Heart health · Reading your report

How to read a lipid profile report, line by line

By Dr. D. R. Gamalathge, MBBS · SLMC No. 36999 · Published 30 October 2026

In short. A lipid profile prints four main lines and often two more worked out from them. Read LDL cholesterol first: it carries the main treatment goal, and how low it should be depends on your overall risk of a heart attack or stroke, not on the reference range printed beside it.

The report comes back as three columns: the numbers, the units, and a column headed “reference range”. Most people read the third column first. Read it last.

Three things at the top of the page

• The date the sample was taken. One result shows where a number sat on that day. Lay it beside your earlier reports to see which way it is moving.
• Fasting or not. A non-fasting sample is acceptable for most people. Fasting matters mainly when triglycerides are very high, so follow the instruction given with the request.
• The units. Many laboratories in Sri Lanka print mg/dL; guidelines and many apps use mmol/L. The conversion is below.

The lines, one by one

Total cholesterol

A sum: the cholesterol carried in all the particles in the blood, HDL included. Because it mixes the helpful with the harmful, read the lines below it first.

HDL cholesterol

HDL has no treatment goal. A low HDL goes with higher risk, but raising it with medicines has not been shown to lower heart risk (European guidance).

Triglycerides

Under 1.7 mmol/L (150 mg/dL) goes with lower risk. A higher figure prompts a wider look at your risk. The 1.7 line marks risk; it is not a goal (European guidance).

LDL cholesterol

The main treatment target. On many reports it is calculated from the three lines above rather than measured, using the Friedewald equation. The calculation is not valid when triglycerides are very high (above about 4.5 mmol/L, 400 mg/dL); LDL should then be measured directly.

VLDL cholesterol

Usually worked out from the triglyceride figure (triglycerides divided by five, in mg/dL), so it adds little that the triglyceride line has not already said.

Non-HDL cholesterol

Total cholesterol minus HDL. It counts the cholesterol in every particle able to contribute to plaque. If your report does not print it, you can work it out yourself. Why non-HDL and ApoB tell you more than the total.

The reference range is not your goal

The flags on most reports come from general cut-offs: 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), triglycerides of 150 mg/dL (1.7 mmol/L) or more. They are general cut-offs, not personal targets.

How low LDL should be depends on your overall risk of a heart attack or stroke over the next ten years, which a doctor works out from your full picture. In US guidance, once treatment starts:

Sri Lanka has not adopted these figures as national goals; they are the ones our reports use, labelled as US guidance. Do not start, stop or change a medicine without talking to your doctor.

mmol/L or mg/dL

Each substance has its own conversion factor, because the molecules differ in weight:

• Cholesterol (total, LDL, HDL, non-HDL): mg/dL × 0.0259 = mmol/L (or divide by about 38.7).
• Triglycerides: mg/dL × 0.0113 = mmol/L (or divide by about 88.6).

What most reports leave out

Lp(a), a cholesterol-carrying particle whose level is mostly set by genes. European guidance suggests measuring it at least once in every adult’s life. ApoB, which counts the particles rather than the cholesterol they carry: what ApoB measures.

What to do with it

1. Read LDL first, then non-HDL, triglycerides and HDL. Read the total last.
2. Put the result beside your earlier reports, in the same units, and look at the direction.
3. Remember that one raised reading is not a diagnosis.
4. Take every report you have to your doctor. Your goal depends on your overall risk, which a doctor works out from your full picture.

Frequently asked questions

Do I need to fast before a lipid profile?

Usually not. A non-fasting sample 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.

Why does my report say “LDL (calculated)”?

Many laboratories work LDL out from total cholesterol, HDL and triglycerides with the Friedewald equation instead of measuring it. When triglycerides are very high the calculation is not valid, and LDL is measured directly.

My result is inside the reference range. Is that good?

Not necessarily. The range is a general cut-off, not a goal set for you. How low LDL should be for you depends on your overall risk, which takes in your age, blood pressure, blood sugar, smoking and family history.

Where it fits in a health review

In our reports, each result sits next to its threshold and one sentence on what it means for you, and every report is reviewed and approved by our physician before it is released. See every biomarker both programmes measure.

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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 now or call 1990 (Suwa Seriya).