Understanding PocDoc Lipid Test Results

Authored by: Dr Matthew Lee; BMSc, MBBS, MSc

What's in this PocDoc Article?

• What do we mean by a recommended range?
• Should I be concerned if my lipid levels are outside the recommended range?
• Understanding your lipid results
• Why might my lipid results be outside the recommended range?
• What steps should I take if my lipid results are outside the recommended range
• Frequently asked questions

What do we mean by a recommended range?

PocDoc measures 5 types of lipid (fat) present in your blood and displays these levels next to the NHS’s recommended guideline levels for a healthy person with no pre-existing medical conditions.

• The Green Zone: If your test results are within the recommended guideline range they will show in green

• The Red Zone: If your test results are outside this recommended range they appear in red

The recommended range is defined as the range where 95% of the results of a healthy population falls. This also means that 5% of people of the same healthy population will have results that fall outside these limits. Therefore, just because a test result is outside this range doesn't automatically mean there's a health concern, it's simply a cause for further investigation.

Further, the recommended range is only applicable for healthy people with no pre-existing medical conditions. If you have previously had a heart attack or stroke, you will be given different ranges or targets for your lipid levels.

Should I be concerned if my lipid results are outside the recommended range?

If your lipid results reveal that you have levels outside the recommended range for any of the 5-lipid markers, it doesn’t necessarily mean that you have a medical condition or need treatment. Healthcare professionals will use your lipid results in several ways. 

If you haven’t had a prior heart attack or stroke, they use the results to determine your risk of having a heart attack or stroke using a tool called QRISK. If you have already had a heart attack or stroke, they may use these results to determine how effective lifestyle changes or medication bring your lipid levels down to a targeted value.

A healthy cholesterol range for you depends on many factors. When considering why your levels may not be in the recommended range, your healthcare provider will consider factors such as your past medical history, lifestyle, medications, and other relevant aspects to interpret your lipid panel results.

Understanding your lipid results

Below is an explanation of each lipid measurement contained in the PocDoc 5-lipid marker test.

• Total Cholesterol
• HDL Cholesterol
• Non- HDL Cholesterol
• Triglycerides
• TC to HDL Ratio

1. Total Cholesterol

The Recommended Range according to the NHS:

• A Healthy Level is 5.0 mmol/L or below

While having a total cholesterol value is informative, it doesn't give a complete picture of your cardiovascular health. A high total cholesterol might be due to elevated HDL-cholesterol ( "Good Cholesterol" ), which is protective, or it might be from elevated Non-HDL cholesterol ( "Bad Cholesterol" ), which is associated with increased cardiovascular risk.

On the other hand, very low total cholesterol could be due to specific health issues or malnutrition. Having a 5-marker lipid test such as PocDoc is preferable to a single total cholesterol measurement in order to understand your cardiovascular risk fully.

2. HDL Cholesterol - The “Good Cholesterol”

The Recommended Range according to the NHS:

• A Healthy Level is 1.0mmol/L or above for men
• A Healthy Level is 1.2mmol/L or above for women

In general, higher levels of HDL-cholesterol provide increased protection against cardiovascular disease, however, according to Heart UK, while HDL levels up to 1.4mmol/L are considered protective, anything beyond that might not bring extra advantages.

3. Non-HDL-Cholesterol – The “Bad Cholesterol”

The Recommended Range according to the NHS:

• A Healthy Level is 4.0mmol/L or below

Although we label non-HDL cholesterol as "bad", this type of cholesterol plays a crucial role in your body. It plays a vital part in bodily functions in the right amounts. 

The problem occurs when there's an overabundance compared to HDL cholesterol. This means the non-HDL cholesterol cannot be transported away from your body and instead can contribute to atherosclerosis, increasing the risk for cardiovascular disease. Therefore, while some non-HDL cholesterol is necessary for bodily functions, maintaining a balanced amount is critical for your cardiovascular health.

4. Triglycerides

The Recommended Range, according to Heart UK:

• States that non-fasting levels should be below 2.3mmol/L

Elevated triglyceride levels, also known as hypertriglyceridemia, are linked to an increased risk of atherosclerosis, increasing your chance of cardiovascular disease. It is important to manage and monitor triglyceride levels to maintain cardiovascular health.

5. Total Cholesterol: HDL-Cholesterol Ratio

The Recommended Range according to the NHS:

• A Healthy Level is a ratio of 6 or below

The TC to HDL ratio is a valuable cardiovascular marker. It divides total cholesterol by HDL cholesterol. This ratio measures cholesterol balance and is an important input into calculations for cardiovascular disease risk. In the UK it is used in the set of algorithms called the QRISK assessment- this calculates an individual's risk of cardiovascular disease in the next 10 years. PocDoc is proud to have partnered with the NHS in order to bring the QRISK assessment into PocDoc to provide the first integrated digital cardiovascular risk assessment tool.

