Understanding Cholesterol Numbers: What’s Healthy, What’s Not

High cholesterol occurs when there is too much “bad” fat in the blood. “Having high cholesterol is associated with heart disease. This has been studied for decades,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital. Knowing your cholesterol numbers is an important way you can lower your risk of heart disease.

The first step to knowing your cholesterol numbers is to get your cholesterol checked. The second is to understand what your cholesterol test result means for your health, so if it’s not within an ideal range, you can do something about it.

What Your Cholesterol Numbers Mean

“When we’re talking about the cholesterol profile, it consists of several different numbers,” says Dr. Knoepflmacher. These numbers are LDL, HDL, triglycerides, and total cholesterol.

LDL (low-density lipoprotein) cholesterol

LDL cholesterol is considered a “bad” type of cholesterol. It contributes to fatty buildup in the arteries (atherosclerosis), which can increase your risk of heart attack and stroke. “[With] LDL, which is the bad cholesterol, generally, the lower the better,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center.

• Ideal LDL cholesterol: Less than 100 mg/dL (particularly if patients are diabetic, or have vascular disease or heart disease)
• Normal LDL cholesterol: Between 100 and 129 mg/dL
• Borderline high LDL cholesterol: Between 130 and 159 mg/dL
• High LDL cholesterol: Between 160 and 189 mg/dL
• Very high LDL cholesterol: Greater than 190 mg/dL

“We very much worry about patients who have an LDL above 190,” says Dr. Bloom.

HDL (high-density lipoprotein) cholesterol

HDL cholesterol is “good” protective cholesterol; the higher your levels, the better off your heart. HDL is a bit of a cholesterol hero. It stops LDL in its tracks and takes it to the liver where it’s broken down and removed from the body.

• Ideal HDL cholesterol: Greater than 60 mg/dL
• Too-low HDL cholesterol: Less than 40 mg/dL

“A level of less than 40 concerns us, because we usually consider that to be a risk factor for the development of heart disease” says Dr. Bloom.

Triglycerides

Triglycerides aren’t cholesterol per se, but they are are form of fat in the blood that also increases your risk of heart disease, especially in women. “Anything less than 150 is typically suggested and recommended,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital.  

• Ideal triglyceride level: less than 150 mg/dL
• Borderline high triglyceride level: Between 150 and 199 mg/dL
• High triglyceride level: Greater than 200 mg/dL

Total cholesterol

Total cholesterol is a sort of “cholesterol score.” It’s calculated by adding your LDL and HDL, and 20% of your triglyceride level. “In general for an average risk person, we want the total cholesterol to be less than 200,” says Dr. Knoepflmacher.

• Ideal total cholesterol: Less than 200 mg/dL
• Borderline high total cholesterol: Between 200 and 239 mg/dL
• High cholesterol: More than 240 mg/dL

How to Treat High Cholesterol

High cholesterol can be treated with medication, but not everybody with elevated cholesterol needs drugs to lower cholesterol, especially at first, says Dr. Bloom. “Depending on the level and depending on your risk factors, sometimes we can have a patient change their lifestyle.”

Ways to lower cholesterol through lifestyle changes include maintaining a heart-healthy diet (like decreasing your saturated fat intake and eating more fiber), quitting smoking, and losing weight (if you need to). Here’s why exercise is a secret weapon for healthier cholesterol levels.

“If [cholesterol is] really high or we’re worried about their increased risk because of diabetes or high blood pressure, we will immediately start them on a medication to lower their cholesterol,” says Dr. Bloom.

Now that you’ve brushed up on your cholesterol smarts, test your knowledge with this cholesterol quiz.