What is total Cholesterol?
Cholesterol is a building block. Your body uses it for cell membranes, hormones and bile, and your liver makes most of it itself; what you eat supplies only a small part. Because fat does not dissolve in blood, cholesterol travels packed in lipoproteins, spheres of protein and fat, and which particle carries it decides what it does. LDL brings cholesterol to the tissues and the artery wall; HDL takes it away again and brings it back to the liver. Total cholesterol adds everything together, whichever particle it was in. Your report shows the total as one number in millimoles per litre (mmol/L). It is the cholesterol number people remember from years ago, but it is a sum that adds two opposite things together. Two people with the same total can have very different risks: one because the LDL is high, the other because the HDL is high. That is why the total says little on its own and you look at the parts. It is also why labs handle it differently: some publish what healthy people measure, by age and sex, others print a single agreed limit. The table further down shows the difference.
Why is total Cholesterol relevant?
The total matters because most of it is cholesterol in LDL particles, and those are the cause of atherosclerosis. A high total is therefore usually a high LDL, and then everything on the LDL page applies: you feel nothing, the damage adds up over years, and lower is better. But the total can also be high because of a high HDL, and that is favourable. From the number alone you cannot tell which of the two it is. That is why nobody steers by the total any more. There is no target for it in the Netherlands; the risk estimate uses total minus HDL, non-HDL cholesterol, because that holds exactly the cholesterol that builds up in the artery wall. What remains of the total are two limits: above 5 mmol/L non-fasting blood counts as abnormal, and above 8 mmol/L a very high cholesterol counts as a severe risk factor in its own right.
Total Cholesterol decision limits
What the total alone cannot show:
These two limits are all the Dutch guideline still attaches to the total, each with its own meaning: the first for a non-fasting draw, the second for weighing risk factors. There is no target for the total, because it counts HDL in; the risk estimate uses total minus HDL.
What Dutch labs actually use
The ceiling is 5 at Certe, 5.0 at Star-shl and 5.2 at Clinical Diagnostics, and runs from 5.8 to 7.8 at Unilabs; only the Unilabs one shifts with age and sex and so describes a measured distribution.
0 – 6.9mmol/L
At Unilabs this is normal. Star-shl, Certe and Clinical Diagnostics publish a limit, not a range; they are listed below.
these 1 labs call 0 – 6.9 mmol/L normal. Outside that range these 1 labs call it abnormal.
Every age, per lab
| Laboratory | Group | Reference range |
|---|---|---|
| Unilabs(Saltro, Medlon, SHO, Atalmedial)2026 | Men up to 19 yrs | 0-5.8 mmol/L |
| Men 20-29 yrs | 0-6.7 mmol/L | |
| Men 30-39 yrs | 0-7.4 mmol/L | |
| Men 40-115 yrs | 0-7.8 mmol/L | |
| Women up to 19 yrs | 0-6.0 mmol/L | |
| Women 20-29 yrs | 0-6.7 mmol/L | |
| Women 30-39 yrs | 0-6.9 mmol/L | |
| Women 40-115 yrs | 0-7.7 mmol/L | |
| Star-shl2026 | All adults | 0 - 5.0 mmol/LDecision limit |
| Certe2026 | Men from 18 yrs | < 5 mmol/LDecision limit |
| Women from 18 yrs | < 5 mmol/LDecision limit | |
| Clinical Diagnostics2026 | All adults | < 5.2 mmol/LDecision limit |
Each band as the lab publishes it, retrieved in 2026, unless marked otherwise.
Total Cholesterol high or low: what it means
A high total usually comes from a high LDL fraction, and that from what you eat, how much you weigh and what you were born with. Saturated fat from fatty meat, butter, full-fat dairy, biscuits and pastry is the biggest lever; excess weight and little exercise add to it, and how much your liver produces and clears again is partly inherited. Cholesterol in food itself, as in eggs and prawns, counts far less than people think: your liver adjusts its own production to it. Saturated fat does the opposite and sets the liver to making more LDL, which is why butter weighs more than an egg. An underactive thyroid can raise the total too. A total above 8 mmol/L, especially from a young age or with cardiovascular disease running young in the family, fits familial hypercholesterolaemia. Sometimes a high total comes from a high HDL, and then nothing is wrong. A low total is usually simply healthy: anyone who eats plant-based and fibre-rich, is lean and exercises often has a low LDL and so a low total. Sometimes it is cholesterol-lowering medication, and sometimes a low HDL, which is a different situation. You bring it down through the LDL. Olive oil instead of butter, nuts and oily fish instead of fatty meat and processed meat, more fibre from oats, legumes, vegetables and fruit, losing weight if you carry too much and moving every day. For most people without an inherited condition that is enough, and you see it back in your blood within weeks to months. With an inherited high cholesterol or existing cardiovascular disease, lifestyle remains the foundation and medication usually joins it. Always look at the parts: LDL and non-HDL say what ends up in the artery wall, HDL and triglycerides show the metabolic pattern. And read the total as a trend: one measurement is a snapshot.
