Overview
Quick answer
In Australia, LDL cholesterol and triglycerides are reported in mmol/L on a standard lipid profile: total cholesterol, triglycerides, and HDL cholesterol, with LDL-C usually calculated and non-HDL-C derived on the same sample. Labs often flag LDL above 3.0 mmol/L and fasting triglycerides above 2.0 mmol/L. Those are AACB decision limits for reviewing cardiovascular risk, not a statin order. Routine lipids no longer require fasting by default (RCPA Manual Lipids, reviewed 2 January 2024). When triglycerides are 4.5 mmol/L or above, calculated LDL is unreliable and the LDL row may be blank.
If your result is already flagged as high cholesterol, start on that guide for five-year risk and familial patterns. The 2023 Australian guideline treats from five-year absolute risk using the total-cholesterol-to-HDL ratio, not an LDL target.
Overview
Key takeaways
Australian lipid reports use mmol/L. US pages quoting LDL 100 or triglycerides 150 are a different scale.
A standard panel reports total cholesterol, triglycerides, and HDL-C, then calculates LDL-C and non-HDL-C on the same sample.
LDL-C is usually estimated, not directly counted: Friedewald in mmol/L is total cholesterol minus HDL-C minus (triglycerides divided by 2.2).
When triglycerides are above 4.5 mmol/L, Friedewald LDL is unreliable. The LDL row may be blank, and the lab may report direct LDL or lean on non-HDL-C and ApoB.
LDL-C measures cholesterol cargo inside particles. ApoB counts particles. When they disagree, risk tracks particle number.
Triglycerides reflect liver VLDL output and metabolic state. They rise after meals and with insulin resistance, alcohol, and some medicines.
H or L flags at total cholesterol 5.5, LDL 3.0, and triglycerides 2.0 (fasting) are decision limits, not reference intervals and not treatment orders (AACB 2018).
The 2023 Australian CVD guideline treats from five-year absolute risk of 10% or above, not from hitting an LDL number. Calculator input is the total-cholesterol-to-HDL ratio.
In 2022 to 2024, 30.2% of Australian adults had total cholesterol at or above 5.5 mmol/L, but only 9.2% of that group already reported a long-term high-cholesterol diagnosis (ABS National Health Measures Survey). Flags are common.
Non-fasting lipids are acceptable for routine screening (RCPA 2024). Record fasting status. Confirmatory fasting may still be used for high triglycerides. Hemexa members fast because glucose and insulin share the mixed form.
Basics
What LDL cholesterol and triglycerides measure
LDL cholesterol and triglycerides are two lines on one venous sample. They are not the same molecule, and they do not answer the same clinical question.
Public health copy still calls LDL "bad cholesterol". That slogan is a sorting label, not a mechanism. What the assay actually reports is cholesterol mass carried inside a class of lipoprotein particles.
LDL cholesterol (LDL-C)
Cholesterol carried inside low-density lipoprotein particles. The RCPA Manual LDL cholesterol page (last reviewed 8 February 2024) lists investigation of lipid abnormalities and cardiovascular risk assessment among its uses. The number is millimoles of cholesterol, not a count of particles. Cholesterol content per particle varies, which is why small dense LDL can leave LDL-C looking ordinary while many particles are still circulating.
Triglycerides
Fat in blood, mainly in very-low-density lipoprotein (VLDL) particles the liver exports (RCPA Manual Triglyceride). After a meal, chylomicrons add more triglyceride for a few hours. That postprandial rise is why fasting status still matters for interpreting a high triglyceride even when a routine lipid profile no longer requires a fast.
One panel, one draw
The RCPA Manual Lipids page (reviewed 2 January 2024) describes a lipid profile as total cholesterol, triglyceride, and HDL cholesterol, with calculation of non-HDL cholesterol and estimation of LDL cholesterol. HDL-C and total cholesterol appear on this page only as much as you need them to read the LDL and triglyceride rows.
ApoB and lipoprotein(a) are separate assays. They are not part of the opening GP lipid profile unless specifically requested. Link out rather than treating this page as their marker guide.
Mechanism
LDL cholesterol versus ApoB
The most useful distinction on a lipid report is cargo versus count. LDL-C is cargo. ApoB is count.
