Cardiovascular health

Cholesterol testing in Sri Lanka: half of adults have never had one

By Dr. D. R. Gamalathge, MBBS · SLMC No. 36999 · Published 12 September 2026 · Reviewed 31 October 2026 · 7 min read

In short. In the 2021 national STEPS survey, about half of Sri Lankan adults had never had their cholesterol measured. A lipid profile is worth reading for LDL, non-HDL cholesterol and triglycerides against South Asian risk, not for the total alone.

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.

In the 2021 national STEPS survey, about half of Sri Lankan adults had never had this measured at all. When the survey measured it, nearly half of adults had a raised level. 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. Measured in the survey, nearly half had a raised level.
• 35.6% of adults in Western Province are pre-diabetic (Katulanda et al., 2025). A further 27.8% already have diabetes. Most feel entirely well, because insulin rises years before glucose does.
• Among adults in their thirties, undiagnosed hypertension outnumbers diagnosed hypertension roughly six to one.
• Ischaemic heart disease was the leading cause of hospital deaths in 2022: 13.6% of all deaths in hospital (Ministry of Health, Annual Health Bulletin 2022–23).

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 a lipid profile 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. A WHO expert consultation set a BMI of 23, not 25, as the point to act in Asian populations, and South Asian waist limits sit below the European ones. 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

Sri Lanka has its own schedule. The Ministry of Health’s Healthy Lifestyle Centres, at primary care institutions, screen adults aged 35 and over who have no diagnosed non-communicable disease. They also screen adults aged 20 to 34 who have smoked tobacco in the past year, have a BMI over 25, have a waist above 90 cm (men) or 80 cm (women), have raised blood pressure or symptoms of diabetes, or have a parent, brother, sister or child with early heart disease or stroke (a man before 55, a woman before 65), diabetes or an inherited cholesterol disorder. The screening includes a total cholesterol check and is repeated in 1 to 3 years, depending on risk (Ministry of Health, STEPS 2021 report).

US guidance recommends a full lipid profile from age 19 and at least every 5 years after that, more often with rising age or other risk factors (ACC/AHA 2026). A doctor may check sooner.

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?

Most reports flag a total cholesterol of 200 mg/dL (5.2 mmol/L) or more, an LDL of 130 mg/dL (3.4 mmol/L) or more, an HDL under 40 mg/dL (1.0 mmol/L) and triglycerides of 150 mg/dL (1.7 mmol/L) or more, cut-offs taken from the US NCEP classification. Those flags are general cut-offs, not personal targets: the same classification calls an LDL below 100 mg/dL (2.6 mmol/L) optimal, and the LDL worth aiming for 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.

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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 two programmes differ by 15 biomarkers: 40 on Essential, 55 on Premium.

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).