Heart and vessels
Cholesterol totaal
The total amount of cholesterol in the blood; one of the building blocks for estimating the risk of cardiovascular disease.
Everything about this testWhat it measures
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.
- 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
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.
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.
If your result is abnormal
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
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.
Limitations
- 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.
How common is this
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.
Who is this 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.
Downsides 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.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results