Essential Heart Health Check

UK NHS targets for cardiovascular risk prevention are: total cholesterol below 5.0 mmol/L; LDL below 3.0 mmol/L for primary prevention, and below 1.8 mmol/L (or at least 50% reduction from baseline) for high-risk individuals or those with established cardiovascular disease; HDL above 1.0 mmol/L in men and above 1.2 mmol/L in women; triglycerides below 1.7 mmol/L. Non-HDL cholesterol targets are typically 0.8 mmol/L higher than the corresponding LDL target. These are population-level benchmarks; your physician report will assess your individual risk profile, accounting for blood pressure, family history, smoking, diabetes, and other factors.

LDL (low-density lipoprotein) is the most atherogenic form — it penetrates arterial walls, oxidises, triggers inflammation, and forms plaques that can rupture and cause heart attacks or strokes. However, LDL alone is an imperfect measure because different people carry very different amounts of cholesterol within each LDL particle. ApoB, which counts the actual number of LDL particles, is more predictive of events than LDL cholesterol content, particularly in those with metabolic syndrome. Non-HDL cholesterol — which captures VLDL, IDL, and Lp(a) in addition to LDL — provides a more complete atherogenic picture than LDL alone within the standard lipid panel.

For many people, dietary changes alone can meaningfully reduce LDL by 10 to 20%. The most impactful dietary strategies include: replacing saturated fats (butter, cheese, fatty meat, coconut oil) with unsaturated fats (olive oil, nuts, oily fish); increasing soluble fibre (oats, beans, lentils, apples) which binds cholesterol in the gut; adding plant sterols and stanols (found in enriched spreads and some yoghurts); losing weight if overweight (particularly visceral fat); reducing refined carbohydrates and added sugar (to lower triglycerides and raise HDL); and moderating alcohol intake. For those with familial hypercholesterolaemia or high cardiovascular risk, medication is usually required alongside dietary changes.

Non-HDL cholesterol is calculated as total cholesterol minus HDL. It encompasses all atherogenic lipoprotein fractions — LDL, VLDL (which carries triglycerides), IDL, and Lp(a) — giving a more complete picture of atherogenic burden than LDL alone. It does not require the sample to be fasted (unlike calculated LDL), though fasting is still recommended for accurate triglyceride measurement. UK NICE guidelines recommend non-HDL as the preferred cholesterol target for cardiovascular risk management, particularly in people with diabetes or those being treated with statins.

hsCRP (high-sensitivity CRP) measures very low levels of C-reactive protein that reflect chronic low-grade vascular inflammation — distinct from the high CRP elevations seen in acute infections. Vascular inflammation is a key driver of atherosclerotic plaque formation and rupture. The JUPITER trial demonstrated that individuals with normal LDL but hsCRP above 2 mg/L had substantially higher cardiovascular event rates and benefited from statin therapy, leading to rosuvastatin being approved for primary cardiovascular prevention in this group. Values below 1 mg/L represent low inflammatory risk; 1 to 3 mg/L moderate risk; above 3 mg/L high risk in the cardiovascular risk context.

For adults with no known cardiovascular risk factors, testing every 2 to 3 years from age 25 is a reasonable baseline monitoring frequency. For those with elevated LDL, a family history of premature cardiovascular disease, diabetes, or hypertension, annual testing is more appropriate. Those on statin therapy or other lipid-modifying treatments should test 3 months after starting or adjusting medication to confirm the response, and then annually once stable. If you are making significant dietary or lifestyle changes, retesting at 3 to 6 months gives meaningful feedback on your cardiovascular response.