Cholesterol levels: what is normal?

This guide is general information and does not replace medical advice. Reference ranges differ between laboratories – always compare your result with the range printed on your own report and discuss abnormal results with a doctor.

A cholesterol test (lipid profile) usually includes total cholesterol, LDL ('bad') cholesterol, HDL ('good') cholesterol and triglycerides. Raised LDL cholesterol builds up in artery walls over years and is one of the main modifiable causes of heart attack and stroke.

Healthy cholesterol levels for adults

The values below are the general targets used by the NHS for healthy adults. Some laboratories report in mg/dL; both are shown.

Non-HDL cholesterol is total cholesterol minus HDL. It contains all the cholesterol in particles that can block arteries and is increasingly used instead of LDL.

Your target depends on your risk

There is no single 'normal' LDL for everyone. European (ESC/EAS) guidelines set lower LDL targets the higher your cardiovascular risk is:

• Low risk: LDL below 3.0 mmol/L (116 mg/dL)
• Moderate risk: below 2.6 mmol/L (100 mg/dL)
• High risk (for example diabetes with organ damage, moderate kidney disease): below 1.8 mmol/L (70 mg/dL)
• Very high risk (previous heart attack or stroke, established vascular disease): below 1.4 mmol/L (55 mg/dL)

Your doctor estimates your risk from age, sex, blood pressure, smoking, diabetes, kidney function and family history.

What causes high cholesterol?

• diet high in saturated fat, little physical activity, excess weight;
• familial hypercholesterolaemia – an inherited condition suggested by total cholesterol above about 7.5 mmol/L or LDL above 4.9 mmol/L, especially with early heart disease in the family;
• an underactive thyroid, kidney or liver disease, type 2 diabetes, some medicines;
• high triglycerides are also linked to alcohol, sugar-rich diet and poorly controlled diabetes.

How to lower cholesterol

• replace saturated fat (fatty meat, butter, cream, pastries) with unsaturated fats (olive or rapeseed oil, nuts, oily fish);
• eat more fibre – oats, beans, lentils, vegetables and fruit;
• be active for at least 150 minutes a week, stop smoking and limit alcohol;
• if lifestyle changes are not enough or your risk is high, your doctor may recommend medicine such as a statin.

When should you see a doctor?

Discuss your result with a doctor if your total cholesterol is above 7.5 mmol/L, LDL above 4.9 mmol/L, triglycerides above 10 mmol/L, if you have diabetes, kidney disease or heart disease, or if close relatives had a heart attack or stroke at a young age.

Sources

• NHS – High cholesterol: nhs.uk
• Mach F et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 2020;41:111–188.
• NICE NG238 – Cardiovascular disease: risk assessment and reduction, including lipid modification (2023): nice.org.uk
• Heart UK – Understanding your cholesterol test results: heartuk.org.uk