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Cardiovascular Health
Half of Sri Lankan adults have never had their cholesterol checked
A man of forty sits down with his first lipid report. Total cholesterol 214 mg/dL. LDL 142. Nothing hurts, nothing has ever hurt, and that is precisely why nobody suggested the test until now.
About half of Sri Lankan adults have never had this measured at all. Of those who have, nearly half were already raised. Cholesterol produces no symptom at any level, so it is found by measuring or it is not found at all.
The numbers most people here have never seen
Four findings from Sri Lankan data, read together.
- Half of adults have never had a cholesterol test. Nearly half of those tested were already raised.
- 35.6% of adults in Western Province are pre-diabetic. A further 27.8% already have diabetes. Most feel entirely well.
- Among adults in their thirties, undiagnosed hypertension outnumbers diagnosed hypertension roughly six to one.
- Ischaemic heart disease causes 13.6% of hospital deaths and has been the leading cause for most of the past decade.
The disease is common. The measurement is not. That gap is not a knowledge problem, because every one of these tests is available in Colombo for the price of a restaurant meal; it is a problem of nobody being asked to take the test until something has already happened.
What the panel actually measures
A lipid profile is one blood sample reporting several values.
- LDL cholesterol. Carries cholesterol into the artery wall, where excess accumulates over decades.
- HDL cholesterol. Moves cholesterol back towards the liver.
- Triglycerides. Reflect diet, alcohol and how the body handles sugar.
- Total cholesterol. The sum of the parts, and the least useful figure on the page.
- Non-HDL cholesterol. Total minus HDL. Captures every particle capable of contributing to plaque.
Why a normal result is not the same as a good one
A reference range describes what is common in the population that range was built from. It does not describe what is ideal for the person holding the report. Sitting inside the range means resembling the reference population, nothing more.
That distinction matters more here, because most widely used ranges were built on European populations. The WHO Asia-Pacific review placed the point at which cardiometabolic risk begins to rise at a BMI of 23, not 25. The International Diabetes Federation sets abdominal-risk waist limits at 90 cm for men and 80 cm for women, below the European figures. A South Asian body reaches the same risk at a lower number.
So "not flagged" and "optimal" are two different statements about the same report.
Total cholesterol is the weakest number on the page
Most people remember one figure from their last test. It is usually the total, and the total combines particles that raise risk with particles that do not.
Non-HDL is better, because it counts everything capable of building plaque. Apolipoprotein B is better still. Each plaque-forming particle carries exactly one ApoB molecule, so ApoB counts particles rather than the cholesterol they are carrying, and two people with an identical LDL can have quite different particle counts sitting behind it.
ApoB is not on a standard Sri Lankan lipid panel. It has to be asked for by name.
How often it should be measured
There is no single interval that fits everyone, and anyone offering one without knowing a history is guessing. What reasonably changes the answer: age, blood pressure, smoking, waist circumference, diabetes or pre-diabetes, and a parent or sibling with early heart disease.
One point is firmer than any interval. A single value gives a position. Repeated values give a direction, and direction is the more useful of the two, because a stable LDL of 130 and an LDL that has climbed from 95 to 130 in four years are the same number describing two entirely different situations.
What to ask for
- The full breakdown, not the total alone. LDL, HDL, triglycerides, non-HDL.
- Interpretation, not a printout. A page of values beside reference ranges is data. What it means over the next decade is the part worth paying for.
- A repeat after any change. Diet, exercise or medication started without a follow-up measurement is an intervention nobody checked.
- Fasting only if asked for. A non-fasting sample is clinically acceptable for most people.
Frequently asked questions
Is fasting necessary before a cholesterol test?
Usually not. A non-fasting lipid profile is acceptable for most people. Fasting is requested when triglycerides are very high or a specific calculation depends on it, so follow the instruction given with the request.
What counts as a normal cholesterol level?
Reference ranges describe what is common, not what is optimal. The target depends on total cardiovascular risk, which is why one LDL value can mean two different things in two people of the same age.
Is cholesterol testing different for South Asians?
The test is identical. The interpretation should not be, because the thresholds at which South Asian bodies accumulate cardiometabolic risk sit below the European equivalents.
Can cholesterol be high while feeling completely well?
Yes, and that is the usual case rather than the exception.
Ask for the breakdown. Then ask what it means. Those are two separate requests, and most panels sold in this country only answer the first. Every investigation SHI includes is listed in full, and the three programmes differ only in how far the reading goes.
Sources: Sri Lanka STEPS Survey 2021 · Katulanda et al., Indian Journal of Endocrinology and Metabolism, 2025 · Wijewickrama et al., BMC Cardiovascular Disorders, 2026 · Sri Lanka Ministry of Health Annual Health Bulletin 2022–23 · WHO Asia-Pacific review, 2004 · International Diabetes Federation.
This article is general information, not individual medical advice. It does not replace assessment by your treating physician. If you have symptoms — chest pain, breathlessness or any urgent concern — seek medical attention immediately (Suwa Seriya 1990).