Hypercholesterolaemia or High Cholesterol

High cholesterol is one of the most common health problems seen by doctors and occurs when there is too much cholesterol in the blood. Cholesterol is a waxy substance that is made by the liver and obtained through the diet. It can be found in the fats (lipids) in your blood.[1]

Australian data shows that about one in three adults has a total cholesterol level higher than recommended (above 5.5 mmol/L). High cholesterol is a significant health concern because it increases the risk of heart disease. It accounts for nearly 3% of all illnesses and health problems across the country and plays a role in more than one-third of the overall impact of heart disease.[2]

Cholesterol is however, essential, in order for your body to continue building healthy cells but the level of cholesterol needs to remain within recommended guidelines. This is because it can lead to a build-up of fatty deposits (often called plaque) in your blood vessels, which overtime, can make it harder for your heart to pump blood effectively through your arteries to your heart.[3]

 

What types of cholesterol are there?

There are two main types, often referred to as ‘good’ and ‘bad’ cholesterol.

Good cholesterol (HDL) helps protect your heart. It carries extra cholesterol away from your blood vessels and back to your liver, where it is broken down and removed from your body. Higher levels of HDL are generally a good thing.

Bad cholesterol (LDL) carries cholesterol from your liver to the rest of your body. If there is too much in your blood, it can build up in the walls of your arteries. Over time, this build-up can narrow or block the arteries, increasing your risk of heart attack or stroke.

Keeping your ‘bad’ cholesterol low and your ‘good’ cholesterol healthy is important for looking after your heart.[4]

Triglycerides

According to the Heart Foundation, ‘Triglycerides are the most common fat in the body. Being overweight, eating a lot of high fat and sugary foods, or drinking too much alcohol can increase your triglyceride levels.  High triglycerides, along with either increased LDL cholesterol or decreased HDL cholesterol can increase your chances of developing fatty build-ups in the arteries – and a higher risk of heart attack and stroke’.  [5]

 Lipoprotein(a)

Lipoprotein(a), or Lp(a), is a type of cholesterol particle in your blood. It is similar to ‘bad’ LDL cholesterol, but it has an extra protein attached to it. This extra protein makes Lp(a) stickier and more likely to contribute to plaque build-up in your arteries.

High levels of Lp(a) can:

  • Increase your risk of heart attack
  • Increase your risk of stroke
  • Contribute to narrowing of the aortic valve in the heart

How is it different from other cholesterol?

  • Lp(a) levels are mostly inherited (genetic).
  • Diet and exercise have little effect on Lp(a) levels.
  • It does not usually show up on a standard cholesterol test — it needs a specific blood test that needs to be ordered by your GP.

You may want to discuss Lp(a) testing with your GP if you:

  • Have a family history of early heart disease
  • Have high cholesterol that is difficult to control
  • Have had heart disease at a younger age without obvious risk factors [6]

What are the recommended levels of cholesterol?

According to the CSIRO[7], the range below is an Australian guide for a healthy blood cholesterol level.

  • Total Cholesterol: <4.0 mmol/L (Individuals at high risk) <5.5 mmol/L (General population)
  • Low Density Lipoprotein Cholesterol (LDL): < 1.8mmol/L (Individuals at high risk) < 2.0 mmol/L (General population)
  • High Density Lipoprotein Cholesterol (HDL): > 1.0mmol/L
  • Triglycerides (TG): < 2.0 mmol/L.
  • Lp(a) optimal Lp(a) levels are generally considered to be less than 75 nmol/L or less than 30 mg/dL. This test is done once and will be a lifelong indication of risk.

What are the symptoms of high cholesterol?

There are no symptoms of high cholesterol. The only way to detect it is through a blood test. High cholesterol can be inherited or is the result of unhealthy lifestyle choices. The best way to control high cholesterol is through a healthy diet, regular exercise, and medication.

What are the causes of high cholesterol?

There is no single cause of high cholesterol, but the common risk factors include:[8]

  • Unhealthy diet, particularly one that is high in saturated and trans fats as well as sugar
  • Overweight and obesity
  • Lack of physical exercise
  • Age – cholesterol tends to rise after the age of 20 yrs
  • Smoking
  • Family history

How is high cholesterol diagnosed in Australia?

Your GP will order you a blood test, specifically a lipid profile, which will show your total cholesterol levels. This involves visiting a pathology centre and having blood drawn from your arm. For an accurate reading, you should not eat or drink anything between nine and twelve hours before the sample is taken.

