is a family history of early heart disease (men < 55, women < 60). NICE CG71 recommends DNA testing and cascade screening of relatives.^{[3]NICE CG71}

• Heart UK — The Cholesterol Charity · helpline 0345 450 5988 (Mon–Fri 10am–3pm)
• British Heart Foundation Heart Helpline · 0808 802 1234 (Mon–Fri 9am–5pm)
• NHS 111 · free, 24/7, for urgent non-emergency advice
• NHS Health Check · free 5-yearly cardiovascular review for adults 40–74 in England — book through your GP