PATIENT INFORMATION LEAFLET
Cholesterol testing and heart health
A cholesterol test is one part of understanding your chance of heart attack and stroke.
Reviewed by the Verra Health clinical team · Last reviewed September 2026
What is cholesterol?
Cholesterol is a waxy substance your body uses to build cells and hormones. Too much of certain types can contribute to fatty deposits in artery walls. Triglycerides are another type of blood fat. High levels can add to cardiovascular risk and, when very high, can increase the risk of pancreatitis.
Who should have cholesterol screening?
- Adults over 40 should generally have lipid screening discussed.
- People younger than 40 may need testing if they have diabetes, high blood pressure, kidney disease, smoking, a strong family history, or other cardiovascular risk factors.
- People with a history of heart attack, stroke, peripheral artery disease, or very high cholesterol need an individualized prevention plan.
Canadian Cardiovascular Society guidance also recommends regular cardiovascular risk assessment for adults aged 40 to 75, often about every 5 years, or sooner when health circumstances change.
What do my results mean?
| Measure | Plain-language meaning |
|---|---|
| LDL cholesterol | Often called “bad” cholesterol. Lower is generally better for cardiovascular risk. |
| HDL cholesterol | Often called “good” cholesterol. It is considered alongside the rest of your risk profile. |
| Non-HDL cholesterol | A measure of cholesterol carried by particles that can contribute to plaque. |
| Triglycerides | Another blood fat that can be affected by food, alcohol, diabetes, weight, and some medicines. |
There is no single “good” cholesterol number for everyone. Treatment targets depend on your overall cardiovascular risk and whether you already have vascular disease or another high-risk condition.
Do I need to fast?
Many cholesterol tests can be done without fasting. Follow the instructions from your clinician or laboratory. Fasting may be useful in some situations, including when triglycerides are elevated or when other blood tests require it.
How can I lower cardiovascular risk?
- Choose a heart-healthy eating pattern with vegetables, fruit, legumes, whole grains, nuts, and less highly processed food.
- Be physically active in ways that fit your health and abilities.
- Avoid tobacco and ask for support if you want to stop smoking.
- Limit alcohol and discuss high triglycerides with a clinician.
- Take prescribed medication as directed and do not stop a statin without discussing it first.
When is medication recommended?
Medication may be recommended if your risk of a heart attack or stroke is high, if you have diabetes or chronic kidney disease, or if your cholesterol is very high. The decision takes into account your results, medical history, likely benefit, possible side effects, and what matters to you. A risk calculator can help, but it is only one part of the discussion.
Statins: the usual first treatment
Statins reduce the amount of cholesterol made by the liver, which lowers LDL cholesterol. They are the best-studied medicines for preventing heart attacks and strokes. In clinical trials, lowering LDL by 1 mmol/L was linked with about a 20–22% relative reduction in major cardiovascular events. The actual benefit for you depends on your starting risk: people at higher risk usually have more to gain.
Possible benefits
- Lower LDL cholesterol and plaque-related risk
- Lower chance of heart attack and ischemic stroke
- Strong evidence in people with previous cardiovascular disease and in selected people without it
Possible side effects
- Muscle aches or weakness can occur; serious muscle injury is very rare
- Headache or digestive symptoms
- A small increase in blood sugar or diabetes risk in some people
- Liver blood-test changes are uncommon and usually monitored when indicated
If you develop symptoms: contact the prescriber before making changes. They may review your other medicines, thyroid health, exercise, dose, and timing. A different statin, a lower dose, or taking it less often may be worth trying. Many people who have symptoms with one statin can take another. Seek urgent care for severe muscle pain, marked weakness, or dark urine.
Other treatments if a statin is not right for you
These medicines may be used instead of a statin, or added to the dose of statin you can tolerate. They are prescription treatments, not supplements. The choice depends on your risk, LDL level, other health conditions, pregnancy plans, cost, and drug coverage.
| Option | Potential benefit | Possible side effects and practical points |
|---|---|---|
| Ezetimibe tablet | Reduces cholesterol absorption and usually lowers LDL by about 15–20%. Often used first when a statin is not tolerated or as an add-on. | Usually well tolerated. Possible diarrhea, abdominal symptoms, headache, or muscle symptoms. Cardiovascular outcome evidence is strongest when added to a statin in high-risk patients. |
| Bempedoic acid (Nilemdo) tablet | Works mainly in the liver and lowers LDL without acting on muscle in the same way as statins. It may reduce cardiovascular events in some higher-risk adults who cannot take statins. | It can increase uric acid and the risk of gout. Muscle spasms, liver-test changes, and rare tendon problems are also possible. Medication interactions and kidney or liver health need to be reviewed. |
| PCSK9 inhibitors alirocumab or evolocumab injection | Lower LDL by around 50–60% and reduce cardiovascular events in selected people at high risk. | Injection-site reactions, flu-like symptoms, or allergy can occur. These medicines cost more, and coverage often requires specific criteria or previous treatments. |
| Inclisiran injection | Lowers LDL with an initial dose, a dose at 3 months, then usually twice-yearly dosing. Useful when adherence to regular tablets is difficult. | Injection-site reactions can occur. It lowers LDL, but cardiovascular outcome evidence is still developing; access and coverage vary. |
| Bile-acid sequestrants powder or tablet | Can lower LDL without entering the bloodstream and may be considered in selected patients. | Constipation, bloating, and drug-absorption interactions are common; they may raise triglycerides and are not suitable for everyone. |
Frequently asked questions
When should I have my cholesterol checked?
Cholesterol testing is generally recommended for adults over 40. Younger people may also need a test if they have diabetes, high blood pressure, kidney disease, a strong family history, or other risk factors. A healthcare professional can advise how often you need testing.
Do I need to fast for a cholesterol test?
Many lipid tests can be done without fasting. If your triglycerides are high or another test is being done at the same time, your clinician or laboratory may give you different instructions.
Is LDL cholesterol the only number that matters?
No. LDL, HDL, non-HDL cholesterol and triglycerides are considered along with blood pressure, diabetes, smoking, family history, age, and any previous heart or vascular disease.
Do high cholesterol results always mean I need a statin?
Not always. The decision is based on your overall risk and medical history, not one cholesterol number alone. When medication is recommended, a statin is usually the first choice because it has strong evidence for preventing heart attacks and strokes. Other options may be considered if you cannot tolerate a statin or prefer not to take one.
What if I do not want to take a statin?
Ask how much benefit treatment is likely to offer you, what side effects to watch for, and whether a different dose, a different statin, or another medicine would be reasonable. Ezetimibe, bempedoic acid, and injectable medicines may be options for some people, but their benefits, costs, and coverage are different.
Are muscle symptoms from statins real?
They can happen, but muscle pain may also have another cause. Do not stop the medicine without advice. A healthcare professional can review your other medicines and health conditions, look for other causes, and discuss a different statin or dose.
Review your results
Bring your laboratory report, medication list, family history, blood pressure readings, and questions to an appointment. A clinician can help you understand your overall risk and decide what follow-up is appropriate.
Trusted information
- Heart & Stroke: managing cholesterol
- Canadian Cardiovascular Society: lipid screening and prevention
- Verra Health: understanding A1C results
This leaflet is for general education and does not replace individualized medical advice.