Cargo: millimoles of cholesterol
LDL-C tells you how much cholesterol is packed inside LDL particles. Two people can share the same LDL-C and still have different particle numbers if one has smaller, cholesterol-depleted particles (Sniderman et al., JAMA Cardiology, 2019).
Count: one ApoB per atherogenic particle
Each LDL, VLDL, and Lp(a) particle carries one apolipoprotein B molecule. Measuring ApoB estimates how many of those particles are circulating. That is the number that better tracks atherosclerotic risk when cargo and count disagree.
Non-HDL cholesterol sits in between
Non-HDL-C is total cholesterol minus HDL-C. It captures cholesterol in every atherogenic particle, including VLDL remnants, without a Friedewald assumption. It is still mass, not particle number. RCPA notes accumulating evidence that non-HDL-C and ApoB outperform LDL-C for risk prediction. That is laboratory commentary, not a change in the 2023 Australian treatment rule.
Discordance is the reason to add ApoB
When LDL-C, non-HDL-C, and ApoB agree, they rank risk similarly. Discordance is more common with high triglycerides, diabetes, obesity, or a very low on-treatment LDL-C. Concordance is still the usual case. ApoB is not always better, and the 2023 guideline did not replace LDL with ApoB for treatment decisions.
If the standard panel and the rest of your risk story already point the same way, you may not need a second assay to understand the result. If they disagree, particle number is the next question. The ApoB marker guide covers costs, units, and ordering.
Reading your results
How to read an Australian lipid report
Australian printouts use field names that vary by laboratory. The unit does not: lipids are mmol/L. Read the row label, the number, the printed interval, and whether fasting status is recorded before you compare the result with anything on the internet.
| Report label | Unit | Typical flag | What it means |
|---|---|---|---|
| Cholesterol / Total cholesterol | mmol/L | H above 5.5 | AACB 2018 decision limit. ABS 2022-24 used the same 5.5 mmol/L cut-off for "abnormally high" total cholesterol. |
| Triglycerides / Triglyceride | mmol/L | H above 2.0 (fasting) | AACB and RCPA. Non-fasting triglycerides run higher after meals, which is why fasting status belongs on the report. |
| HDL cholesterol | mmol/L | L below 1.0 (men) or 1.2 (women) | AACB sex-specific floors. Needed to calculate LDL-C, non-HDL-C, and the TC:HDL ratio. |
| LDL / LDL cholesterol | mmol/L | H above 3.0; often calculated | AACB decision limit. RCPA also lists lower aims (under 2.5 or 1.8 mmol/L) for higher risk tiers. Those aims sit beside, not instead of, the 2023 guideline. |
| Non-HDL cholesterol | mmol/L | Risk-stratified aims under 3.8 / 3.3 / 2.6 | Calculated as total minus HDL. Useful when calculated LDL is missing or untrustworthy. Still cholesterol mass, not particle count. |
| Chol/HDL or TC/HDL ratio | ratio | Used by the Aus CVD Risk Calculator | This ratio is the lipid input to the 2023 guideline calculator. LDL-C is not an input. |
Pathology Tests Explained notes that cholesterol can differ by about 10% from month to month. RCPA notes tourniquet time and recent illness as preanalytical factors. Trend the same assay where you can, and do not over-read a single flagged line.
Calculation
Friedewald equation and a blank LDL row
Most Australian labs estimate LDL-C. Direct LDL is the backup when the estimate fails.
Friedewald equation (mmol/L)
LDL-C (mmol/L) ≈ total cholesterol - HDL-C - (triglycerides / 2.2)
Invalid when triglycerides are 4.5 mmol/L or above (Friedewald 1972; ABS National Health Measures Survey excludes these results from LDL statistics). Alternative equations exist in the literature. This page does not claim a named Australian lab uses a specific alternative unless that lab prints it on the report.
Cholesterol: mmol/L versus mg/dL
To convert a US cholesterol result, divide mg/dL by 38.67. An LDL of 100 on a US page is about 2.6 mmol/L. Do not mix the two scales on the same comparison.
