What Should Your Cholesterol Be? UK Levels Explained Simply
By OffShift · 10 min read Last Updated: April 2026
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Quick Summary
- Total cholesterol should be under 5.0 mmol/L (NHS Health Check target)
- Non-HDL cholesterol (the number NICE now focuses on) should be under 4.0 mmol/L
- LDL ("bad") should be under 3.0 mmol/L — lower if you've got other risk factors
- HDL ("good") should be above 1.0 for men, 1.2 for women — higher is better
- Your TC:HDL ratio matters more than your total number alone — aim for under 4.5
Most UK cholesterol advice online is written in American units (mg/dL). The NHS uses mmol/L. If your blood test comes back with numbers that don't match what you read online, you're probably looking at US figures. This guide uses UK units throughout and reflects the 2023 NICE guideline update.
Short Answer: For UK adults, total cholesterol should be under 5.0 mmol/L, non-HDL under 4.0 mmol/L, LDL under 3.0 mmol/L, and HDL above 1.0 (men) or 1.2 (women). NICE now recommends non-HDL cholesterol as the primary measure rather than total cholesterol. Your ratio of total to HDL matters more than any single number. If any of your numbers are off, diet and exercise can usually fix it in 3 months without statins.
UK vs US Cholesterol Units
If you search "cholesterol levels" online, most of the results use American units — mg/dL. The NHS uses mmol/L. The numbers look very different:
| Measurement | UK (mmol/L) | US (mg/dL) |
|---|---|---|
| Total cholesterol (healthy) | Under 5.0 | Under 200 |
| LDL (healthy) | Under 3.0 | Under 100 |
| HDL (healthy — men) | Above 1.0 | Above 40 |
| HDL (healthy — women) | Above 1.2 | Above 50 |
| Triglycerides (healthy) | Under 1.7 | Under 150 |
To convert mg/dL to mmol/L, divide by 38.67 for cholesterol and by 88.57 for triglycerides. Or just ignore US numbers and stick to UK guidance.
What the NHS and NICE Actually Recommend
The NHS Health Check (available free to adults 40–74) uses these thresholds:
- Total cholesterol under 5.0 mmol/L
- HDL above 1.0 mmol/L for men, above 1.2 mmol/L for women
- LDL under 3.0 mmol/L
- Triglycerides under 1.7 mmol/L (fasting)
- Total cholesterol to HDL ratio under 4.5
In 2023, NICE updated its guidance (NG238) to shift focus from total cholesterol to non-HDL cholesterol — which is total cholesterol minus HDL. Non-HDL captures all the "bad" types together, which is a better predictor of cardiovascular risk than LDL alone.
Non-HDL target: under 4.0 mmol/L for primary prevention.
If you've already had a heart attack or stroke, or you're on a statin, the targets are lower (LDL under 2.0 mmol/L, non-HDL under 2.6 mmol/L).
What Each Number Actually Means
Total Cholesterol
The sum of all cholesterol types in your blood. Useful as a screening number but not enough on its own. Two people with the same total cholesterol can have very different heart risk depending on their HDL and LDL ratios.
LDL (Low-Density Lipoprotein)
"Bad" cholesterol. LDL carries cholesterol from the liver into the bloodstream, where it can build up on artery walls. Higher LDL = higher risk.
Target: under 3.0 mmol/L for primary prevention, under 2.0 mmol/L if you're high risk.
HDL (High-Density Lipoprotein)
"Good" cholesterol. HDL carries cholesterol out of the bloodstream back to the liver for removal. Higher HDL = lower risk, up to a point.
Target: above 1.0 mmol/L for men, above 1.2 mmol/L for women. Above 1.5 is excellent. Above 2.0 may actually lose its benefit — some research suggests very high HDL isn't protective.
Non-HDL Cholesterol
Total cholesterol minus HDL. Captures all the "bad" types (LDL, VLDL, IDL) in one number. The new NICE primary measure.
Target: under 4.0 mmol/L.
Triglycerides
A different type of fat in your blood. Elevated triglycerides usually respond well to weight loss, reducing alcohol, cutting sugar, and increasing omega-3 intake.
Target: under 1.7 mmol/L (fasting). Above 2.3 mmol/L is considered high risk.
Total Cholesterol to HDL Ratio (TC:HDL)
Calculated by dividing total cholesterol by HDL. Often more useful than individual numbers.
Target: under 4.5. Above 6.0 is high risk.
What's Normal for Your Age?
UK averages by age group (from Health Survey for England data):
| Age | Average Total Cholesterol | Average HDL |
|---|---|---|
| 16–24 | 4.2 mmol/L | 1.4 mmol/L |
| 25–34 | 4.8 mmol/L | 1.3 mmol/L |
| 35–44 | 5.3 mmol/L | 1.3 mmol/L |
| 45–54 | 5.5 mmol/L | 1.4 mmol/L |
| 55–64 | 5.4 mmol/L | 1.4 mmol/L |
| 65+ | 5.0 mmol/L | 1.4 mmol/L |
"Average" doesn't mean "healthy" — average UK cholesterol is above the target level because most people don't meet the target. Don't compare yourself to the average. Compare to the target.
Reality Check: The 40% Problem
About 40% of UK adults have total cholesterol above 5.0 mmol/L. That doesn't mean 40% need a statin — it means the current UK diet and lifestyle is quietly pushing most people toward cardiovascular risk they're unaware of.
