Heart and vessels · Blood

Cholesterol, total

The total amount of cholesterol in the blood; one of the building blocks for estimating the risk of cardiovascular disease.

At a glance

Measured in blood
In 18 test panels
No special preparation

Explanation

Cholesterol, total: what is measured?

Cholesterol is a fat-like substance that the body needs for cell walls, hormones and bile. The liver makes most of it itself; a smaller part comes from food. Total cholesterol is the sum of all the cholesterol in the blood, spread over different transport particles (mainly LDL and HDL). The value on its own therefore says less than the distribution: the GP looks at total cholesterol together with HDL, from which follows the non-HDL cholesterol (total minus HDL) that is used in the risk estimate.

What can it detect?

Increased risk of cardiovascular disease (together with age, sex, smoking, blood pressure and HDL in the SCORE2 risk table)
Strongly raised cholesterol that may fit familial hypercholesterolemia (inherited high cholesterol)
Effect of lifestyle changes or cholesterol-lowering medicines

Result

What does the result mean?

Cholesterol, total too high

A raised total cholesterol usually means that there is a lot of LDL cholesterol in the blood; in the long term, this increases the chance of hardening of the arteries (atherosclerosis), a heart attack and a stroke. It causes no symptoms itself. What the value means depends strongly on the other risk factors: a total cholesterol of 6 mmol/l carries different weight for a smoker in their sixties with high blood pressure than for a non-smoker in their thirties. Part of a high total cholesterol can also consist of HDL, which is actually favorable. Other causes of a high value: an underactive thyroid, kidney disease, pregnancy and some medicines. With a total cholesterol above about 8 mmol/l, the GP considers inherited high cholesterol.

Cholesterol, total too low

A low total cholesterol is usually favorable and is often due to genetic makeup, a healthy lifestyle or cholesterol-lowering medicines. An unexpectedly low or falling value can also go with an overactive thyroid, malnutrition, liver disease or a long-lasting inflammation or other illness. It causes no symptoms itself; a low value is not a reason for testing on its own, unless there are also symptoms or other abnormal values.

After an abnormal result

With a raised value, the GP determines the full lipid profile (HDL, LDL, triglycerides) and the other risk factors, and uses these to estimate the ten-year risk of cardiovascular disease. Depending on that, lifestyle advice, a repeat measurement or treatment follows; with a strongly raised value, testing for inherited high cholesterol.

Reliability

How reliable is the test?

Total cholesterol is a risk marker, not a test that confirms or rules out a disease. According to the Dutch GP guideline (NHG) on cardiovascular risk management, the GP estimates the ten-year risk of cardiovascular disease with the SCORE2 table, in which age, sex, smoking and blood pressure are taken into account in addition to non-HDL cholesterol (total minus HDL). So a single value is not a diagnosis: the same result can mean a low risk for one person and a high risk for another. The measurement itself is well standardized and, according to the guideline, does not need to be done fasting.

What can affect the result?

The value fluctuates from day to day; with a borderline value, a second measurement is needed before conclusions are drawn.
During and up to a few weeks after an acute illness, surgery or heart attack, cholesterol is temporarily lower than normal.
Pregnancy, an underactive thyroid, kidney disease, liver disease and medicines such as corticosteroids, water pills and some contraceptive pills affect the value.
Fasting is not needed; only with strongly raised triglycerides can the value be slightly higher after a meal.

Who it is for

Who is the test useful for?

Useful for

Useful as part of a cardiovascular risk estimate according to the Dutch GP guideline (NHG): with smoking, high blood pressure, diabetes, overweight, kidney damage, or cardiovascular disease or strongly raised cholesterol in the family, and for monitoring cholesterol-lowering treatment. The SCORE2 risk table has been validated from age 40. A cholesterol value on its own without the other risk factors offers little to go on. In young, healthy adults without risk factors and without a family history, a repeat measurement usually changes the picture little.

How common is it?

In 2024, more than 1.6 million people in the Netherlands were known to their GP with a lipid metabolism disorder, including high cholesterol; that is about 9 in 100 inhabitants. The diagnosis is made most often between the ages of 55 and 70, more often in men up to about age 50 and more often in women after that. More than 1.7 million people have a cardiovascular disease.

VZinfo (RIVM) based on Nivel primary care registrations, 2024

Drawbacks and risks

A cholesterol value on its own is often read as 'too high' or 'good' without the other risk factors; this can lead to unnecessary worry or, on the contrary, false reassurance.

Get tested

Cholesterol, total: test panels

Cholesterol, total is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Blood draw
Cholesterol (Total)
Total cholesterol; part of lipid profile.
€ 17,00
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Cholesterol Package (Total, HDL, LDL, Triglycerides)
Total cholesterol, HDL, LDL, and triglycerides.
€ 32,00
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€ 134,00
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Weight Loss Test
Panel for metabolism and weight; glucose, lipids, and hormones.
€ 89,00
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General Health Checkup
With this General Health Check-up, you gain detailed insight into your overall health and well-being.
€ 125,00
Fingerstick
Cholesterol Package
Lipid profile: Total cholesterol, HDL, LDL, and triglycerides.
€ 32,00
Fingerstick
Cholesterol (Total)
Total cholesterol; component of the lipid profile.
€ 17,00
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InsideTracker
InsideTracker Blood Analysis: analyze 48 biomarkers for complete health optimization and personalized recommendations.
€ 335,00
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Hormone Recovery (After Steroids)
Testosterone, free testosterone, SHBG, LH, FSH, estradiol, TSH, liver function, and lipid profile. For recovery after anabolic steroid use.
€ 325,00

How reliable is the test?

Cholesterol, total