Triglycerides: mmol/L versus mg/dL
To convert a US triglyceride result, divide mg/dL by 88.57. A triglyceride of 150 on a US page is about 1.7 mmol/L. Australian flags still use the AACB fasting limit of 2.0 mmol/L.
Blank or asterisked LDL row
Usually because triglycerides are too high for the Friedewald estimate. The laboratory may report a direct LDL assay, emphasise non-HDL cholesterol, or suggest ApoB. Ask which row your clinician is using for risk assessment.
Collection
Fasting and when to draw
A non-fasting sample is now a suitable alternative for a routine lipid profile (RCPA Manual Lipids, reviewed 2 January 2024; LDL cholesterol page, 8 February 2024). Fasting status should still be recorded on the report. Pathology Tests Explained (Cholesterol, updated 26 February 2025) notes that many laboratories prefer non-fasting, and that an 8 to 12 hour fast may be asked for a repeat to confirm an abnormal result.
Fasting still helps when triglycerides are high, when you are comparing two results over time, or when calculated LDL was unreliable because triglycerides were high. Australian Prescriber 2024 prefers fasting where possible in those settings. That is a confirmatory rule, not a claim that every screening lipid panel must be fasted.
If the same request form includes fasting glucose or fasting insulin, you fast for the whole visit even though lipids alone would not require it. That mixed-panel rule is covered on the fasting blood test guide. Hemexa membership includes fasting glucose and insulin on the same draw as standard lipids, so members always fast. That is the mixed-form rule, not a claim that cholesterol itself requires fasting.
For mixed-panel water-only rules, see the fasting blood test guide.
Flags versus treatment
Why a flagged LDL is not a treatment target
Three different numbers get printed near lipid results in Australia. They are not interchangeable.
Decision limits, not reference intervals
The AACB 2018 harmonisation guideline says the printed limits (total cholesterol 5.5, LDL-C 3.0, triglycerides 2.0 fasting, HDL-C 1.0 in men and 1.2 in women) are decision limits for flagging. They are not population reference intervals and they are not clinical action limits. A flag means review cardiovascular risk. It does not, by itself, start a medicine.
Risk-stratified LDL aims sit beside the guideline
RCPA lists LDL aims under 3.0, under 2.5, and under 1.8 mmol/L by risk tier (LDL cholesterol page, reviewed 8 February 2024). The 2023 Australian cardiovascular guideline does not set a primary-prevention LDL target. Treat those RCPA aims as laboratory commentary layered onto the same report, not as a replacement for five-year absolute risk.
Five-year absolute risk is the treatment frame
The 2023 guideline, Heart Foundation-led and RACGP-endorsed, starts lipid-modifying treatment from five-year absolute risk of 10% or above, and considers treatment between 5% and under 10%. The Aus CVD Risk Calculator uses the total-cholesterol-to-HDL ratio. LDL-C is not an input. Total cholesterol above 7.5 mmol/L is treated regardless of the calculator; that detail lives on the high cholesterol hub.
The difference between a population reference interval, a decision limit, and a preventative target is explained on the reference range versus optimal range guide. This page does not republish that essay. Hemexa preventative bands in the member app are company policy, not RCPA or Medicare rules.
Add-on tests
When ApoB or lipoprotein(a) add value
ApoB and lipoprotein(a) earn their keep when the standard panel cannot finish the story. They do not replace the opening lipid profile.
High triglycerides, diabetes, or metabolic syndrome
LDL-C may underestimate particle number when VLDL is high. ApoB resolves that mismatch.
LDL-C and the risk story disagree
A flagged LDL with low calculated risk, or a quiet LDL with early family heart disease, is the discordance case. ApoB is the particle-number answer.
Family history of early cardiovascular disease
Lipoprotein(a) is mostly genetic and is usually measured once in adulthood. It can be high when the standard panel looks ordinary.
On a statin, LDL low, residual risk
ApoB can show remaining particle load when LDL-C has already fallen. That is monitoring, not a reason to skip the standard panel.
ApoB and Lp(a) are not routine Medicare screening assays. MSAC application 1512 was not supported for ApoB as a funded high-risk assessment test. Typical private add-on prices already published on Hemexa marker guides are about $30 to $80 for ApoB and $40 to $90 for Lp(a). Familial hypercholesterolaemia suspicion belongs on the high cholesterol hub, not this page.