Why might my lipid results be outside the recommended range?

There are a number of potential explanations why your PocDoc lipid results are outside the recommended range, including:

1. Familial and Genetic Causes

Familial Hypercholesterolemia (FH)

Familial Hypercholesterolemia (FH): is a genetic disorder caused by inherited mutations in genes, including LDLR, APOB, and PCSK9 , which play a role in the processing and removal of cholesterol from the blood. As a result of this inability to remove cholesterol from the blood, from birth, people with FH have an increase in LDL-cholesterol and total cholesterol. Over time this increases their risk of cardiovascular disease.

According to the Simon Broome Criteria, possible FH is defined as having total cholesterol greater than 6.7mmol/L or LDL-cholesterol greater than 4.0mmol/L in a child aged younger than 16 years or total cholesterol greater than 7.5mmol/L or LDL-cholesterol greater than 4.9mmol/L in an adult plus:

• Tendon xanthomas in a 1st degree relative (parent, sibling, child) or in a 2nd degree relative (grandparent, uncle, aunt)

or:

• DNA-based evidence of an LDL receptor mutation or familial defective apo B-100 or a PCSK9 mutation

and either:

• A family history of heart attack younger than50 years of age in a 2^nd degree relative or younger than 60 in a 1^st degree relative

• Or a family history of raised cholesterol greater than 7.5mmol/L in an adult 1st or 2^nd degree relative or greater than 6.7mmol/L in a child or sibling aged younger than 16 years

If a healthcare professional suspects FH they will refer you for further tests such as genetic testing. According to CDC, if FH is detected early and treated with lipid-lowering therapies, the risk of heart disease can be reduced by about 80%. However, if left untreated, 30% of females may experience heart attacks by the age of 60, and 50% of males by the age of 50.

How Common is Familial Hypercholesterolemia (FH)?

Familial Hypercholesterolemia (FH) is the most common inherited condition that causes high lipid levels. According to the NHS, in the United Kingdom, there are approximately 220,000 people who have FH. This means that around 1 in 250 persons in the UK have this condition. Of these persons with FH, less than 8% are currently identified.

Inherited causes are one possible cause of lipid levels being outside the recommended range. However, it’s important to understand they are not the most likely explanation. Your healthcare provider will use the lipid results, physical examination findings and family history to assess your risk using a diagnostic tool such as the Simon Broome criteria. This tool determines whether a person has FH. Your healthcare provider will offer guidance, and diagnosis, including confirmatory blood and genetic tests, and potential treatments.

Other less common inherited conditions that may cause lipid results to be outside the recommended range include:

• Polygenic Hypercholesterolemia: This is another genetic disorder which causes people to have moderately elevated cholesterol levels, which can increase the risk of cardiovascular disease

• Familial combined hyperlipidemia (FCH) :This condition causes an overproduction of mainly VLDL-Cholesterol and LDL-Cholesterol . This results in elevated lipid levels of total cholesterol and triglycerides

• Familial dysbetalipoproteinemia: is a condition in which leads to elevated triglycerides and total cholesterol characterized by a skin lesion in the palms where there is an accumulation of fat

• Familial hypertriglyceridemia: this condition is due to the overproduction of VLDL-Cholesterol from the liver. People with this condition have high levels of triglycerides and VLDL in their lipid profile

2. Medication-Induced Causes:

Various medications can impact your lipid levels and can cause readings outside of the recommended ranges. Medications that are known to affect lipid levels in your blood, include, but are not limited to:

• Steroids
• Diuretics
• Beta-blockers
• Antipsychotics
• Antiretroviral Drugs
• Immunosuppressants
• Blood Pressure medication
• Diabetic medication
• Cholesterol lowering medication
• Erectile dysfunction medication

These medications affect lipid metabolism in your body and can lead to higher levels than you would normally expect. If your lipid levels are outside the recommended range, discuss the medications you are on with your healthcare provider. PocDoc includes questions about medications in the app so that we can make people aware of how medicines can affect the results.

3. Lifestyle Choices 

Various lifestyle choices impact lipid levels and can cause levels outside of the recommended range. Possible lifestyle-induced causes of high cholesterol include:

Physical Activity

A systematic review of 13 studies and two review articles showed that regular physical activity significantly benefits cholesterol levels. These findings revealed that both aerobic exercises and resistance training can raise HDL-cholesterol, the "good cholesterol", and aid in reducing LDL-cholesterol, the "bad cholesterol". High-intensity workouts and a combination of aerobic with resistance exercises have shown the greatest improvements in lipid levels.

