Interpreting Your Cholesterol Test

A cholesterol test can help you understand your risk of heart disease

Pills on the results of blood testing, including testing for cholesterol
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A lipid or cholesterol panel is a blood test used to determine the amount of fat in your blood, and measuring blood fats is an important tool in determining your risk of heart disease

There are four major fat components that will be listed on your lipid panel:

  • Total cholesterol
  • Low-density lipoprotein (LDL)
  • High-density lipoprotein (HDL)
  • Triglycerides

But what exactly are these fats, and what do your specific results mean?

Here are the basics on how to interpret your cholesterol panel and what it means for your heart health. 

Total Cholesterol Levels

One of the readings you will see from your laboratory results is a number called "total cholesterol," which tells you the total number of fats you have in your blood.

According to the  National Heart, Lung, and Blood Institute, a desirable total cholesterol level is less than 200 mg/dL. Levels between 200 mg/dL and 239 mg/dL are considered borderline for high cholesterol while levels at or above 240 mg/dL are considered high. 

Of course, it's important to note that you should not determine your cholesterol levels just by your total cholesterol level. Instead, your cholesterol level needs to be further broken down into LDL, HDL, and triglycerides in order to give you insight into your risk for heart disease.

High-Density Lipoproteins

High-density lipoproteins, or  HDL, are considered to be the "good cholesterol", because HDL’s role in the body is to take cholesterol to the liver for degradation or processing, as opposed to allowing the cholesterol to hang around in the blood.

This is why having a high HDL level is considered good. In fact, levels above 60 mg/dL are believed to actually protect against heart disease. 

HDL levels between 40 and 59 mg/dL are considered an acceptable level, with the higher the level the better. An HDL level below 40 mg/dL. In this case, a low HDL level is a major risk factor for heart disease.

Genetics can play a role in HDL, and women tend to have higher HDL levels than men. That said, a sedentary lifestyle and smoking are two classic factors that contribute to a low HDL level and are within your control, unlike your genetic makeup or your gender.

Triglycerides

Elevated triglycerides also raise your risk for heart disease. A borderline triglyceride level is one that is between 150 to 199 mg/dL while a high triglyceride level is one that is 200mg/dL or higher. 

While certain genetic conditions or medications may cause some people to have high triglyceride levels, the vast majority have elevated levels due to poor lifestyle habits like eating very high carbohydrate-rich diets, drinking too much alcohol, smoking cigarettes, and not exercising—and of course, this leads to being overweight or obese. 

Low-Density Lipoproteins

Low-density lipoproteins, also known as LDLs, are considered the "bad cholesterol". This type of lipoprotein circulates from the liver to other organs and tissues in the body, carrying cholesterol where it is needed. LDL contributes to fat build-up in a person's arteries, which can eventually lead to narrowing and blockage of the arteries, causing a heart attack or stroke.

The current guidelines for LDL levels are:

  • LDL levels less than 100 mg/dL are considered optimal.
  • LDL levels between 100 to 129 mg/dL are considered near or above optimal.
  • LDL levels between 130 to 159 mg/dL are considered borderline high.
  • LDL levels between 160 to189 mg/dL are considered high.
  • LDL levels at or above 190 mg/dL are considered very high.

In general, a diet high in "bad" fats like saturated fats (for example, butter and red meat) and trans fats (for example, fried foods and baked goods) contributes to a high LDL level among other factors like genetics and a lack of physical activity. 

Optimal LDL Level

While the LDL levels mentioned above are slotted into neat categories, doctors do not use those ranges anymore—they have changed their approach, so to speak. Instead of targeting a specific LDL number (for example, raising someone's cholesterol medication until their LDL is less than 130mg/dL), doctors now treat the person and their overall "heart" health.

In other words, doctors use a person's LDL level as one factor in accessing their overall risk of having a heart attack or stroke. Based on that overall risk for cardiovascular disease, a doctor may recommend lifestyle behaviors and sometimes a cholesterol-lowering medication (called a statin). 

Examples of heart-healthy lifestyle behaviors include:

  • Eating a diet low in saturated fats (and zero trans fats)
  • Exercising daily
  • Avoiding smoking 

A Word From Verywell

Getting your cholesterol levels checked is an important part of your preventive care. In fact, according to the  American Heart Association, every person aged 20 and older shoulder get their cholesterol levels checked every four to six years (and more often, if you have a history of heart disease or are taking a statin.)  

Sources:

American Heart Association. (2017). What Your Cholesterol Levels Mean. 

National Heart, Lung, and Blood Institute. (2016). What Is Cholesterol?

Stone N et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 

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