Causes
Common causes of high LDL-C and triglycerides
A high result is a prompt to look for a cause, not a diet protocol and not a supplement stack. Secondary drivers are common. Extreme values need a clinician, not a webpage.
Triglycerides (often multifactorial)
- Insulin resistance and metabolic syndrome (see the HOMA-IR guide)
- Uncontrolled type 2 diabetes (see the HbA1c guide)
- Excess alcohol
- Hypothyroidism (see the thyroid blood test guide)
- Obesity and a recent large meal if the sample was non-fasting
- Some medicines, including oestrogen, corticosteroids, and some antipsychotics (class mention only; your GP interprets the drug list)
- Rare genetic chylomicronaemia at extreme triglyceride levels: one sentence, not a chapter, and urgent clinical assessment
LDL cholesterol
- Primary elevation, including a familial hypercholesterolaemia pattern: see the high cholesterol hub, not this page, for Dutch-score detail
- Secondary causes including hypothyroidism, nephrotic syndrome, and some medicines
- Dietary saturated fat can raise LDL-C. This page does not prescribe a diet
Very high triglycerides need clinical assessment the same day if there is abdominal pain or known pancreatitis risk. This guide does not replace that conversation with your GP.
How to order
How Australians get lipid tests
| Approach | Best for | Typical cost | What it includes |
|---|---|---|---|
| GP-requested lipid profile | Clinically indicated screening or follow-up | Often bulk-billed or low gap when indicated | Total cholesterol, triglycerides, HDL-C, with calculated LDL-C and non-HDL-C |
| Medicare items 66500 and 66536 | The funded chemical list, not a wellness battery | Schedule fees $9.70 (66500) and $11.05 (66536) | Cholesterol and triglycerides on 66500; HDL-C on 66536. Calculated LDL has no separate item |
| Private comprehensive panel or membership | Preventative monitoring with ApoB and Lp(a) on the same programme | Memberships that include these markers start around AU$1,199 per year | Standard lipids plus ApoB and Lp(a) among 76–80 signature markers |
Pathology in Australia requires an authorised request from a registered medical practitioner. Collection is through Healius Pathology collection at 2,000+ centres. Results typically return in 24 to 72 hours. A membership panel does not replace a GP visit for chest pain, pancreatitis symptoms, or a very high isolated result. See the Medicare blood tests guide for the 66500 chemical ladder.
FAQ
Frequently asked questions
- What is tested in an LDL cholesterol and triglycerides blood test in Australia?
- A standard lipid profile measures total cholesterol, triglycerides, and HDL cholesterol from one blood sample. The laboratory then calculates LDL cholesterol (usually with the Friedewald equation) and non-HDL cholesterol on the same report. All are reported in mmol/L. ApoB and Lp(a) are separate tests, not part of the opening GP panel unless specifically requested.
- What is a normal LDL cholesterol level in Australia?
- Australian reports use mmol/L. Many labs flag LDL cholesterol above 3.0 mmol/L (AACB harmonised decision limit). That flag means review your overall cardiovascular risk; it is not the same as a treatment target. The 2023 Australian cardiovascular guideline treats from five-year absolute risk, not from an LDL number. RCPA also lists lower aims (under 2.5 or 1.8 mmol/L) for higher risk tiers, set with your clinician.
- What is a normal triglyceride level in Australia?
- Triglycerides are reported in mmol/L. A common fasting flag is above 2.0 mmol/L (AACB harmonised limit). Non-fasting triglycerides run higher after meals, which is why fasting status should be recorded on the report. Very high triglycerides (above 4.5 mmol/L) can make calculated LDL unreliable.
- Do you need to fast for a cholesterol or triglyceride test in Australia?
- Not routinely. The RCPA Manual states a non-fasting sample is a suitable alternative for a routine lipid profile, and fasting status should be recorded. A fasting repeat (often 8 to 12 hours, water only) may be used to confirm high triglycerides or when comparing results over time. If your form also includes fasting glucose or insulin, you fast for the whole visit. See the Hemexa fasting guide for the mixed-panel rule.
