New Guidelines for Cholesterol Testing and Management in General Practice

Managing cholesterol is important for preventing heart disease and stroke. The 9th Edition of the Guidelines for Preventive Activities in General Practice gives clear advice on when to test cholesterol and how to manage high levels. Here’s what you need to know in simple terms.

When Should Cholesterol Be Tested?

For Most Adults:
- Cholesterol checks should start at age 45 for men and women.
- A blood test is needed every five years unless other health concerns exist.
- The test includes total cholesterol, “bad” cholesterol (LDL-C), “good” cholesterol (HDL-C), and triglycerides (TGs).
- Fasting before the test is important if triglycerides need to be checked.
For Aboriginal and Torres Strait Islander People:
- Cholesterol checks should start earlier, at age 35, as the risk of heart disease is higher.

If test results are abnormal, a second test should be done on a different day to confirm.

Who Is at Risk?

Doctors group patients into three risk levels based on their chances of developing heart disease in the next 5 to 10 years. Each group has different recommendations:

1. Low Risk (<10% chance of heart disease):

Focus on healthy lifestyle changes (like diet and exercise).
Get cholesterol checked every five years.

2. Moderate Risk (10–15% chance of heart disease):

Make stronger lifestyle changes and check cholesterol every two years.
If cholesterol remains high after six months, doctors may prescribe medication like statins, especially if you have a family history of heart problems or come from certain backgrounds (e.g., Aboriginal, South Asian, or Pacific Islander).

3. High Risk (>15% chance of heart disease or certain health conditions):

People with diabetes (especially over 60), kidney disease, very high blood pressure, or extremely high cholesterol fall into this group.
Doctors will immediately start cholesterol-lowering medications, along with advice on lifestyle changes.
Cholesterol should be tested every year.

If You Already Have Heart Disease:

Regular follow-up and medications are essential.
Cholesterol checks are done yearly.

How to Lower Cholesterol

1. Lifestyle Changes

Everyone, no matter their risk level, should work on healthy habits:

Eat well: Avoid too much saturated fat and salt.
Stay active: Aim for 30 minutes of exercise most days.
Watch your weight: Keep your waist size below 94 cm for men or 80 cm for women and your BMI under 25.
Quit smoking: This greatly lowers heart disease risk.
Drink less alcohol: Men should stick to 2 drinks a day or less, and women should drink 1 drink or less.

2. Medications

If lifestyle changes aren’t enough or your risk is high, medications like statins can help. These aim to:

Lower total cholesterol below 4.0 mmol/L.
Reduce LDL (“bad” cholesterol) to less than 2.0 mmol/L.
Raise HDL (“good” cholesterol) above 1.0 mmol/L.
Keep triglycerides under 2.0 mmol/L.

Your doctor will decide the best treatment based on your health and risk factors.

Special Points to Remember

Screening for Cholesterol: Some quick tests (like finger-prick samples) can give a rough idea, but full blood tests are needed to confirm results.
Other Health Problems: If you have diabetes, kidney disease, or high blood pressure, you’ll need cholesterol checks yearly because these conditions increase heart risk.

Why It Matters

By following these guidelines, you and your doctor can catch high cholesterol early and take steps to lower your risk of heart disease and stroke. Simple lifestyle changes, regular check-ups, and medication when needed can make a big difference.

Sources:

RACGP, Red Book, https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Red%20Book/Guidelines-for-preventive-activities-in-general-practice.pdf, last accessed 27.11.24.