LDL cholesterol (LDL-C)
- What to know
- The main target for nutrition and treatment. Your target level depends on your cardiovascular risk (section 3).
Lab tests and nutrition
Cholesterol and lipid profile
High cholesterol usually causes no symptoms - it is found through a blood test. This page explains what the lipid profile results mean, why each person's target is different and how much nutrition can change the result - based on European clinical guidelines and research.
What the lipid profile shows
The key marker in the lipid profile is LDL cholesterol: this is the value for which European guidelines set targets. The other markers complete the picture and help assess risk more precisely.
| Marker | What to know |
|---|---|
| LDL cholesterol (LDL-C) | The main target for nutrition and treatment. Your target level depends on your cardiovascular risk (section 3). |
| Total cholesterol | A summary value. A very high level is a reason to rule out an inherited form (section 6). |
| HDL cholesterol (HDL-C) | Needed to calculate non-HDL cholesterol |
| Non-HDL cholesterol | Total cholesterol minus HDL. A secondary treatment target; since 2025 it has been used in the SCORE2 risk chart. |
| Triglycerides | There is no separate target. A level below 1.7 mmol/L indicates lower risk; a higher level is a reason to look for other risk factors. |
| Apolipoprotein B (ApoB) | A secondary treatment target; not measured for everyone |
| Lipoprotein(a), Lp(a) | Largely inherited. It is recommended to measure it at least once in adult life. A level above 50 mg/dL (105 nmol/L) is considered a risk-enhancing factor. After menopause Lp(a) may rise, so a repeat measurement is reasonable, especially if it was borderline before. |
Total cholesterol
- What to know
- A summary value. A very high level is a reason to rule out an inherited form (section 6).
HDL cholesterol (HDL-C)
- What to know
- Needed to calculate non-HDL cholesterol
Non-HDL cholesterol
- What to know
- Total cholesterol minus HDL. A secondary treatment target; since 2025 it has been used in the SCORE2 risk chart.
Triglycerides
- What to know
- There is no separate target. A level below 1.7 mmol/L indicates lower risk; a higher level is a reason to look for other risk factors.
Apolipoprotein B (ApoB)
- What to know
- A secondary treatment target; not measured for everyone
Lipoprotein(a), Lp(a)
- What to know
- Largely inherited. It is recommended to measure it at least once in adult life. A level above 50 mg/dL (105 nmol/L) is considered a risk-enhancing factor. After menopause Lp(a) may rise, so a repeat measurement is reasonable, especially if it was borderline before.
Do you need to fast before the test? For most markers the difference is small: after a meal, triglycerides are on average about 0.3 mmol/L higher. With elevated triglycerides, diabetes or metabolic syndrome, calculated LDL should be interpreted with more caution, so it is best to agree the test conditions with your doctor.
Why your target may differ from the "normal range" on the lab report
The laboratory reference range is the same for everyone, but the LDL cholesterol target depends on each person's cardiovascular risk. Your doctor determines the risk category - since 2025 using the SCORE2 chart and other factors.
| Risk category | LDL cholesterol target |
|---|---|
| Low | below 3.0 mmol/L |
| Moderate | below 2.6 mmol/L |
| High | below 1.8 mmol/L and a reduction of at least 50% from baseline |
| Very high | below 1.4 mmol/L and a reduction of at least 50% from baseline |
Low
- LDL cholesterol target
- below 3.0 mmol/L
Moderate
- LDL cholesterol target
- below 2.6 mmol/L
High
- LDL cholesterol target
- below 1.8 mmol/L and a reduction of at least 50% from baseline
Very high
- LDL cholesterol target
- below 1.4 mmol/L and a reduction of at least 50% from baseline
"Baseline" means LDL without cholesterol-lowering medication
So the same result, for example LDL 2.9 mmol/L, may be on target for one person and well above target for another
What nutrition can do
Each of the main measures lowers LDL cholesterol by about 5-10%. When they are combined, the effect is larger: in a meta-analysis of the "Portfolio" diet (7 comparisons, 439 participants with hyperlipidaemia), LDL fell by about 17%, or 0.73 mmol/L. Note that the comparison was with a diet already aimed at lowering cholesterol, and that there are still few studies.