What lowers it
Usually simply healthy, sometimes treatment.
| Cause | How often |
|---|---|
| Plant-based and fibre-rich eating, a healthy weight, plenty of exerciseThe ordinary outcome of a healthy lifestyle; there is no floor | Often |
| Lipid-lowering medicationThe total falls along with the LDL fraction | Often |
What raises it
A sum that rises by two routes.
| Cause | How often |
|---|---|
| A high LDL fractionThe fraction that enters the artery wall and that treatment steers by | Often |
| A diet high in saturated fatFatty meat, butter, full-fat dairy, biscuits and pastry; olive oil, nuts and oily fish in their place lower LDL | Often |
| A high HDL fractionThe total simply counts HDL in, so that lifts it too | Sometimes |
| Familial hypercholesterolaemiaInherited; the total is then markedly high from a young age and cardiovascular disease often runs young in the family | Rare |
How does a total Cholesterol blood test work?
- Referral
- Not needed. You can have total cholesterol measured without going through a doctor first.
- Fasting
- Not needed. Cholesterol barely changes with a meal; the ordinary fat profile is drawn non-fasting.
- The draw
- One tube of blood from a vein in your arm, usually at the inner elbow. We measure cholesterol from a vein; we do not use a finger prick.
- The result
- A single number in millimoles per litre (mmol/L), next to the reference value your lab uses. Usually available within 24 hours.
- Measured together
- Total cholesterol is measured in one go with HDL, LDL and triglycerides. Total minus HDL gives the non-HDL cholesterol your risk is estimated with.
- Which test
- Total Cholesterol is in the Heart health test (€69) and in .
- Where to draw
- You can draw at 250+ locations near you, no referral needed. See the locations
Frequently asked questions
What is cholesterol?
Cholesterol is a fat-like substance your body needs for your cell membranes, your hormones and your bile. Your liver makes most of it itself. Because fat does not dissolve in blood, cholesterol travels packed in particles, and those particles differ. Total cholesterol adds everything together, whichever particle it was in.
What is a normal total cholesterol level?
That depends on your lab, because labs do not publish the same kind of number. Some print what healthy people measure, rising with age and sex; most name a single limit around 5 mmol/L for every adult. More important than the total are the parts: LDL and non-HDL.
What does a high total cholesterol mean?
Usually that your LDL is high, and then: you feel nothing, the damage in the artery wall adds up over years, and lower is better. But the total counts your HDL in too, so it can also be high without anything being wrong. So look at LDL and non-HDL, the total minus HDL. Above 8 mmol/L a very high cholesterol is a severe risk factor in its own right.
What does a low total cholesterol mean?
Just as little as a high total, and for the same reason: HDL counts in. Usually a low total is simply a low LDL from food and exercise, or the effect of medication, and that is favourable. It can also be a low HDL, and that is a different situation. Look at the separate fractions.
How do I lower my total cholesterol?
By lowering your LDL: olive oil instead of butter, nuts and oily fish instead of fatty meat and processed meat, more fibre from oats, legumes, vegetables and fruit, losing weight if you carry too much and moving every day. For most people without an inherited condition that is enough; with an inherited high cholesterol or existing cardiovascular disease, medication usually joins it.
Should I give up eggs?
For most people, no. Cholesterol from food reaches your blood only to a limited extent, because your liver adjusts its own production to it. Saturated fat does the opposite: it sets the liver to making more LDL. That is why the butter you fry the egg in weighs more than the egg itself, and why fatty meat, full-fat dairy and pastry count more than eggs or prawns.
Is there a target for total cholesterol?
No, not any more. Treatment steers by LDL, with non-HDL cholesterol as an equally valid target, because that holds exactly the cholesterol that builds up in the artery wall. For the total two limits remain: above 5 mmol/L abnormal in non-fasting blood, and above 8 mmol/L a severe risk factor.
Why does the upper limit differ so much per laboratory?
Because most labs print an agreed limit and some print what healthy people measure. At Unilabs the ceiling rises with age, from 5.8 mmol/L in young men to 7.8 mmol/L from age forty, because cholesterol rises over the years. The others name one number for every adult.
What happened to the cholesterol ratio?
The ratio of total to HDL is no longer used in the Dutch risk estimate. Since 2024 it uses non-HDL cholesterol, the total minus HDL, because that holds the cholesterol of all the harmful particles and can be measured non-fasting. If the ratio still appears on your report, non-HDL is the number to look at.
Which tests include total Cholesterol?
Total Cholesterol is in the Heart health test (€69, also as an add-on for €39), in the comprehensive test (€229) and in .
Related biomarkers
Read on
Sources
- 1.CVRM, Dutch multidisciplinary guideline on cardiovascular risk management, module on estimating cardiovascular risk. 2024. richtlijnendatabase.nl
- 2.CVRM, summary of the guideline on cardiovascular risk management. 2024. richtlijnendatabase.nl
- 3.CVRM, module on lipid-lowering treatment and LDL-C targets in (frail) older people above 70. 2024. richtlijnendatabase.nl
- 4.CVRM, module on fasting versus non-fasting sampling. 2018. richtlijnendatabase.nl
- 5.CVRM, module on diet. 2018. richtlijnendatabase.nl
- 6.Unilabs, test catalogue (Dutch): cholesterol. 2026. bepalingenklapper.nl
- 7.Star-shl, test catalogue (Dutch): cholesterol. 2026. star-shl.nl
- 8.Certe, test catalogue (Dutch): cholesterol. 2026. bepalingenwijzer.certe.nl
- 9.Clinical Diagnostics, lab guide (Dutch): cholesterol and ratio. 2026. clinicaldiagnostics.nl
Educational information only, not medical advice. Consult a healthcare professional for clinical decisions.
Read about our scientific approachShare