High Cholesterol

In the United States, the following guidelines are used to help evaluate adults at potential risk for developing coronary artery disease based on their cholesterol and triglyceride levels. Four measurements are included:

• Total cholesterol (which is the sum of your LDL + HDL + 20% of the triglyceride level)
• LDL cholesterol
• HDL cholesterol
• Triglycerides

Guidelines for total cholesterol

A blood test called a lipoprotein panel can measure your cholesterol levels. Cholesterol in your blood is measured in milligrams per deciliter (mg/dL).

• Desirable: Below 200 mg/dL
• Borderline High: 200-239 mg/dL
• High: 240 mg/dL and above

Guidelines for LDL cholesterol

LDL cholesterol levels are a bit more complicated as they consider whether the individual has a history of coronary artery disease.

• Desirable: 100-129 mg/dL
  • Below 100 mg/dL - For people with diabetes or are at risk for coronary artery disease; near optimal for people with uncomplicated artery disease
  • Below 70 mg/dL - For individuals with coronary disease
• Borderline high: 130-159 mg/dL
  • (High in individuals with coronary artery disease)
• High: 160-189
  • (Very high for individuals with coronary artery disease)
• Very high: 190 mg/dL and above

Guidelines for HDL cholesterol

These guidelines differ slightly by gender; owing to estrogen production, pre-menopausal women tend to have higher HDL levels than their male peers. As opposed to the LDL cholesterol levels, the higher the level of HDL cholesterol found in the blood, the better.

• At risk: In women, below 50mg/dL
  • In men, below 40 mg/dL
• Better: In women, 50-59 mg/dL
  • In men, 40-59 mg/dL
• Desirable: 60 mg/dL and above

Guidelines for triglycerides

Triglycerides are not a type of cholesterol, but they are part of a lipoprotein panel (the test that measures cholesterol levels).

• Desirable: Below 150 mg/dL
• Borderline high: 150-199 mg/dL
• High: 200-499 mg/dL
• Very high: 500 mg/dL and above

What Your Cholesterol Test Measures

A standard lipid panel measures several types of fats, or lipids, in your blood. For the most accurate results, you are usually asked to fast (drink water only) for 9 to 12 hours before your blood draw.

These fats are transported through the bloodstream by proteins called lipoproteins. A typical lipid panel includes:

• Total Cholesterol: The overall amount of cholesterol in your blood.
• LDL (Low-Density Lipoprotein): Often called "bad" cholesterol.
• HDL (High-Density Lipoprotein): Often called "good" cholesterol.
• Triglycerides: A type of fat used for energy storage.

Together, these overall cholesterol numbers give your doctor a snapshot of your cardiovascular health. However, a modern evaluation often includes calculated values, such as non-HDL, or specialized tests, like ApoB, to provide a more complete view of your heart risk.

LDL Cholesterol (“Bad” Cholesterol): Why Lower Is Usually Better

LDL is often called "bad" cholesterol because it contributes to plaque buildup inside the arteries. Over time, excess LDL particles can narrow and stiffen blood vessels, a process known as atherosclerosis.

For most people, lower LDL levels are associated with a lower risk of heart attack and stroke. However, optimal LDL targets depend on individual risk. Someone with a history of heart disease or stroke may need significantly lower LDL levels than a younger adult without other risk factors.

Age, sex, and race can affect your levels. Cholesterol tends to rise with age, and for women, risk increases significantly after menopause. Additionally, certain racial or ethnic groups, such as Asian Americans, may have a higher predisposition for elevated LDL.

HDL Cholesterol (“Good” Cholesterol): Why It’s Only Part of the Picture

HDL cholesterol helps remove excess cholesterol from the bloodstream and transports it to the liver to get rid of. Higher HDL levels are generally associated with lower cardiovascular risk. While a level of 40–50 mg/dL is a standard starting point, a level of 60 mg/dL or higher is considered optimal for heart protection.

That said, HDL is only one part of the overall picture. Even people with high HDL may be at increased risk if LDL cholesterol or triglycerides are elevated. Smoking, in particular, lowers HDL levels and reduces this protective effect.

Triglycerides: Fat in Your Blood and Metabolic Health

Triglycerides are the most common type of fat in the body and store unused calories for energy. Levels often rise when calorie intake, especially from refined carbohydrates and alcohol, exceeds the body’s needs.

Elevated triglycerides are associated with conditions such as obesity, Type 2 diabetes, and metabolic syndrome, all of which increase cardiovascular risk.

Management often requires a combination of dietary changes and physical activity.

Non-HDL Cholesterol: A Broader Look at “Bad” Cholesterol

Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol. This value reflects all cholesterol particles that can contribute to plaque buildup, not just LDL.

It is a simple way to get a broader look at your risk without needing extra, expensive tests.

Many experts consider non-HDL cholesterol a stronger predictor of cardiovascular risk than LDL alone, particularly in people with elevated triglycerides.

ApoB: Counting the Particles That Raise Risk

ApoB is a protein found on every cholesterol particle capable of causing atherosclerosis. Measuring ApoB allows clinicians to count the number of harmful particles rather than estimating risk based only on cholesterol concentration.

This test is especially useful for people with diabetes, metabolic syndrome, or normal LDL levels but suspected elevated risk.

Important: If you have existing heart disease, diabetes, or multiple risk factors, your doctor may set much more aggressive targets.