| What to change | Expected LDL reduction | Practical targets |
|---|---|---|
| Avoid trans fats | 5-10% | Hard margarines and foods made with them are best avoided completely |
| Less saturated fat | 5-10% | Less than 10% of calories, and less than 7% if cholesterol is elevated. Replacing saturated fat with polyunsaturated fat at 1% of calories lowers LDL by 0.055 mmol/L on average. |
| More fibre | 5-10% | 25-40 g per day, including at least 7-13 g of soluble fibre. For oat beta-glucan, the dose with a proven effect is 3 g per day; in a meta-analysis of 58 trials it lowered LDL by 0.19 mmol/L (4.2%) on average. |
| Foods with plant sterols and stanols | 7-10% at 2 g per day; about 11% at 3 g | With a main meal; the effect appears within 2-3 weeks. The effect on cardiovascular events has not yet been studied. |
| Reduce excess body weight | 5-10% | Gradually, at a pace you can realistically maintain |
| Less dietary cholesterol | less than 5% | Up to 300 mg per day |
| More physical activity | less than 5% | Has a greater effect on triglycerides and HDL |
Avoid trans fats
- Expected LDL reduction
- 5-10%
- Practical targets
- Hard margarines and foods made with them are best avoided completely
Less saturated fat
- Expected LDL reduction
- 5-10%
- Practical targets
- Less than 10% of calories, and less than 7% if cholesterol is elevated. Replacing saturated fat with polyunsaturated fat at 1% of calories lowers LDL by 0.055 mmol/L on average.
More fibre
- Expected LDL reduction
- 5-10%
- Practical targets
- 25-40 g per day, including at least 7-13 g of soluble fibre. For oat beta-glucan, the dose with a proven effect is 3 g per day; in a meta-analysis of 58 trials it lowered LDL by 0.19 mmol/L (4.2%) on average.
Foods with plant sterols and stanols
- Expected LDL reduction
- 7-10% at 2 g per day; about 11% at 3 g
- Practical targets
- With a main meal; the effect appears within 2-3 weeks. The effect on cardiovascular events has not yet been studied.
Reduce excess body weight
- Expected LDL reduction
- 5-10%
- Practical targets
- Gradually, at a pace you can realistically maintain
Less dietary cholesterol
- Expected LDL reduction
- less than 5%
- Practical targets
- Up to 300 mg per day
More physical activity
- Expected LDL reduction
- less than 5%
- Practical targets
- Has a greater effect on triglycerides and HDL
If your triglycerides are elevated. Cutting down on alcohol has the strongest effect - more than 10%. Physical activity, reducing excess weight and eating fewer carbohydrates, especially sugars, also help. Added sugar - no more than 10% of calories. Moderate alcohol intake (up to 10 g per day) is acceptable only if triglycerides are normal.
What this looks like on your plate:
- More often: wholegrain foods, lean and oily fish, skinless poultry, skimmed milk and yoghurt; grill, boil or steam
- In moderation: olive oil and other non-tropical vegetable oils, unsalted nuts, low-fat dairy and cheese, eggs, white bread, rice and pasta; stir-fry with a little oil, roast
- Occasionally and in small amounts: regular cheese, cream, whole milk, butter, palm and coconut oil, sausages, bacon, organ meats, pastries and croissants; fry
You do not need to change everything at once. A few changes you can keep up for a long time are more useful than a perfect two-week plan.
About supplements. The updated ESC/EAS 2025 guidelines do not recommend supplements or vitamins without documented safety and a significant LDL-lowering effect. Red yeast rice has been reported to lower cholesterol, but there is no convincing evidence of clinical benefit.
Nutrition and medication
If your doctor has prescribed cholesterol-lowering medication, nutrition works together with it, not instead of it. For example, European guidelines consider foods with plant sterols as an addition to drug therapy when the target has not been reached.
Do not stop your medication or change the dose on your own, even if your results improve after changing your diet. That decision belongs to your doctor; I help you build a way of eating that supports your treatment.
When to see a doctor straight away
In these situations changing your diet alone is not enough - you need a medical assessment
Familial (inherited) hypercholesterolaemia is possible if:
- total cholesterol is 8 mmol/L or higher without treatment - in you or an adult relative;
- you or close relatives had early coronary heart disease - men before 55, women before 60;
- you or a relative have tendon xanthomas (thickenings on the tendons);
- there has been sudden cardiac death at a young age in the family
Very high triglycerides. The risk of pancreatitis becomes clinically significant above 10 mmol/L, but pancreatitis is also possible at 5-10 mmol/L. Discuss such a result with your doctor straight away.
How I can help
In a consultation I review your lipid profile together with your other test results, your current diet and your daily routine. Together we choose the changes that will have the greatest effect in your situation and that you can manage in everyday life.
50-60 minutes in Zoom · €100 · 10 days of support · 20-minute follow-up included
Request an online consultationLab test list before the consultation
The list of tests used when preparing for a consultation, together with recommendations for blood sampling. The final set depends on the specific situation and the patient's health condition.
Lipid metabolism - the focus of my research
In my doctoral research I study dairy polar lipids and blood lipid profiles in perimenopausal women. One of the papers was published in Nutrients in 2026.
That is why in consultations I rely on research data and current guidelines rather than general advice, and I say honestly where the evidence is still insufficient