Cholesterol Profile (Standard Lipid Panel)#

The clinician reviewed your full lipid profile and risk factors (age, blood pressure, diabetes status, smoking, family history) and concluded that cholesterol-lowering medication is not needed right now.

Recommended approach in the low-risk group is lifestyle improvement, not medication:

• Exercise: 30 minutes of moderate activity at least 5 days per week (brisk walking, cycling, swimming).
• Mediterranean-style eating: plenty of vegetables, fruit, whole grains, legumes, nuts; olive oil instead of butter; fish and lean poultry more often; less red meat and processed food.

A repeat lipid panel in 12 months is the typical follow-up.

A high HDL was traditionally considered protective, but recent evidence is more nuanced. Very high HDL (above 2.5 mmol/L) does not appear to provide additional benefit and may even be associated with increased risk in some studies. Clinicians now focus more on lowering LDL, ApoB, and non-HDL rather than chasing higher HDL. Lifestyle improvements (exercise, weight loss, less refined carbohydrate) raise HDL modestly. There is no medication routinely prescribed to raise HDL.

High triglycerides (above 1.7 mmol/L) usually point to:

• Diet high in refined carbohydrates, sugar, or alcohol
• Excess body weight, particularly abdominal
• Prediabetes or diabetes
• Hypothyroidism
• Some kidney and liver conditions
• Certain medications (steroid pills, some diuretics, hormonal medications, some HIV medications)

Triglycerides above 4.5 mmol/L need careful follow-up because they can affect pancreas health. Triglycerides above 10 mmol/L are a medical urgency - please contact a clinician or urgent care promptly.

Cholesterol levels fluctuate by 5 to 10% even in the same person from week to week. Single measurements can be misleading for several reasons:

• Acute illness, infection, or surgery in the past 6 to 8 weeks can temporarily lower cholesterol.
• Pregnancy raises lipids substantially - screening is generally deferred until at least 3 months postpartum.
• Recent heavy alcohol use raises triglycerides.
• Inadequate fasting (if your lab still asks for fasting) can raise triglycerides.
• Lab variability - the same blood sample tested twice can give slightly different numbers.

Repeat testing in 4 to 12 weeks is reasonable for borderline results before making treatment decisions.

Both. Genetics set the baseline (some people make a lot of cholesterol in the liver regardless of diet), but diet, exercise, weight, and smoking shift the number meaningfully. Most people see LDL changes of 5 to 15% with diet and exercise alone. Familial hypercholesterolemia - an inherited form with very high LDL from childhood - usually requires medication regardless of lifestyle.

Some prescription medications increase cholesterol or triglycerides as a side effect. Common ones:

• Steroid pills (often used for autoimmune diseases)
• Certain antipsychotic medications
• Some immune-suppressing medications used after organ transplant
• Some anti-HIV combination medications
• Certain diuretics ("water pills") and beta-blockers
• Hormonal medications, including some birth-control pills and some testosterone preparations

If you are on one of these and your lipid panel is abnormal, the clinician will weigh whether your other medication can be adjusted, whether cholesterol-lowering treatment is appropriate, or both.

A family history of early cardiovascular disease (heart attack or stroke before age 55 in a male relative or before age 65 in a female relative) raises your risk independently of your current numbers. In this situation:

• Screening earlier than age 40 is reasonable.
• The clinician may use a lower LDL treatment target.
• Consider one-time testing of lipoprotein(a) (Lp(a)) - see the NMR Lipid Profile page.
• Consider screening for familial hypercholesterolemia if your LDL is very high (above 5.0 mmol/L).

ApoB and Lp(a) are advanced lipid measures that the CCS now recommends in specific situations:

• ApoB: considered an alternative to LDL, and may be more accurate in people with high triglycerides, diabetes, or obesity. Some clinicians use ApoB instead of LDL for treatment decisions.
• Lp(a): a genetically determined particle linked to higher heart disease risk. CCS 2021 recommends a once-in-a-lifetime Lp(a) measurement in adults, especially those with a family history of early heart disease. The level is largely set by genetics and does not change much with diet or most medications.

See the NMR Lipid Profile page for more on ApoB, Lp(a), and particle-based testing.

After starting a statin-class medication or other cholesterol-lowering medication, a follow-up lipid panel at 8 to 12 weeks tells your clinician whether the medication is working and at the right dose. Once your numbers are stable on therapy, annual retesting is typically sufficient.

In the past, some clinicians ordered tests as insured (paid by the provincial plan) when strict criteria were not met. Provinces audit clinicians to ensure publicly funded resources are used per the rules. TeleTest follows provincial coverage rules carefully so we can continue offering care. If you do not meet insured-screening criteria, you can pay through TeleTest's partner labs to access the test.

Insured cholesterol screening under provincial plans is typically once every 5 years if you are low risk and well, more often if you have risk factors or are on treatment. If you want more frequent testing, you can pay out of pocket through TeleTest's partner labs at any interval.

Cholesterol rises substantially in pregnancy as part of normal physiology and is not interpretable against standard reference ranges. Routine lipid screening is generally deferred until at least 3 months after delivery (or longer if breastfeeding). If you have a known severe lipid disorder, your obstetrician or maternal-fetal-medicine team will manage that during pregnancy.

Routine cholesterol screening is not recommended in healthy children. However, children with a strong family history of early heart disease or familial hypercholesterolemia should be screened, usually between ages 9 and 11 with a follow-up between 17 and 21. TeleTest does not currently provide pediatric care - please see a family doctor or pediatrician.