Understanding Cholesterol — A Plain English Guide for Australians Over 60

Few health topics generate as much confusion as cholesterol — partly because the guidance keeps evolving, and partly because the terminology itself is genuinely confusing. Good cholesterol, bad cholesterol, triglycerides, statins, targets that seem to keep changing. This guide breaks it all down in plain English — what cholesterol actually is, why it matters more after 60, and what the newest 2026 medical guidelines mean for you.

What Cholesterol Actually Is

Cholesterol is a waxy, fat-like substance that is part of all animal cells. It is essential for many of the body’s metabolic processes, including the production of hormones, bile, and vitamin D. Cholesterol is produced by the liver and also made by most cells in the body.

In other words — your body genuinely needs cholesterol to function. The problem isn’t cholesterol itself. It’s having too much of the wrong kind circulating in your blood over a long period of time.

Cholesterol is carried around in the blood by little “couriers” called lipoproteins.

The Two Main Types — Explained Simply

LDL — often called “bad” cholesterol

Low-density lipoprotein makes up most cholesterol and is considered “bad” because it can stick to the walls of arteries and cause a fatty build-up called plaque. Too much plaque leads to blockages that prevent blood from flowing properly to the heart.

HDL — often called “good” cholesterol

High-density lipoprotein is healthy because it carries LDL away from the arteries and back to the liver, where it is broken down and passed as waste.

Triglycerides

A third type of fat in your blood, separate from cholesterol but measured at the same time. High triglycerides are linked to increased heart disease risk, particularly when combined with low HDL or high LDL.

Why This Matters So Much After 60

Around 45,000 Australians died from cardiovascular disease in 2022 — representing approximately 1 in 4 deaths nationally. Approximately 120 Australians die every day from cardiovascular disease, roughly one person every 12 minutes.

Approximately half of all adult Australians have a blood cholesterol level above 5 mmol/L, making high blood cholesterol a major health concern in Australia.

The genuinely important thing to understand is that cardiovascular disease develops over decades — there can be a long period between when plaque buildup starts and when a heart attack or stroke happens. Checking and understanding your numbers is critical.

This means the cholesterol level you have right now reflects years — sometimes decades — of accumulated risk. It also means that managing it now genuinely matters, regardless of your age.

What the New 2026 Guidelines Actually Changed

In March 2026, the American College of Cardiology and American Heart Association released significant updated guidelines that are already shaping how doctors think about cholesterol management worldwide, including in Australia.

The biggest shift — thinking beyond a single number

The 2026 guidelines represent a shift away from the binary “good vs. bad” cholesterol labels and toward a more precise understanding of unhealthy lipoprotein particles, cumulative lifetime risk, and individual biological history.

Lower targets for higher risk individuals

The updated guidelines include lower LDL targets for higher-risk individuals, reflecting growing evidence that “lower for longer” genuinely reduces the buildup of plaque and the subsequent risk of heart disease, stroke, kidney disease, and peripheral vascular disease.

A new emphasis on Lipoprotein(a) — a one-time test worth knowing about

A significant new recommendation is one-time screening for lipoprotein(a) — known as Lp(a) — to uncover hidden cardiovascular risk that standard cholesterol tests can miss.

Lp(a) is largely genetically determined and measured just once in a lifetime. If elevated, it acts as a risk-enhancing factor that should prompt more aggressive management of other modifiable risk factors — though it isn’t directly treatable with currently available standard therapies.

A new, more personalised risk calculator

The guidelines recommend a new cardiovascular disease risk calculator called PREVENT, which helps estimate the likelihood that adults aged 30 to 79 will develop cardiovascular disease — incorporating factors like body mass index, cholesterol levels, and tobacco use to calculate both 10-year and 30-year risk.

Worth knowing if you’re in Australia: Australian prescribing, PBS eligibility, and local clinical practice may differ from the American guidelines — access to newer medications depends on PBS criteria, specialist review, and individual patient context. Talk to your GP about how these updated international guidelines apply to your specific situation in Australia.

A Common Worry — Does Lowering Cholesterol Affect Memory or Brain Function?

This is a genuinely common concern, particularly given how important cholesterol is for brain function.

The 2026 guidelines are firm on this point — cholesterol-lowering treatment does not cause dementia. In fact, by protecting the small blood vessels in the brain from plaque buildup, these treatments often help prevent vascular dementia and cognitive decline.

When to Get Tested

If you are 45 or older — or 30 or older if you are Aboriginal or Torres Strait Islander — see your doctor for a cholesterol test as part of a Heart Health Check.

