Understanding Your Cholesterol Level

Cholesterol, a waxy, fat-like substance, is naturally present in cell walls or membranes everywhere in the body. Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. If you have too much cholesterol in your bloodstream, the excess may be deposited in the arteries of the heart, which could lead to heart disease.

A simple blood test checks your cholesterol levels. This test measures total cholesterol, low-density lipoproteins (LDL) cholesterol, high-density lipoproteins (HDL) cholesterol, and triglycerides in your blood. Your doctor will interpret your blood test results to determine if you have high cholesterol.

Cholesterol is measured in milligrams per deciliters (mg/dL) of blood.

Total cholesterol is the sum of all the cholesterol in your blood. Your risk for heart disease is greater with higher levels of total cholesterol. If your total cholesterol level falls into the high-risk category, your risk of heart disease is twice that of someone with the same risk factors, whose total cholesterol level is 200 mg/dL or less.

Your total cholesterol will fall into 1 of 3 categories. However, the risk of cardiovascular disease associated with these levels of cholesterol and triglycerides will depend upon the presence or absence of other risk factors, such as the presence of known cardiovascular disease (eg, prior heart attack or stroke), hypertension, diabetes, cigarette smoking, age, sex, and positive family history. Thus, cardiovascular risk and treatment options must be considered in light of your overall cardiovascular risk profile.

• Desirable – Less than 200 mg/dL
  
  
• Borderline High Risk – 200-239 mg/dL
  
  
• High Risk – 240 mg/dL and above

LDL cholesterol is considered the “bad” cholesterol. Your risk of heart disease goes up if you have a high level of LDL cholesterol in your blood.

Your LDL cholesterol level will fall into 1 of 5 categories:

• Optimal – Less than 100 mg/dL
  
  
• Near Optimal/Above Optimal – 100-129 mg/dL
  
  
• Borderline High – 130-159 mg/dL
  
  
• High – 160-189 mg/dL
  
  
• Very High – 190 mg/dL and above

HDL cholesterol is considered the “good” cholesterol because it helps keep cholesterol from building up in the walls of your arteries. A high level of HDL cholesterol may protect you against heart disease, whereas a low level of HDL cholesterol is considered to be a major risk factor for heart disease. 

Your HDL cholesterol level will fall into 1 of 3 categories:

• High (Desirable) – 60 mg/dL and above
  
  
• Acceptable – 40-59 mg/dL
  
  
• Low – 40 mg/dL and less

Triglycerides are a form of fat carried through the bloodstream. A high level of triglycerides may be a sign of a lipoprotein problem that contributes to heart disease.

Your triglyceride level will fall into 1 of 4 categories:

• Normal – Less than 150 mg/dL
  
  
• Borderline High – 150-199 mg/dL
  
  
• High – 200-499 mg/dL
  
  
• Very High – 500 mg/dL and above

Because high levels of total cholesterol are associated with an increased risk of heart disease, you and your doctor will discuss any treatment that may be required based on your test results.

If you have high cholesterol, the main goal of a treatment program is to lower your LDL cholesterol level. There are 2 main ways to lower your LDL cholesterol level:

• Lifestyle changes include a low-saturated fat, low-cholesterol diet; exercise; and weight loss if you are overweight.
  
  
• Drug treatment is used in conjunction with lifestyle changes. Your doctor may add a cholesterol-lowering medicine to your treatment program if lifestyle changes alone do not lower your LDL cholesterol level.

If you have high triglycerides, in some circumstances, lowering these may become the main goal of treatment. There are 2 main ways to lower your triglycerides:

• Lifestyle changes include a low carbohydrate diet, exercise, and weight loss.

• Drug treatment may be used in conjunction with lifestyle changes. Your doctor may add a triglyceride-lowering medicine to your treatment program if lifestyle changes alone do not lower your LDL cholesterol level.

You should also control any other risk factors that could affect your LDL cholesterol and triglyceride levels, such as high blood pressure and diabetes. You should quit cigarette smoking if you smoke.

|Web Links|

High Cholesterol
 
American Heart Association
 
National Cholesterol Education Program, Live Healthier, Live Longer – Cholesterol Counts for Everyone
 
National Cholesterol Education Program, Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
 
High Blood Cholesterol – What You Need to Know
 
MEDLINEplus Health Information, US National Library of Medicine and National Institutes of Health, Cholesterol

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Author: Gary E Sander, MD, PhD, Professor, Department of Internal Medicine, Division of Cardiology, Louisiana State University School of Medicine and Medical Center.

Coauthor(s): Lauri Graham, Medical Writer, .com, Inc.

Editors: Alan D Forker, MD, Program Director of Cardiovascular Fellowship, Professor of Medicine, Department of Internal Medicine, University of Missouri at Kansas City School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Michael E Zevitz, MD, Clinical Assistant Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science, Chicago.