Lipid Profile

1) As part of a cardiovascular risk assessment

Cardiovascular disease means disease of the heart, such as a heart attack, or of the arteries. These conditions are partly due to laying down of excess cholesterol in the artery walls (known as atherosclerosis, or “furring up of the arteries”). The balance of different cholesterol fractions measured as part of the lipid profile (e.g. "bad" non-HDL-C vs "good" HDL-C) can influence how fast and extensive this process is. Therefore, the commonest reason to measure a person’s lipid profile is to help estimate their risk of developing cardiovascular disease in the future. This then helps with decisions about lifestyle changes and medical treatments to reduce future risk. In the UK, most doctors use a “risk calculator” (QRISK2 or QRISK3) which uses the cholesterol: HDL ratio along with other known risk factors (such as age, gender, smoking, blood pressure, diabetes, obesity, and certain chronic illnesses) for this purpose.

2) In cases of pancreatitis

Pancreatitis is a serious medical condition in which the pancreas becomes inflamed. It has many causes, one of which is high levels of triglycerides in the blood. Therefore, if you ever develop pancreatitis, your lipid profile would usually be checked to look for elevated triglycerides. If found, these can be reduced effectively by lifestyle changes and medical treatments.

3) To monitor response to treatment
If you are prescribed lipid-modifying treatments, for example to reduce risk of cardiovascular disease or pancreatitis, your lipid profile may be checked periodically to determine if the treatment is working adequately.

• In the UK, your lipid profile is commonly tested by your GP when you reach the age of 40, as part of a routine cardiovascular health check.
• It may be checked at other times if you are thought to be at increased risk of cardiovascular disease for another reason.
• It will be checked if you develop another medical condition which can be due to abnormal lipids, such as pancreatitis.
• If you have a close relative with inherited high cholesterol (familial hypercholesterolaemia).
• Finally, it will likely be checked at regular intervals if you have been prescribed lipid-modifying treatments, such as statins.

Please see the separate pages on each component of the lipid profile for discussions about each component of the lipid profile - cholesterol, non-HDL, HDL, triglycerides, LDL

Ideal levels for adults are as follows:

Total cholesterol: below 5.0 mmol/L

Non-HDL cholesterol: below 4.0 mmol/L

LDL cholesterol: below 3.0 mmol/L

HDL cholesterol: above 1.0 mmol/L for a man, above 1.2 mmol/L for a woman

TC: HDL ratio above 6 is considered high risk - the lower this ratio is the better

Triglycerides: below 1.7 mmol/L after fasting or below 2.3 mmol/L without fasting

A lipid profile should ideally be measured when a person is healthy. In particular, cholesterol can be temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). To get a true representation of your cholesterol, you should wait at least six weeks after any illness before having it measured. In women, cholesterol and triglyceride concentrations are high during pregnancy. Women should wait at least three months after the baby is born to have a lipid profile measured. Some drugs are known to affect the lipid profile, including oral corticosteroids, beta blockers, oral contraceptives, thiazide diuretics, oral retinoids and phenytoin.

For many years LDL-C was used as the main measure of "bad" cholesterol. However it is now recognised that cholesterol carried on other lipoproteins is also harmful. For this reason, the recommendations changed in 2014 so that non-HDL-C may be reported instead of LDL-C.