Guidelines for preventive activities in general practice

The Red Book
8.3 Cholesterol and other lipids
☰ Table of contents

Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Aboriginal and Torres Strait Islander peoples

Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Adults should have their blood lipids (a fasting sample should be used when assessing elevated triglycerides [TG])50 assessed every five years starting at 45 years of age (A for males, C for females). Lipid levels should be interpreted in the context of an absolute CVD risk assessment after 45 years of age (35 years of age for Aboriginal and Torres Strait Islander peoples; B). Aboriginal and Torres Strait Islander adults should have lipid tests performed every five years from 35 years of age (B).


Table 8.3.1. Cholesterol and lipids: Identifying risk

Who is at risk?

What should be done?

How often?

Low risk

Absolute cardiovascular disease (CVD) risk <10%

Provide lifestyle advice (I, A)34

Repeat lipids every five years*

Moderate risk

Absolute CVD risk 10-15%

Provide intensive lifestyle advice (II, B)34,36–38, 42 

Consider pharmacotherapy† if not reaching target after six months (I, A) or if family history of premature CVD or patient is of Aboriginal or Torres Strait Islander, South Asian, Middle Eastern, Maori or Pacific Islander descent (II, C)

Repeat lipids every two years

High risk

  • Absolute CVD risk >15%
  • Patient with the following clinically determined high-risk factors:
    • diabetes and >60 years of age
    • diabetes with microalbuminuria (>20 µg/min or urine albumin-to-creatinine ratio [UACR]) >2.5 mg/mmol for males, >3.5 mg/mmol for females)
    • Chronic kidney disease (CKD); persistent microalbuminuria or stage 4 renal failure (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) or stage 3a renal failure eGFR <45 mL/min/1.73 m2)
    • previous diagnosis of familial hypercholesterolaemia
    • Systolic blood pressure (SBP) ≥180 mmHg or diastolic blood pressure (DBP) ≥110 mmHg
    • serum total cholesterol >7.5 mmol/L‡
    • Aboriginal and Torres Strait Islander peoples aged >74 years

Refer to Section 8.2. Blood pressure

Provide intensive lifestyle advice (II, C) 34, 42 

Commence cholesterol-lowering therapy (simultaneously with antihypertensive unless contraindicated) (II, C to III, D)§

Every 12 months
(III, C)

  • Existing CVD (previous event, symptomatic CVD)

Provide lifestyle risk factor counselling and commence pharmacotherapy to lower risk51

Every 12 months
(III, C)

*Lipid blood test results within five years can be used to calculate absolute CVD risk every two years. Patients with diabetes, cardiac disease, stroke, hypertension or kidney disease should have their lipids tested every 12 months (III, C) 

†In Australia, pharmacotherapy with statins are only subsidised on the pharmaceutical benefits scheme (PBS) for limited criteria 

‡Those with low-density lipoprotein cholesterol (LDL-C) >4.0 or total cholesterol >7.5 should be reviewed for family history and clinical features of FH52 

§D recommendation for clinically determined high risk 

CKD, chronic kidney disease; CVD, cardiovascular disease; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; FH, familial hypercholesterolaemia; low-density lipoprotein cholesterol, LDL-C; PBS, Pharmaceutical Benefits Scheme; SBP, systolic blood pressure; UACR, urine albumin-to-creatinine ratio


Table 8.3.2. Cholesterol and lipids: Preventive interventions



Blood lipids

Total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TGs)50, 53–55 

If lipid levels are abnormal, a second confirmatory sample should be taken on a separate occasion (as levels may vary between tests) before a definitive diagnosis is made. A fasting sample should be used when assessing elevated TGs 

Screening tests using capillary blood samples produce total cholesterol results that are slightly lower than on venous blood. These may be used, providing they are confirmed with full laboratory testing of venous blood for patients with elevated levels and there is good follow up 

In adults with low absolute cardiovascular disease (CVD) risk, blood test results within five years may be used for review of absolute CVD risk unless there are reasons to the contrary

Lifestyle modification

Lifestyle risk factors should be managed at all risk levels34, 40 

All people, regardless of their absolute CVD risk level, should be given dietary advice. Those at low to moderate absolute CVD risk should be given dietary and other lifestyle advice (refer to Chapter 7. Prevention of chronic disease

Advise to aim for healthy targets:

  • Encourage any physical activity and aim for at least 30 minutes of moderate-intensity physical activity on most, if not all, days
  • Recommend smoking cessation
  • Suggest a target waist measurement <94 cm for men and <80 cm for women, and a body mass index (BMI) <25 kg/m2
  • Recommend salt restriction ≤4 g/day (65 mmol/day sodium)
  • Encourage limiting alcohol intake to ≤2 standard drinks per day for males and ≤1 standard drink per day for females


Lipid-lowering therapy for primary prevention should (while balancing risks and benefits) aim towards34, 49:

  • total cholesterol <4.0 mmol/L
  • HDL-C ≥1.0 mmol/L
  • LDL-C <2.0 mmol/L
  • non-HDL-C <2.5 mmol/L
  • TG <2.0 mmol/L

Refer to the Australian medicines handbook for pharmacotherpy options

BMI, body mass index; CVD, cardiovascular disease; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; TG, triglyceride


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