The short answer: for most people the next step after a high cholesterol result isn't another blood test; it is your QRISK3 score, because NICE decides on treatment from your overall 10-year risk, not cholesterol alone. Your GP can manage most of this for free. Extra tests earn their place in three situations: total cholesterol above 7.5 mmol/L (ask about familial hypercholesterolaemia), heart disease before 60 in your family or a borderline risk score (ask about lipoprotein(a)), and high triglycerides, diabetes or obesity (ApoB adds most).
A routine NHS lipid profile (no fasting needed for most people, NICE NG238) usually reports:
What it does not include: lipoprotein(a), ApoB, HbA1c or fasting insulin, unless your GP adds them. For more on each marker, see cholesterol blood test UK.
Work down the list and stop at the first step that applies. This follows NICE, HEART UK and ESC/EAS guidance; it is not a diagnosis, and your GP's advice comes first.
Blood tests are not the next step. See your GP, or call 999 for chest pain that is severe or doesn't settle.
Go to: your GPNICE advises considering familial hypercholesterolaemia (FH) in adults above this level, especially with premature heart disease in the family (NICE CG71). FH is assessed on the NHS, including genetic testing and testing of relatives. A private panel is not the route.
Ask your GP: "Could this be FH?"NICE recommends offering a statin for primary prevention when your 10-year risk is 10% or more (NICE NG238). If you don't know your score, ask for it. Tell your GP if a parent or sibling had angina or a heart attack before 60, because QRISK3 counts it (Hippisley-Cox et al., BMJ, 2017).
Ask your GP: "What is my QRISK3?"HEART UK recommends measuring lipoprotein(a) once in people with a personal or family history of premature cardiovascular disease, or a borderline increased (under 15%) 10-year risk (Cegla et al., Atherosclerosis, 2019). Lp(a) is inherited and isn't in the standard NHS panel. A high result can tip a borderline decision.
Next test: Lp(a), onceIn these groups LDL cholesterol can understate the number of plaque-causing particles. The ESC/EAS 2019 guidelines recommend ApoB for risk assessment particularly in people with high triglycerides, diabetes, obesity or metabolic syndrome (Mach et al., European Heart Journal, 2020). HbA1c and fasting insulin show whether insulin resistance is part of the picture.
Next tests: ApoB, HbA1c, fasting insulinYour GP will recheck your lipids, and NICE looks for a reduction in non-HDL cholesterol of more than 40% at around three months (NICE NG238). That monitoring is free and routine; private testing rarely adds anything here.
Go to: your GP's routine reviewLifestyle changes and a repeat test in the timeframe your GP suggests are usually enough. Lp(a) once in a lifetime is still reasonable (ESC/EAS 2019 recommends it for every adult), but it isn't urgent.
Optional: Lp(a) onceYou want Lp(a), which the NHS rarely measures and you only need once · your triglycerides are high or you have diabetes and want ApoB · you want HbA1c, fasting insulin, liver and thyroid read alongside your lipids · you want a result to take to your GP to support a conversation about family history.
You'd only be repeating the lipid profile your GP already did · you're being assessed for FH or are under a lipid clinic · you have symptoms that need examining · you're on a statin and due a routine review. In these cases your GP is the better, cheaper route.
Checked on each provider's own website on 15 October 2026. "Not listed" means the marker did not appear on the product page we checked.