- How is LDL cholesterol calculated in Australia?
- In mmol/L, most Australian labs estimate LDL-C with the Friedewald equation: total cholesterol minus HDL-C minus (triglycerides divided by 2.2). The estimate is unreliable when triglycerides are 4.5 mmol/L or above, so the LDL row may be blank. The laboratory may then report a direct LDL assay, emphasise non-HDL cholesterol, or suggest ApoB.
- Why is my LDL cholesterol blank or not calculated?
- Usually because triglycerides are too high (often 4.5 mmol/L or above) for the Friedewald estimate. The laboratory may report direct LDL, emphasise non-HDL cholesterol, or suggest ApoB. Ask which row your clinician is using for risk assessment.
- What is the difference between LDL cholesterol and ApoB?
- LDL cholesterol measures the amount of cholesterol inside LDL particles. ApoB counts the number of atherogenic lipoprotein particles (one ApoB per particle). When the two disagree, especially with high triglycerides or diabetes, cardiovascular risk often tracks the particle number. ApoB is usually a private add-on in Australia. The ApoB marker guide covers costs and ordering.
- What causes high triglycerides on a blood test?
- Common contributors include insulin resistance, metabolic syndrome, type 2 diabetes, excess alcohol, hypothyroidism, obesity, and some medicines. Triglycerides also rise after eating, which is why fasting status matters when interpreting a flagged result. Very high levels need urgent clinical assessment; this guide does not replace that conversation with your GP.
- Does Medicare cover a lipid panel in Australia?
- Total cholesterol and triglycerides sit on the MBS 66500 chemical list. HDL cholesterol is item 66536. Calculated LDL has no separate item. A GP-requested lipid profile is often bulk-billed when clinically indicated. ApoB and Lp(a) are not routine Medicare screening assays. See the Medicare blood tests guide for the 66500 chemical ladder.
- How often should I have LDL and triglycerides tested?
- For low-risk adults, Australian public-health messaging often cites lipid checks about every five years from middle age. People with diabetes, high risk, or on treatment need more frequent monitoring per their GP. Hemexa membership retests standard lipids every six months on the biannual panel as company policy, alongside glucose and insulin on the same draw. The how often blood tests guide covers the official clocks.
How Hemexa fits
How Hemexa can help
Hemexa membership includes a standard lipid panel on the biannual retest schedule, alongside fasting glucose, insulin, and HOMA-IR on the same mixed-form fast. Hemexa preventative bands in the member app are company policy, not RCPA or Medicare rules, and this page does not republish a single company lipid table.
Standard lipids on the biannual panel
Hemexa includes total cholesterol, HDL cholesterol, triglycerides, calculated LDL, non-HDL cholesterol, and the TC:HDL ratio on the annual baseline and again on the included six-month retest, part of 76–80 signature markers. Those markers are biannual because they move with diet, weight, and treatment.
ApoB annual, Lp(a) once
ApoB is on the annual baseline. Lipoprotein(a) is measured once, on your first baseline. Neither is a substitute for the standard lipid profile, and neither is a routine Medicare screening assay.
GP-reviewed requests and Healius Pathology collection at 2,000+ centres
Hemexa coordinates authorised pathology requests and collection at 2,000+ centres nationwide through Healius Pathology, our only collection partner. Members fast because glucose and insulin share the request form, not because cholesterol itself requires fasting.
Not a substitute for GP treatment decisions
Hemexa does not prescribe statins, set an LDL treatment target, or replace your GP for chest pain, pancreatitis symptoms, or familial hypercholesterolaemia work-up. Trend charts show mmol/L over time so the next clinical conversation has a series, not a single flagged line.
Sources
References
Royal College of Pathologists of Australasia. Lipids (RCPA Manual, last reviewed 2 January 2024). View source ↗
Royal College of Pathologists of Australasia. LDL cholesterol (RCPA Manual, last reviewed 8 February 2024). View source ↗
Royal College of Pathologists of Australasia. Cholesterol. View source ↗
Royal College of Pathologists of Australasia. Triglyceride. View source ↗
Royal College of Pathologists of Australasia. HDL cholesterol. View source ↗
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Educational information only. See the health disclaimer.