The NHS recommends at least 150 minutes of moderate-intensity activity a week or 75 minutes of vigorous-intensity activity, and strength exercises on 2 or more days a week. Any activity is better than none though, and will have a positive impact on your lipid levels.

Poor Diet:

A meta-analysis of 60 controlled trials showed that saturated fats and trans fats are associated with high lipid levels. The study concluded that trans fats and saturated fats should be replaced with unsaturated fats in a diet in order to improve lipid levels. Essentially this means cutting back on things containing saturated fats, such as processed and fatty meats like hamburgers and sausages and eating more lean meats like turkey and fish.

Even a small increase in the amount of unsaturated fats consumed was shown to significantly improve the ratio of total to HDL cholesterol which helped to reduce the risk of cardiovascular disease.

The British Heart Foundation is in agreement and also recommends a diet with foods high in unsaturated fat rather than foods with high saturated fats. This diet has been shown to increase HDL-Cholesterol, the “Good Cholesterol” and lower LDL-Cholesterol, the “Bad Cholesterol”.

Smoking:

A study using data from the National Health and Nutrition Examination Survey from 1999-2012, showed that smoking negatively affected cholesterol levels in adults in the United States. Smokers had lower HDL-cholesterol, the “good cholesterol”, and higher levels of “bad cholesterol”, Non-HDL cholesterol, compared to non-smokers. This finding has been supported by a review of 54 other studies.

Heart UK explains that smoking causes the “bad” LDL-cholesterol to become 'stickier', leading it to block arteries. It also decreases the “good” HDL-cholesterol that helps remove cholesterol from artery walls. Smoking damages artery walls, causing cholesterol to gather in these areas, making arteries clog faster, and increasing risks of heart attacks and strokes.

Alcohol:

When you drink alcohol, the liver processes it and makes triglycerides and cholesterol which raises the levels in your blood. Heart UK recommends reducing alcohol consumption to help lower cholesterol levels and decrease the risk of cardiovascular disease.

The NHS recommends drinking no more than 14 units of alcohol a week, spread across 3 days or more, to keep health risks from alcohol low. That's around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer.

Obesity:

The US's National Lipid Association published a consensus statement showing that obesity significantly affects lipid levels, impacting around 60-70% of obese and 50-60% of overweight individuals. Obesity leads to higher levels of triglycerides and VLDL-cholesterol due to the liver creating more of these harmful lipid particles. Further, the individual has a decreased ability to clear these lipids as HDL-cholesterol was also lower in obese and overweight individuals.

NHS guidelines for obesity are:

• BMI of 25 to 29.9 – You are in the overweight range

• BMI of 30 to 39.9 – You are in the obese range

• BMI of 40 or above – You are in the severely obese range

If you have a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background, you may be at increased risk at a lower BMI. This is taken into account in the QRISK algorithms within PocDoc. Speak to your healthcare provider for further information on your individual risk.

4. Normal body level fluctuations (biological variation):

Lipid levels naturally vary daily, during the month, during different seasons and during different periods of our lives. Having your lipid levels transiently going outside of the recommended range because of normal fluctuations is not necessarily a cause for concern. This is one reason why regular testing of cholesterol is beneficial; helping you to understand what levels are normal for you. Reasons for normal biological variation in lipid levels include:

Day to Day Variation

According to the National Cholesterol Education Program guidelines, there are notable day-to-day variations in lipid levels meaning your lipid levels will change from one day to the next. The normal day-to-day variations for total cholesterol were 5%, triglycerides 20%, HDL-Cholesterol 10%, and calculated LDL-Cholesterol 8% levels. Therefore if your lipid levels are on the borderline between the recommended and outside this range, or even 20% higher in the case of triglycerides, it is important to consider that this may not be outside the recommended range and may be due to day-to-day variation.

Seasonal Variation

Studies have shown a seasonal effect on blood cholesterol levels. This variation in blood lipid levels has shown cholesterol levels up to 5% higher in winter than in summer.

Menstrual Cycle:

Studies have shown that lipid levels, specifically total cholesterol, LDL-cholesterol and HDL-cholesterol, fluctuate over the menstrual cycle due to changing reproductive hormone levels. While the variations across the menstrual cycle phases averaged 5-8%, these shifts can cross clinical boundaries for recommended lipid levels.

Specifically, the study showed that fewer women were classified as having high cholesterol when measured during the luteal phase compared with the follicular phase. 7.9% had high total cholesterol in the luteal phase compared to 14.3% in the follicular phase, and 10.5% had high LDL in the luteal phase compared to 17.8% in the follicular phase.

Pregnancy:

Your lipid levels rise during pregnancy to help with the growth and development of the baby.

