Should I be worried about a mildly elevated cholesterol if everything else looks fine?

Even a mildly elevated cholesterol can trigger early changes in the vessel wall. Mouse studies show that even with mildly elevated cholesterol, certain cells in the outer layer of the large blood vessels become more active and produce more connective tissue. What this means exactly for humans over the long term is still unclear, but it does suggest that 'mildly elevated' is not the same as 'harmless'.

Whether you really need to worry depends strongly on what else your blood test results show. Triglycerides are a good example: moderately elevated triglycerides (roughly 2 to 10 mmol/l) are associated with a higher risk of cardiovascular disease. But that risk is closely intertwined with other factors, such as your HDL cholesterol (the 'protective' cholesterol) and whether you have insulin resistance. Triglycerides alone therefore say little; it is the overall picture that matters.

A common misconception is that a normal LDL cholesterol means everything is fine. That is not always true. People with an elevated level of a specific lipoprotein called lipoprotein(a) carry an extra risk of heart attack or stroke even when their LDL appears to be well controlled. This lipoprotein is not always measured as standard, but it can genuinely make a difference. Have it measured if cardiovascular disease runs in your family.