Which cholesterol value is the most important?

Your cholesterol profile typically contains values including:

1. Total cholesterol

2. LDL (low-density lipoprotein) cholesterol - recognised as a strong risk factor for atherosclerosis (the lower your LDL, the better)

3. HDL (high-density lipoprotein) cholesterol - recognised as a protective factor for atherosclerosis (in general, the higher your HDL, the better)

4. Non-HDL cholesterol (total cholesterol - HDL) - a risk factor for atherosclerosis (the lower your non-HDL cholesterol, the better)

In general, a cardiologist looks mainly at the values of your LDL and HDL cholesterol. Typically, they would advise keeping your LDL cholesterol as low as practically possible. Ideally, less than 2.5mmol/L if you have no other risk factors, but if you’ve had a previous heart attack or diabetes and hypertension, a much lower target may be suggested (ideally <1.4mmol/L).

There are emerging sensitive markers of premature atherosclerosis. One such marker is “lipoprotein little a”, also written as Lp(a). This is essentially a protein which is similar to LDL, but with an extra protein attached, called apolipoprotein (a). This makes Lp(a) more prone to causing inflammation in the arteries, leading to premature atherosclerosis.

Although there’s no current treatment to reduce Lp(a), elevated levels mean you might need to double down on reducing other risk factors for premature atherosclerosis – keeping your blood pressure, sugar metabolism, and LDL cholesterol in the optimal ranges, with a lower threshold to starting cholesterol treatment.