Studies show that in a normal pregnancy, total cholesterol can increase up to 50%, LDL-Cholesterol up to 40%, HDL-Cholesterol up to 25%, and triglycerides up to 300%. For this reason, the PocDoc questionnaire includes a question about pregnancy so that we can highlight this may result in lipid levels outside the recommended range.

5. Test accuracy

No diagnostic test is 100% accurate. The PocDoc test has been shown to be accurate compared to laboratory values over hundreds of tests. The uncertainty around a given PocDoc result can be defined by the 95% confidence interval. For a PocDoc Total Cholesterol reading of 4.9, this means that the reading could be as low as 4.7 or as high as 5.0.

 Read our full article on the accuracy of PocDoc’s 5 lipid marker test coming soon!

6. Medical Conditions

The PocDoc questionnaire includes questions about certain diseases which lead to higher lipid levels:

Thyroid disease

Thyroid dysfunction can significantly impact cholesterol levels. Studies show that hypothyroidism (an underactive thyroid) often increases total cholesterol, LDL-cholesterol, and triglycerides while decreasing HDL-cholesterol levels. In contrast, for hyperthyroidism (an overactive thyroid), there is a decrease in levels of total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol, and the LDL: HDL ratio.

Rheumatoid arthritis (RA)

Rheumatoid arthritis (RA) has a large effect on lipid levels, specifically by lowering the beneficial HDL-cholesterol levels. Therefore for persons with RA it is essential to monitor and manage lipid levels to mitigate long-term heart disease risks.

Systemic Lupus Erythematosus (Lupus)

Persons with lupus can have increased levels of VLDL-cholesterol and LDL-cholesterol and decreased levels of HDL-cholesterol. This drop in HDL-cholesterol, the “good cholesterol”, is a common sign of cholesterol imbalance in persons with lupus, including children.

Chronic kidney disease (CKD)

Chronic kidney disease (CKD) impacts lipid levels by increasing triglyceride levels and lowering the HDL-cholesterol levels however, LDL-cholesterol doesn't typically increase. This is due to CKD slowing down the breakdown of certain fat-rich proteins in the blood.

What steps should I take if my lipid results are outside the recommended range?

Since many factors contribute to cardiovascular disease and every person is unique, there’s no single way to treat lipid levels outside the recommended range. Your healthcare provider will provide guidance to you based on your own set of circumstances. They may recommend continued lipid level monitoring, lifestyle changes and possibly medications such as lipid-lowering therapies (LLTs).

Download PocDoc's Understanding Lipid Test Results Booklet Here

FAQs about PocDoc's Lipid Test Results

1) If test levels are outside the recommended range, does this mean I have a real problem?

• Test levels outside the recommended range can indicate a potential issue, but it's essential to understand that many factors can influence lipid levels. Things like day-to-day variation, seasonal effects, menstrual cycles, and pregnancy can cause fluctuations

• While a result outside the recommended range can be an important signal for further investigation, it doesn't necessarily mean you have a severe problem

2) If all my lipid test levels are within the recommended ranges, does this mean I have no problems?

• Test levels within the recommended ranges are a positive sign concerning cardiovascular health, but this is just one factor of your overall health profile. Factors like family history, lifestyle habits, and underlying conditions affect your overall health

• Lipid results within the recommended ranges is reassuring, but continuing regular health check-ups and maintaining a healthy lifestyle are still essential

3) How soon should I retest if my results show levels outside the recommended range?

• If your lipid levels are outside the recommended range, your healthcare provider might recommend a retest to confirm the findings within a few weeks to a few months

• This can vary depending on how far outside the recommended range your results are and any potential underlying causes or concerns.

4) How do I discuss my lipid results with my healthcare provider?

• Approach the conversation openly and with a desire to understand. Ask your healthcare provider to explain the results in detail and what they might mean for your health

• Bring a list of your medications, any recent changes in your health or lifestyle, and any questions or concerns you might have

• Remember, it's a collaborative relationship, and your healthcare provider is there to guide and support you

5) How often should the average person get their lipid levels checked?

• Prominent medical bodies such as the American Heart Association encourage routine lipid level checks for adults starting as early as 20 years old. If you're over 40 or have risk factors – such as being overweight, having a poor diet, smoking, or other health issues – they recommend regular lipid panel testing

• Regular health checks, including lipid panel testing, are a proactive, sensible option for anyone interested in staying on top of their health. If all your lipid levels are in the healthy ranges, regular testing using PocDoc's lipid marker test can offer you a detailed and proactive understanding of your current health status, and crucially, allows for early detection of potential health issues

• By consistently monitoring your lipid levels, you're not just relying on infrequent GP visits or waiting for noticeable symptoms to manifest. Instead, you're taking a proactive, informed approach to your health

Download PocDoc's Understanding Lipid Test Results Booklet Here