Cholesterol: Levels, Tests and How to Lower It

About half of Australian adults have blood cholesterol above 5 mmol/L, and most have no idea. There is nothing to feel. No ache, no warning. That is the whole problem with cholesterol, and why a blood test does the work your body will not. This guide covers what the numbers mean in Australia and what genuinely lowers them. Testing belongs with your regular GP, though if chest symptoms have turned up tonight and your clinic is shut, an after-hours GP consultation or a telehealth appointment is available.

What is cholesterol?

Cholesterol is a waxy fat your body needs. It builds cell walls, makes hormones and goes into bile for digesting food. Your liver makes most of what you use, which is the first thing people find surprising.

It travels through the blood attached to proteins, and the two carriers behave differently. LDL drops cholesterol off in artery walls, where it builds up over years and narrows the vessel - hence the "bad" label. HDL collects the excess and carries it back to the liver. Triglycerides are a separate blood fat, reported alongside, rising with alcohol, sugar and excess weight.

Cholesterol levels in Australia

Australian guidance puts total cholesterol below 5.5 mmol/L for someone with no other risk factors. With high blood pressure, diabetes, existing heart disease, or if you smoke, the LDL target tightens to below 2.0 mmol/L.

Those numbers come with a caveat. Since 2023, Australian practice has moved away from treating one number in isolation towards absolute cardiovascular risk - cholesterol combined with age, sex, blood pressure, smoking and diabetes to estimate your actual chance of a heart attack or stroke in the next five years.

Context changes everything. A total cholesterol of 5.8 in a 35-year-old non-smoker with normal blood pressure means something quite different from the same reading in a 62-year-old smoker with diabetes. Your GP runs that calculation. A number alone, googled at midnight, cannot.

High cholesterol symptoms: there usually are none

Worth saying plainly, because so many people search for it. High cholesterol produces no symptoms. No tiredness, no headaches, no chest tightness, no tingling. You cannot feel it and you cannot tell by looking.

The first sign, for too many Australians, is the heart attack or stroke itself. That is not scaremongering - it is what happens when a condition stays silent for twenty years.

One exception exists. Familial hypercholesterolaemia, an inherited condition causing very high cholesterol from birth, sometimes produces visible signs - yellowish deposits on the eyelids, thickened lumps over the Achilles tendon or knuckles, a pale ring around the cornea in someone under 45. These are uncommon, and their absence proves nothing. If a parent or sibling had a heart attack young, mention it regardless of how you feel.

The cholesterol blood test

A lipid profile measures total cholesterol, LDL, HDL and triglycerides from one blood sample. Fasting is sometimes requested, though many labs no longer require it - follow what your doctor tells you.

Testing is advised from age 45, every five years, and from age 18 for Aboriginal and Torres Strait Islander people. Earlier and more often with diabetes, high blood pressure or a family history of early heart disease.

What causes high cholesterol?

Diet gets the blame and is only part of the story. Saturated fat, excess weight, inactivity, smoking and heavy drinking all push levels up. So do diabetes, kidney disease and an underactive thyroid, along with certain medications.

Genetics do more than people expect. Cholesterol runs in families, and familial hypercholesterolaemia affects roughly one in 250 people, most undiagnosed. Age raises it too, and in women levels commonly climb after menopause.

How to lower cholesterol

Diet and lifestyle shift cholesterol meaningfully for most people, and Australian dietary guidance is fairly specific about what helps.

Cholesterol lowering foods

• Oats, barley and legumes - soluble fibre binds cholesterol in the gut
• Oily fish twice a week - salmon, sardines, mackerel
• Nuts, seeds, avocado and olive oil instead of butter and cream
• Plenty of vegetables, fruit and wholegrains
• Foods fortified with plant sterols, which block absorption
• Less deep-fried takeaway, pastries, biscuits and processed meat
• Red meat one to three times a week, trimmed and lean

The egg question

Dietary cholesterol - eggs, prawns, liver - affects blood cholesterol far less than saturated fat does. Current Australian advice treats the relationship as broadly neutral, with up to seven eggs a week reasonable even at higher risk. What you fry them in matters more than the eggs.

Beyond the plate

Thirty minutes of brisk activity most days raises HDL. Quitting smoking improves it within weeks. Losing even a little excess weight helps, as does cutting back on alcohol. None of this is novel, which is exactly why it gets skipped.

Managing cholesterol naturally - and when that is not enough

Lifestyle change is the right first step for most people, and for many it does the job. Give it three to six months, then retest.

Some people cannot get there on diet alone, whatever they try, because their liver simply produces too much. Familial hypercholesterolaemia is the clearest example. Treating that as a willpower problem, or delaying medication while trying another supplement, costs arteries that do not grow back. If your doctor recommends medicine, it is because your overall risk warrants it - not because you failed. If you want to talk that through outside clinic hours, a bulk billed telehealth appointment is one way to do it.

Where to go for this

Cholesterol testing and ongoing management sit with your regular GP, who can order the bloods and follow the numbers over years. A Medicare-funded Heart Health Check covers cholesterol alongside the rest of your cardiovascular risk - worth asking whether you qualify. An after-hours service is not where any of that happens. 13CURE covers the acute end - chest discomfort, palpitations or breathlessness when clinics are shut. Bookings run Monday to Friday 6pm to 8am, Saturdays from 12pm, and 24 hours Sundays and public holidays. Consultations are bulk billed for eligible Medicare and DVA cardholders - the bulk billing GP page covers eligibility, and a home doctor visit may be available depending on location, listed on the areas we cover page.