How prevalent is high cholesterol in Australia? 

According to the Australian Bureau of Statistics[9]:

  • One in twelve (8.4% or 2.1 million) people had self-reported high cholesterol in 2022
  • The prevalence of high cholesterol has increased since 2011–12 (6.8%)
  • Almost three in ten (29.0%) people aged 75 years and over had high cholesterol.

How can you lower high cholesterol?

According to the National Heart Foundation[10], there are a number of positive actions that you can take to help lower cholesterol.

Healthy eating

The recommended healthy eating plan is no different than that recommended for all Australians.

According to the CSIRO [11] many years of research has identified the types of foods that will improve cholesterol levels and reduce the risk of heart disease. These are:

  • Cut back on foods high in sugar, salt and unhealthy fats (e.g. cakes, pastries, biscuits, ice-cream, sugary drinks).
  • Include healthy unsaturated fats daily (e.g. olive oil, nuts, seeds, avocado). Aim for a handful of nuts/seeds each day.
  • Eat fish, especially oily fish, 2–3 times per week.
  • Choose fibre-rich wholegrains daily, particularly sources of soluble fibre (e.g. oats, psyllium, legumes).
  • Include soy protein (e.g. soy milk, soy products).
  • Aim for at least 5 serves of vegetables and 2 serves of fruit each day.
  • Consider plant sterol–enriched foods where appropriate such as margarine containing plant sterol.
  • Replace saturated fats with unsaturated fats where possible
  • Reduce your alcohol intake

Physical Activity

Physical activity is recommended as it can help raise HDL or ‘good’ cholesterol and lower triglycerides. The most helpful types of activities are aerobic, cardio and resistance training.

Everyone benefits from regular exercise, and it is one of the best things to do to maintain overall health and well-being. For good health, people should aim for at least 30 minutes of moderate physical intensity activity every day. This means raising the heart rate, breathing harder whilst still being able to hold a conversation.

Examples include brisk walking, cycling, swimming, gardening and water aerobics. Additionally, muscle strengthening exercises such as push-ups, squats, or lifting tasks such as carrying the shopping twice a week are recommended.

Medication

Your GP may suggest taking medication to lower your cholesterol level. The most common type of cholesterol lowering medications are called statins. These medications lower the LDL or ‘bad’ cholesterol level in your blood. They also reduce the risk of heart attack or stroke for people who are at high risk.

It is important that you follow the directions carefully and see your GP regularly.

 

Conclusion

Looking after your heart health doesn’t have to be complicated.

To help prevent heart disease and stroke, it’s important to see your GP regularly and have your cholesterol checked. A simple blood test can show whether your levels are in a healthy range.

If your cholesterol is higher than recommended, small lifestyle changes — such as improving your diet, increasing physical activity, maintaining a healthy weight, and not smoking — can make a big difference.

In some cases, lifestyle changes alone aren’t enough. Your GP may recommend medication to help lower your cholesterol and keep it at a safe level.

Regular check-ups and early action are the best ways to protect your heart and reduce your risk.

 

[1] Victor Chang Cardiac Research Institute website 2026, accessed 23rd February 2026 https://www.victorchang.edu.au/heart-disease/high-cholesterol

[2] Adam J Nelson, Stephen J Nicholls, Managing hypercholesterolaemia, Aus Prescriber 2024;47:7-14, 20th February 2024.

[3] ibid

[4] Author in footnote 1 above

[5] National Heart Foundation website 2026 accessed 23rd February 2026 https://www.heartfoundation.org.au/your-heart/high-blood-cholesterol

[6] Pathology Tests Explained website 2026 accessed 23rd February 2026 https://pathologytestsexplained.org.au/ptests.php?q=Lipoprotein+%28a%29

[7] CSIRO website 2026, accessed 23rd February 2026 https://www.csiro.au/en/research/health-medical/nutrition/Cholesterol-facts#:~:text=Total%20Cholesterol:%20%3C4.0%20mmol/,mmol/L%20(General%20population)

[8] Author in footnote 5 above

[9] Australian Bureau of Statistics website accessed 23rd February 2026 https://www.abs.gov.au/statistics/health/health-conditions-and-risks/high-cholesterol/latest-release#:~:text=stroke%5B1%5D.-,Self%2Dreported%20high%20cholesterol,aged%2075%20years%20and%20over.

[10] Author in footnote 5 above

[11] Author in footnote 7 above