Total Cholesterol

Cholesterol is a type of fat present in the blood, which is required for proper body functioning. But high cholesterol can lead to plaque deposits (fat build-up) in the arteries, which can cause narrowing of the arteries, reducing blood supply to organs such as the heart and brain.

A total cholesterol test is a blood test that measures the overall amount of cholesterol circulating in the blood. Commonly, it is also known as a cholesterol test or a serum total cholesterol test. Doctors usually look at this test result together with other lipid tests, mainly to understand whether a person may be at higher risk of heart diseases in the future.2 Lipid testing also helps decide whether follow-up, lifestyle changes, or cholesterol-lowering treatment may be needed, and to monitor progress over time.

In simple terms, a cholesterol test gives a picture of circulating lipids/fats in the blood and helps in understanding the long-term risk of heart diseases. If the total cholesterol is higher than expected, it can suggest a greater chance of health conditions such as heart attack or stroke.

High cholesterol levels usually have no signs or symptoms, so testing is usually based on age or presence of risk factors.

The total cholesterol test is recommended in the following categories of people:

• Healthy adults as a part of routine check-up.
• People with diabetes, high blood pressure, or heart disease.
• Those with a family history of high cholesterol.
• Individuals with obesity or a smoking habit.
• Adolescents between 17-21 years of age.
• Children between 9-11 years of age.

As there are no symptoms of high cholesterol, monitoring depends on age, risk factors etc. following table highlights different health scenarios and the frequency recommended for a serum total cholesterol test.

A cholesterol test itself cannot detect a specific disease or health disorder; it is combined with other lipid tests and risk factors to detect the following conditions:

• Dyslipidaemia/abnormal cholesterol levels- This test helps in detecting dyslipidaemia and guides lifestyle changes, or treatment to reduce the risk of developing heart disease.
• Hypercholesterolaemia or high blood cholesterol.
• Atherosclerosis- Elevated levels of cholesterol can lead to build-up of fats in the arteries, reducing blood flow.
• Risk of Coronary artery disease (CAD)- A condition where arteries supplying blood to the heart are narrowed due to build-up of cholesterol in them.
• Atherosclerotic cardiovascular disease (ASCVD) risk- The likelihood of developing conditions such as heart attack or stroke due to build-up of cholesterol.
• Peripheral artery disease (PAD)-reduced blood flow to the arms or legs due to narrowing of the arteries.

What to Expect Before the Total Cholesterol Test

You must fast for 10 to 12 hours before the test. During the fasting period, drink plain water freely. Avoid all food, milk, tea, coffee, juices, and beverages other than water. Avoid smoking and alcohol for at least 24 hours, as both can falsely elevate triglyceride levels. Avoid strenuous exercise in the 24 hours before the test. Continue your regular medications unless your doctor advises otherwise. Morning appointments are strongly recommended.

What to Expect During the Blood Collection

A phlebotomist cleans the skin with an antiseptic, then places an elastic band around your upper arm to make the veins easier to access. A small needle is inserted into the vein; you may feel a brief pinch. Blood is collected into a labelled tube in under a minute.

What to Expect After the Total Cholesterol Test

A small cotton swab and bandage are placed over the site to stop any minor bleeding. You can eat and drink immediately after the test - have a light meal as soon as possible after the fast. If dizzy, sit and relax for a few minutes.

A cholesterol test measures the following:

• Total cholesterol (TC): Total amount of cholesterol present in the blood.

Usually, this test is done as a part of a lipid panel which includes the low-density lipoprotein (LDL) test (bad cholesterol- high levels increase the risk of heart disease), high-density lipoprotein (HDL) test (good cholesterol- high levels lower the risk of heart disease) and the triglyceride test (high levels suggest increased risk of heart disease).

The normal range for total cholesterol is <200 mg/dL.

The table below provides a general interpretation of cholesterol results:

The total cholesterol level is an indicator of heart disease risk. However, alone this is not a reliable indicator, other factors such as age, smoking, weight, history of hypertension etc, along with additional tests are needed to reach a clinical conclusion.

Potential Risks and Complications:

The serum total cholesterol test is a simple blood test and is generally safe. There can be minor side effects associated with blood sample collection. Some people may experience slight bleeding or pain at the needle insertion site. After blood withdrawal, some people may feel dizzy. However, these effects are usually mild and relieved quickly by themselves.

Limitations:

While the total cholesterol test is an important marker of heart health, it may have some limitations:

• The test alone cannot identify an underlying condition or cause. Therefore, doctors usually recommend a complete lipid profile test to have a better picture.
• Another limitation is that your doctor may recommend 9-12 hours of fasting before the blood sample is taken.
• Also, the test results may be affected by diet, such as consuming a fat-rich diet immediately prior to the test may influence test results.

Along with the total cholesterol test, doctors may recommend additional tests such as the following to confirm a diagnosis or to identify the underlying cause:

• Complete Lipid Profile
• Triglycerides
• Non-HDL-C
• Apolipoprotien B (ApoB) Test- It gives a measure of harmful cholesterol-containing particles present in the blood.
• Lipoprotein(a) [Lp(a)] Test- Genetic marker which can help in assessing the risk of having heart disease in the future.
• Homocysteine and hs-CRP
• Coronary artery calcium (CAC) scan- It helps in assessing this future risk of heart disease.
• A blood pressure routine check.
• Blood glucose testing.

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