| Provider and test | Price | Lp(a) | ApoB | HbA1c | Fasting insulin | Collection |
|---|---|---|---|---|---|---|
| TrueVitals Ultimate (140 markers) | £349 + £19 clinic draw or £39 home visit | Yes | Yes | Yes | Yes, + HOMA-IR | Venous only, clinic or home visit |
| Medichecks Lipoprotein (a) Blood Test | £59 | Yes | Not listed | Not listed | Not listed | Not stated on listing |
| Forth Advanced Cholesterol Home Test Kit | £89 | Yes | Yes | Not listed | Not listed | Finger-prick free; AutoDraw +£20; nurse +£59; clinic +£45 |
| Thriva Lp(a) Cardiovascular Risk Profile | £108 (nurse +£60) | Yes | Yes (apolipoproteins) | Not listed | Not listed | Autodraw device |
| Medichecks Optimal Health Blood Test | £249 | Yes | Yes | Yes | Not listed | Venous: self-arranged, clinic +£35, nurse +£59 |
| Lola Health Peak Insights 70 | £200 own phlebotomist; £235 clinic or home | Not listed | Yes | Yes | Not listed | Venous |
Prices checked October 2026. Sources: medichecks.com (Specialist Tests collection, Optimal Health Blood Test); forthwithlife.co.uk Advanced Cholesterol Home Test Kit; thriva.co Lp(a) Cardiovascular Risk Profile; lolahealth.com/products/peak-insights. Panels change; confirm before you buy. More: UK blood test companies compared.
Your GP, most of the time. Your lipid profile, QRISK3, FH assessment and statin monitoring are all free on the NHS, and your GP is the person who can prescribe. See NHS vs private blood tests.
Just Lp(a) or ApoB. Medichecks' £59 Lp(a) test or Forth's £89 Advanced Cholesterol kit (Lp(a) and ApoB, finger-prick option) cost far less than a full panel. See Medichecks alternative and Forth alternative.
You want a home kit. TrueVitals has no finger-prick kit; every sample is a venous draw, and you book your clinic or home visit by phone after payment.
Where TrueVitals fits. If you're in step 4 or 5 above and want Lp(a), ApoB, HbA1c and fasting insulin in one sample, with liver, kidney and thyroid markers that matter if you start a statin, Ultimate covers them and a clinician reviews a written report of every result. We're newer than Medichecks or Forth; see a sample report. If heart disease runs in your family, read family history of heart disease: the tests to ask for.
First, make sure your GP has calculated your QRISK3 score, because NICE uses it (not cholesterol alone) to decide on treatment (NICE NG238). If your total cholesterol is above 7.5 mmol/L, ask whether familial hypercholesterolaemia should be considered (NICE CG71). If you have a family history of heart disease before 60, or your risk is borderline, ask about lipoprotein(a), which HEART UK recommends measuring once in those situations. ApoB helps most when triglycerides are high or you have diabetes or obesity.
Non-HDL cholesterol is total cholesterol minus HDL: all the cholesterol carried in particles that can cause plaque. It is already on most NHS lipid reports. NICE uses it to monitor treatment, looking for a reduction of more than 40% from baseline about three months after starting a statin (NICE NG238).
ApoB counts the number of plaque-causing particles, while LDL cholesterol measures how much cholesterol they carry. For most people the two tell the same story. They can disagree when triglycerides are high or in diabetes, obesity and metabolic syndrome, which is why the ESC/EAS 2019 guidelines recommend ApoB particularly in those groups (Mach et al., European Heart Journal, 2020). It is not routinely measured in NHS primary care.
Usually not. NICE does not require a fasting sample for a routine lipid profile (NICE NG238). If your triglycerides come back very high your GP may repeat the test fasting. Fasting does matter for some other markers, such as fasting insulin; see fasting before a blood test.
Often not. Repeating the same lipid profile privately adds little: your GP already has the numbers and the QRISK3 score that NICE uses to decide on treatment. Private testing is worth it for the markers the NHS rarely measures, mainly lipoprotein(a) (once in a lifetime) and ApoB, or if you want the wider metabolic picture such as HbA1c and fasting insulin.
That is a decision to make with your GP. NICE recommends offering a statin for primary prevention when 10-year risk is 10% or more, after discussing lifestyle changes and your preferences (NICE NG238). Extra test results, such as a high Lp(a), can be useful in that conversation, but they do not replace it.
Ultimate adds Lp(a), ApoB, HbA1c and fasting insulin to your cholesterol, with a clinician-reviewed report within 4 working days. 140 biomarkers (139 for women), £349 plus £19 clinic draw or £39 home visit.
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