If you have a strong family history of heart disease, your doctor may recommend earlier and more comprehensive screening, including checking lipoprotein(a) and identifying risk at a younger age.

High cholesterol generally doesn’t have obvious symptoms — which is exactly why regular testing matters, regardless of how well you feel.

What Healthy Cholesterol Levels Look Like

Your GP will interpret your specific results in the context of your overall cardiovascular risk — but as a general guide:

If you have cardiovascular risk factors such as high blood pressure, pre-existing cardiovascular disease, diabetes, or you smoke, the aim for LDL cholesterol levels is generally less than 2 mmol/L.

Important note: Target levels vary significantly based on your individual risk profile — age, family history, existing conditions, and lifestyle factors all influence what your GP will consider a healthy target for you specifically. There is no single number that applies to everyone, which is exactly why a proper Heart Health Check with your GP matters more than comparing numbers with friends or family.

What Genuinely Helps Lower Cholesterol

Diet — what the evidence actually supports

A heart healthy eating pattern includes a variety of healthy protein sources, especially fish and seafood, legumes such as beans and lentils, nuts and seeds. Smaller amounts of eggs and lean poultry can also be included. If choosing red meat, make sure it’s lean and limit to 1-3 times a week.

Choose unflavoured milk, yoghurt, and cheese — reduced fat options if you have high cholesterol — and healthy fat choices like nuts, seeds, avocados, olives and their oils for cooking. Use herbs and spices to flavour food instead of adding salt.

Eating foods that contain plant sterols can also help lower high cholesterol — these are cholesterol-like substances that occur naturally in fruits, vegetables, nuts, and cereals in small amounts.

Physical activity

According to leading cardiology researchers — physical activity remains one of the most powerful, evidence-based ways to improve heart health, supporting both longevity and quality of life at every stage.

As I wrote in why walking is the best exercise for retirees — even something as simple and accessible as regular walking provides genuine cardiovascular benefit.

Other lifestyle factors:

Maintaining a healthy weight, avoiding tobacco products, and prioritising sleep all contribute meaningfully to cardiovascular health alongside diet and exercise.

When Lifestyle Changes Aren’t Enough — Medication

It’s worth being honest about something many people don’t realise:

Most people cannot typically “eat their way” to significantly lower cholesterol — much of the cholesterol in your body is actually made by your liver, not just absorbed from food.

This isn’t meant to discourage healthy eating — diet absolutely matters and contributes meaningfully. But for many people, particularly those with a genetic tendency toward high cholesterol, medication becomes a necessary part of management alongside lifestyle changes, not instead of them.

Statins — the most common treatment

Statins are the most common medication used to lower blood cholesterol. They slow the amount of cholesterol made in your liver, so the liver uses cholesterol already in your blood instead — lowering the level of LDL cholesterol.

Some people get muscle aches from statins. However, diet and exercise remain important even if you are taking medication.

If statins aren’t enough on their own

Additional medications exist if needed, including Ezetimibe, which blocks cholesterol absorption in the gut, PCSK9 Inhibitors, which are injectable medications that supercharge the liver’s ability to clear LDL particles, and Bempedoic Acid, which lowers liver cholesterol production and inflammation.

The honest reassurance: If statins do not lower your cholesterol enough, you may need additional medicines, and your doctor may refer you to a specialist who treats cardiovascular disease. Needing additional medication isn’t a personal failing — cholesterol management is genuinely individual, and your GP will work with you to find what’s right for your specific situation.

Questions Worth Asking Your GP

• What is my actual cardiovascular risk based on my full profile, not just my cholesterol number?
• Should I have a one-time Lp(a) test given the new 2026 guidelines?
• What target should I be aiming for given my specific risk factors?
• Are there specific dietary changes that would make the biggest difference for me?
• If I’m prescribed a statin, what side effects should I watch for?
• How often should my cholesterol be retested?

The Bottom Line

Cholesterol management has become more sophisticated and more personalised under the new 2026 medical guidelines — moving away from one-size-fits-all targets toward genuinely individual risk assessment.

The fundamentals remain the same as ever: regular testing, a heart healthy diet, regular physical activity, and an honest conversation with your GP about your individual risk and treatment options.

High cholesterol generally has no symptoms — which is exactly why a Heart Health Check matters, regardless of how well you currently feel.

Have you had a Heart Health Check recently? What did you learn? Share your experience in The Good Years Club community 💙

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