The good news: most mild-to-moderately raised cholesterol responds well to three changes — cutting saturated fat, increasing soluble fibre, and doing something active most days. We've seen people drop their total cholesterol by 0.8–1.2 mmol/L in 12 weeks with those changes alone, no medication. The trick is consistency, not drastic action. Eight habits done 90% of the time beats 20 done for a fortnight.
When to Worry (and When Not To)
| Your Number | Total Cholesterol | Action |
|---|---|---|
| Under 4.0 mmol/L | Excellent | Keep doing what you're doing |
| 4.0–5.0 mmol/L | Healthy | Maintain diet, stay active |
| 5.0–6.5 mmol/L | Mildly raised | Diet and exercise changes first |
| 6.5–7.8 mmol/L | Moderately raised | GP appointment, lifestyle changes, possibly medication |
| Above 7.8 mmol/L | High | GP appointment — may indicate familial high cholesterol |
Familial hypercholesterolaemia (FH) affects about 1 in 250 people in the UK and runs in families. If your total cholesterol is above 7.5 mmol/L or LDL above 4.9 mmol/L, especially if family members have had heart attacks under 60, ask your GP about FH.
What Raises Your Cholesterol
- Saturated fat — butter, fatty meat, full-fat dairy, coconut oil
- Trans fats — processed baked goods, some margarines (mostly banned in UK)
- Lack of exercise — particularly raises triglycerides and lowers HDL
- Being overweight — especially visceral fat
- Smoking — lowers HDL significantly
- Excess alcohol — raises triglycerides
- Genetic factors — familial hypercholesterolaemia, APOE variants
- Thyroid underactivity — can raise cholesterol and is treatable
- Some medications — some diuretics, beta-blockers, steroids
What Lowers Your Cholesterol
- Soluble fibre — oats, beans, lentils, apples (aim for 25–30g fibre daily)
- Plant sterols — Benecol, Flora ProActiv, and similar fortified products
- Oily fish — 2 portions per week (salmon, mackerel, sardines)
- Nuts — unsalted, about a handful daily
- Olive oil — in place of butter where possible
- Exercise — 150 minutes per week moderate activity
- Weight loss — if overweight
- Less alcohol — especially for triglycerides
Most of the above can drop your cholesterol 10–15% within three months. That's often enough to avoid statins for mild cases.
If you can't eat oily fish twice a week, an omega-3 supplement is a reasonable backup. Nu U Nutrition Omega 3 Fish Oil 1000mg (buy on Amazon) gives 540mg EPA + 360mg DHA per serving — enough to match the effect of the recommended fish intake. It's made in the UK and works out at roughly £5–£8 for a 3-month supply.
Getting Your Cholesterol Tested
Options in the UK:
- NHS Health Check — free for 40–74-year-olds, every 5 years
- NHS opportunistic testing — if you ask your GP, especially with symptoms or family history
- Private tests — Medichecks, Thriva, Forth offer lipid panels from around £29
- Pharmacy tests — Boots and some Superdrug branches offer cholesterol tests in-store
If you're under 40, the NHS won't routinely test your cholesterol unless you have symptoms or family history. Private tests are worth it for anyone with a family history of heart disease or who just wants to know their baseline.
Sources & Further Reading
- NHS — High cholesterol
- NICE NG238 — Cardiovascular disease: risk assessment and reduction
- British Heart Foundation — Cholesterol
- Heart UK — Understanding your cholesterol test
Related Articles
- Blood Test Results Explained: The Complete UK Guide
- Medichecks vs Thriva vs Forth: Honest Review 2026
- How to Get a Blood Test Without Your GP
- Cheapest Private Blood Tests in the UK
Frequently Asked Questions
Is 5.2 mmol/L cholesterol bad?
It's slightly above the NHS target of 5.0 mmol/L but not dangerous on its own. Look at the rest of your lipid panel — if your HDL is high (above 1.4) and your LDL is under 3.0, a total of 5.2 may be fine. If your LDL is high or your HDL is low, it's worth making diet and lifestyle changes.
What's the difference between LDL and non-HDL cholesterol?
LDL is one specific type of "bad" cholesterol. Non-HDL is all the bad types combined (LDL, VLDL, IDL). Non-HDL is calculated by subtracting HDL from total cholesterol and is the measure NICE now uses as the primary target because it captures more of the risk.
Can I lower my cholesterol without statins?
For most people with mildly raised cholesterol (5.0–6.5 mmol/L), yes — diet and lifestyle changes can drop it 10–15% in 12 weeks. For higher numbers or people with existing heart disease, medication is often needed alongside lifestyle changes. Always discuss with your GP before stopping or refusing medication.
How quickly does cholesterol drop with diet changes?
You can see meaningful changes in 6–12 weeks with consistent diet changes. Full benefit usually takes 3–6 months. Adding soluble fibre (oats, beans) and plant sterols (Benecol, Flora ProActiv) tends to show faster results than cutting saturated fat alone.
Should I fast before a cholesterol test?
Most UK labs now do non-fasting lipid panels, which are accepted by NICE. Fasting is only required if your GP specifically asks for fasting triglycerides or glucose tests. Check with whoever ordered the test.
What cholesterol level is "too high" and needs treatment?
Generally, total cholesterol above 7.5 mmol/L or LDL above 4.9 mmol/L triggers a GP review for possible medication, regardless of other factors. Below that, the decision depends on your overall cardiovascular risk — age, blood pressure, family history, smoking, diabetes. Your GP calculates this using a QRISK score.
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult your GP before making changes to your diet, exercise routine, or health management.
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