Definition

The total cholesterol test is a type of test used to assess the lipid or fat levels in the bloodstream. Lipid levels in the blood include "bad" cholesterol (LDL), "good" cholesterol (HDL), and triglyceride fat. As a result, the total cholesterol test measures the overall amount of all three types of cholesterol present in the blood.

This test is commonly linked to dyslipidemia and is regularly conducted to detect abnormalities in blood fat metabolism. Dyslipidemia may occur due to genetic issues or be caused by other underlying conditions such as:

• Kidney problems

• Diabetes

• Cardiovascular diseases, including heart and blood vessel issues triggered by fatty plaque formation

• Metabolic syndrome, a combination of obesity, diabetes, and high blood pressure

Indication

The total cholesterol test is typically performed in the following scenarios:

• Patients who may have dyslipidemia

• To estimate cardiovascular risk in patients

• As a routine part of screening or checking lipid profiles

• As one of the secondary parameters for therapy in patients with a high cardiovascular risk

Contraindication

There are no specific contraindications, diseases, or medical conditions that would prevent someone from undergoing this test.

Preparation Before the Test

No special preparations are required prior to a total cholesterol test. This test can be conducted without the need for fasting and may be performed at any time of day.

Test Procedure

A total cholesterol test involves collecting a 0.5 ml sample of blood serum. This sample is obtained from a vein and is placed into a designated tube. The laboratory personnel conducting the test will wear appropriate gloves and personal protective equipment (PPE).

Before drawing the blood sample, the technician will apply an elastic band around the arm and clean the area of the needle puncture with antiseptic gauze. Typically, blood is drawn from the area around the elbow crease. After blood collection, the elastic band is removed, and the puncture site is pressed and cleaned with antiseptic gauze. This procedure is quick and usually only takes a few minutes. 

Normal and Abnormal Values

Unlike HDL cholesterol levels, which are categorized based on gender, the normal range for total cholesterol values is differentiated by age. The general normal and abnormal ranges for total cholesterol test results are as follows:

For Adults:

For Children (Under 18 Years):

Results and Recommendations (Follow-up Tests)

Normal Results

If the results of your total cholesterol test are within the normal range, it suggests that you are likely maintaining a healthy lifestyle. The American Heart Association (AHA) advises adults to have their cholesterol levels checked every 4-6 years starting at age 20, as cholesterol levels begin to rise around this age.

The Centers for Disease Control and Prevention (CDC) also recommends that children undergo cholesterol tests at least twice: once between the ages of 9-11 and again between 17-21 years old. Children with a family history of high cholesterol (dyslipidemia), obesity, or diabetes should have their cholesterol tested at ages 2-8 and 12-16.

Slightly High Results

If your total cholesterol test results indicate slightly elevated values, it is important to verify whether you followed the proper preparation for fasting, which typically requires 8-14 hours of fasting before the test. The duration of fasting may vary slightly across different laboratories due to variations in equipment and testing methods. In most cases, the optimal fasting time is between 10 to 12 hours, avoiding all food and drink except water. If you are uncertain, repeating the cholesterol test can provide clarity.

The total cholesterol value helps assess the overall risk for cardiovascular diseases, including heart and blood vessel diseases. If your or your child’s total cholesterol value falls within the slightly high range, it is advisable to consult a healthcare professional. A doctor will evaluate your health status by considering additional lipid profile tests, including triglyceride levels, LDL cholesterol, and HDL cholesterol.

High Results

If your total cholesterol test results indicate high values, seeking medical consultation is essential. The doctor will likely recommend dietary and lifestyle changes aimed at improving overall health. In some cases, medication may be prescribed to help lower cholesterol levels. According to the Dyslipidemia Management Guidelines in Indonesia, the best methods for reducing total cholesterol and LDL cholesterol involve decreasing the intake of saturated and trans fats, while increasing the consumption of foods containing phytosterols. Additionally, increasing fiber intake, losing excess weight, and enhancing physical activity levels can help reduce total cholesterol and improve HDL cholesterol levels.

When test results show very high cholesterol levels, especially exceeding 310 mg/dL, the doctor might suspect a genetic disorder such as Homozygous Familial Hypercholesterolemia (HoFH) or Monogenic Dyslipidemia. These rare and potentially life-threatening conditions require immediate attention and further examination.

Consult the Right Doctor

For adults, the results of the total cholesterol test should be reviewed with a general practitioner, who can recommend further testing or initiate appropriate treatment. You may also choose to consult with a cardiologist, internist, or endocrinology specialist to discuss your cholesterol levels in greater detail. For pediatric patients, if the test results deviate from the normal range, it is important to seek consultation with a pediatrician.

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