What cholesterol numbers mean?

Cholesterol Numbers: What Do They Mean

Cholesterol in the blood and blood vessel.

What is total blood cholesterol?

Your total blood cholesterol is a measure of the cholesterol components LDL (low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, and VLDL (very low-density lipoprotein, which is the triglyceride-carrying component of lipids). Total cholesterol values cannot be interpreted in the absence of the cholesterol components listed below.

What are the kinds of cholesterol?

LDL (low density-lipoprotein) cholesterol is also called “bad” cholesterol. LDL can build up on the walls of your arteries and increase your chances of getting heart disease. If you do not have heart or blood vessel disease and are not at high risk for developing heart disease, the following guidelines apply.

Your LDL cholesterol number is:

  • Optimal if it is less than 100.
  • Near optimal/above optimal if it is 100-129.
  • Borderline high if it is 130-159.
  • High if it is 160-189.
  • Very high if it is 190 or above.

The treatment goal for individuals with heart disease or blood vessel disease is to reach an LDL of less than 70. The treatment goal for high-risk individuals (those with diabetes or other multiple risk factors for heart disease) is to reach an LDL of at least less than 100.

HDL (high-density lipoprotein) cholesterol is also called “good” cholesterol. HDL protects against heart disease by taking the bad cholesterol out of your blood and keeping it from building up in your arteries. Your HDL cholesterol number is:

  • Low (and considered a risk factor) if it is less than 40.
  • Good (and able to help lower your risk of heart disease) if it is 60 or more.

Triglycerides are the chemical form in which most fat exists in food and the body. Triglycerides are mostly carried in VLDL and chylomicrons. VLDL comes from the liver and also has cholesterol. Chylomicrons come from dietary fat.

Along with cholesterol, triglycerides form plasma lipids. Excess triglycerides in plasma have been linked to the occurrence of coronary artery disease in some people. Like cholesterol, increases in triglyceride levels can be detected by plasma measurements. These measurements should be made after an overnight food and alcohol fast. Your triglyceride numbers are:

  • Normal if they are less than 150.
  • Borderline high if they are 150-199.
  • High if they are 200-499.
  • Very high if they are 500 or higher.

Who should get a cholesterol screening?

Everyone over the age of 20 should get their cholesterol levels measured at least once every 5 years. The test that is performed is a blood test called a lipoprotein profile. That includes:

  • Total cholesterol level
  • HDL
  • Triglycerides

LDL level is calculated from the above 3 values.

What affects cholesterol levels?

A variety of factors can affect your cholesterol levels. They include:

  • Diet: Saturated fat, trans fat and cholesterol in the food you eat increase cholesterol levels. Try to reduce the amount of saturated fat, trans fat and cholesterol in your diet. This will help lower your blood cholesterol level. Saturated fat and trans fat have the most impact on blood cholesterol.
  • Weight: In addition to being a risk factor for heart disease, being overweight can also increase your triglycerides. Losing weight may help lower your triglyceride levels and raise your HDL.
  • Exercise: Regular exercise can lower total cholesterol levels. Exercise has the most effect on lowering triglycerides and raising HDL. You should try to be physically active for 30 minutes on most days.
  • Age and gender: As we get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, women’s LDL levels tend to rise and HDL can drop.
  • Heredity: Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

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Understanding your cholesterol levels

Maintaining healthy cholesterol levels is a great way to keep your heart healthy. It can lower your chances of getting heart disease or having a stroke.

But first, you have to know your cholesterol numbers.

The American Heart Association recommends

All adults age 20 or older should have their cholesterol (and other risk factors) checked every four to six years. Work with your doctor to determine your risk for cardiovascular disease and stroke.

Learn how to get your cholesterol tested

Your test results: A preview

Your test results will show your cholesterol levels in milligrams per deciliter of blood (mg/dL). Your total cholesterol and HDL (good) cholesterol are among numerous factors your doctor can use to predict your lifetime or 10-year risk for a heart attack or stroke. Your doctor will also take other risk factors into account, such as age, family history, smoking and high blood pressure.

Lipid profile or lipid panel is a blood test that will give you results for your HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and your total blood (or serum) cholesterol.

Watch an animation about cholesterol score.

HDL (good) cholesterol

For many years, doctors used ranges to evaluate HDL (good) cholesterol levels. Today, doctors think about risk in broader terms. They evaluate HDL cholesterol levels in context, along with other risk factors.

People with high blood triglycerides usually also have lower levels of the good kind of cholesterol, or HDL. Genetic factors, type 2 diabetes, smoking, being overweight and being sedentary can all lower HDL cholesterol. Women tend to have higher levels of HDL cholesterol than men do.

LDL (bad) cholesterol

Since LDL is the bad kind of cholesterol, a low LDL level is considered good for your heart health.

In the past, doctors relied on specific ranges for LDL. Today, doctors consider LDL levels as one factor among many when evaluating cardiovascular risk. (The latest American Heart Association guidelines endorse this more integrated approach.) Talk to your doctor about your LDL cholesterol level as well as other factors that impact your cardiovascular health.

