What Is Total Cholesterol?

Get the Facts About Total Cholesterol and Your Heart

Test tube filled with blood and cholesterol test form document. Credit: GIPhotoStock / Getty Images

Total cholesterol is the total amount of cholesterol in your blood. Your total cholesterol includes low-density lipoprotein (LDL, or “bad”) cholesterol and high-density lipoprotein (HDL, or “good”) cholesterol.

What Are Lipoproteins?

The LDL and HDL lipoproteins are tiny “packages” in your blood, with fat (lipid) on the inside and proteins on the outside, that carry cholesterol throughout your body.

  • Cholesterol is a waxy, fat-like substance found in every cell in your body.

What Makes Lipoproteins “Good” or “Bad”?

HDL, the good cholesterol.  You hear a lot about keeping your cholesterol low. But in the case of the HDL component of total cholesterol, the higher your level, the better. The problem is, it can be hard to keep your HDL levels high. That’s because it’s often hard to control lifestyle factors that can lower it, including type 2 diabetes, being overweight, not getting enough exercise, and smoking. Genetic factors can also play a role.

LDL, the bad cholesterol.  This “bad boy” of the cholesterol family needs to be kept at the lowest level you and your doctor can achieve. Although statin medications can help, your diet matters, too: LDL cholesterol goes up if your diet is high in saturated and “trans” fat, also called trans fatty acid. (This is the manufactured fat used to increase food products’ shelf life and flavor stability.)

And then there's triglyceride,  the most common type of fat in your body.  It’s not cholesterol. But it’s measured because, when it’s high and so is your LDL, or when it’s high and your HDL is low, the scene is set for development of atherosclerosis – buildup of fatty “plaques” on artery walls – and increased risk of heart disease (and stroke).


How Is Total Cholesterol Measured?

This is done using a blood test called a lipoprotein panel, which also measures your triglycerides.  For this test, you provide a blood sample that’s taken after you’ve fasted (not eaten anything and drunk only water) for 9 to 12 hours before your test.

Your total cholesterol score is calculated using the equation: HDL level + LDL level + 20% of your triglyceride level. 

“Why Do I Need to Be Tested for Total Cholesterol?”

Keeping total cholesterol levels within a healthy range is important for people of all ages, whether they have heart disease or not.  If, like many people, you have high blood cholesterol and don’t know it, the only way you can find out is by having your blood tested. Why? Because, by itself, high blood cholesterol doesn’t cause symptoms. That’s why, if you’re age 20 years or older, you should have your cholesterol tested at least every 5 years.

Understanding Total Cholesterol Test Results

Test results for total cholesterol are expressed in milligrams per deciliter (mg/dL) of blood and ranked as follows:

  • Desirable level: Less than 200 mg/dL
  • Borderline high level: 200-239 mg/dL
  • High level: 240 mg/dL and above

What Does a Total Cholesterol Test Result Tell You?

As you've seen, your total cholesterol level reflects your risk for heart disease. In general, the higher the level, the higher your risk. So why does the test also measure the lipoproteins in your total cholesterol as well as your triglycerides?

  • LDL (“bad”) cholesterol is the main “engine” of cholesterol buildup and blockage in your arteries.
  • HDL (“good”) cholesterol helps prevent heart disease by removing cholesterol from your arteries and sending it to your liver for elimination. 
  • As you've seen, triglyceride is another form of fat in your blood that can increase your heart disease risk.

If your total cholesterol is too high, your doctor may recommend lifestyle changes and/or medications to lower it.



“What is cholesterol?” National Heart, Lung, and Blood Institute (2016).

“What your cholesterol levels mean.” American Heart Association (2014).  

“Cholesterol levels: what you need to know.” National Institutes of Health: MedlinePlus (2012).

“High blood cholesterol: what you need to know.” National Heart, Lung, and Blood Institute (2005).  

“Triglycerides: why do they matter?” Mayo Clinic (2015).   

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