A diet high in saturated and trans fat is unhealthy because it tends to raise LDL cholesterol levels.

Triglycerides

Triglycerides are the chemical form in which most fats exist – in foods, as well as in our bodies.

Normal triglyceride levels vary by age and sex. People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) cholesterol level and a low HDL (good) cholesterol level. Many people with heart disease or diabetes also have high triglyceride levels.

Several factors can contribute to an elevated triglyceride level, including:

  • Being overweight, or obesity
  • Physical inactivity
  • Cigarette smoking
  • Excess alcohol consumption
  • A diet very high in carbohydrates (more than 60 percent of total calories)
  • These factors can be addressed with lifestyle changes. Underlying diseases or genetic disorders can also cause high triglyceride levels.

Total blood (or serum) cholesterol score

This component of your test results is actually a composite of different measurements. Your total blood cholesterol score is calculated by adding your HDL and LDL cholesterol levels, plus 20 percent of your triglyceride level.

Here again, “normal ranges” are less important than your overall cardiovascular risk. Like HDL and LDL cholesterol levels, your total blood cholesterol score should be considered in context with your other known risk factors.

Your doctor can recommend treatment approaches accordingly.

Learn more about:

  • Your cholesterol score
  • Getting your cholesterol tested
  • Good versus bad cholesterol

Making sense of cholesterol tests

The pros and cons of total cholesterol, HDL, LDL, and triglyceride testing

Updated: January 29, 2020Published: February, 2005

Time to get your cholesterol checked. Okay, but which test should you get? It’s not so simple anymore. Here is a rundown of some of the choices and their pros and cons:

Total cholesterol. This is the simplest and least expensive test. The test doesn’t require any sophisticated lab work, either. The simple, do-it-yourself home cholesterol tests measure total cholesterol.

But total cholesterol includes both “good” high-density lipoprotein (HDL) cholesterol, and the “bad” varieties, chiefly low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL). So, if your total cholesterol is in the desirable category, it’s possible that you may have unhealthy levels of HDL (too low) and LDL and VLDL (too high). Think of total cholesterol as a first glimpse, a peek. Doctors are not supposed to make any treatment decisions based on this number alone.

Cholesterol levels can be lowered by stress (physical or psychological) or infection. An injury, cancer, stroke, or heart attack may have the same effect. So, if your cholesterol levels are unusually high or low, your doctor will probably want to repeat the test some weeks later. Abnormal readings may also lead to tests for other medical problems.

HDL cholesterol. HDL wins its laurels as the “good” cholesterol because it sponges up cholesterol from blood vessel walls and ferries it to the liver for disposal. In contrast, LDL deposits the harmful fat in vessel walls.

An HDL level of 60 or above is associated with a lower risk of heart disease, and below 40 is associated with a higher risk.

Cholesterol: The good and the bad of it

HDL High-density lipoprotein

  • Makes up 20%–30% of total cholesterol
  • The “good” cholesterol
  • Moves cholesterol from arteries to the liver.

LDL Low-density lipoprotein

  • Makes up 60%–70% of total cholesterol
  • Main form of “bad” cholesterol
  • Causes build-up of plaque inside arteries.

VLDL Very-low-density lipoprotein

  • Makes up 10%–15% of total cholesterol
  • With LDL, the main form of “bad” cholesterol
  • A precursor of LDL.

LDL cholesterol. The LDL measurement is usually considered the most important for assessing risk and deciding on treatment. The definition of a healthy level keeps on getting lower. For people at low risk of heart disease, an LDL of less than 100 is desirable, However, people at higher risk of heart disease, an LDL of less than 70 or perhaps even lower is considered “optimal.” Some experts say that an LDL of less than 70 would be a healthy LDL goal for all of us.

Your LDL is computed by plugging the measurements for total cholesterol, HDL, and triglycerides into a: LDL = Total cholesterol – HDL – (Triglycerides ÷ 5). LDL can also be measured directly in a non-fasting blood sample.

You have to fast for about 10 hours before the test because triglyceride levels can shoot up 20%–30% after a meal, which would throw off the equation. Alcohol also causes a triglyceride surge, so you shouldn’t drink alcohol for 24 hours before a fasting cholesterol test.

The numbers to know

Test

Generally desirable level

Total cholesterol

under 200 mg/dL

LDL (bad) cholesterol

under 100 mg/dL

HDL (good) cholesterol

over 60 mg/dL

Triglycerides

under 150 mg/dL

C-reactive protein (CRP) is a protein in the blood that increases with inflammation. Because atherosclerosis is fundamentally an inflammatory process, many experts believe that CRP testing could lead to early detection and therefore save lives. The American Heart Association says CRP tests are most helpful for people at intermediate risk for heart disease, but not those at the low and high ends of the risk spectrum.

You should get a fasting cholesterol test at least once every five years for everyone beginning at age 20. A fasting cholesterol test gives you the important numbers: total, LDL, and HDL cholesterol, as well as triglyceride levels.

For more information, read “11 foods that lower cholesterol.”

Image: blueshot/Getty Images

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