It's important to keep your cholesterol levels within healthy limits. And if you have other risk factors for developing heart disease, you need to be even more careful — especially with your low-density lipoprotein (LDL), or "bad," cholesterol level.
Interpreting your cholesterol numbers
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your lipid panel (cholesterol test) results back to see if your cholesterol falls in optimal levels.
| Total cholesterol (U.S. and some other countries) |
Total cholesterol* (Canada and most of Europe) |
|
|---|---|---|
| Below 200 mg/dL | Below 5.2 mmol/L | Desirable |
| 200-239 mg/dL | 5.2-6.2 mmol/L | Borderline high |
| 240 mg/dL and above | Above 6.2 mmol/L | High |
| LDL cholesterol (U.S. and some other countries) |
LDL cholesterol* (Canada and most of Europe) |
|
|---|---|---|
| Below 70 mg/dL | Below 1.8 mmol/L | Optimal for people at very high risk of heart disease |
| Below 100 mg/dL | Below 2.6 mmol/L | Optimal for people at risk of heart disease |
| 100-129 mg/dL | 2.6-3.3 mmol/L | Near optimal |
| 130-159 mg/dL | 3.4-4.1 mmol/L | Borderline high |
| 160-189 mg/dL | 4.1-4.9 mmol/L | High |
| 190 mg/dL and above | Above 4.9 mmol/L | Very high |
| HDL cholesterol (U.S. and some other countries) |
HDL cholesterol* (Canada and most of Europe) |
|
|---|---|---|
| Below 40 mg/dL (men) Below 50 mg/dL (women) |
Below 1 mmol/L (men) Below 1.3 mmol/L (women) |
Poor |
| 50-59 mg/dL | 1.3-1.5 mmol/L | Better |
| 60 mg/dL and above | Above 1.5 mmol/L | Best |
| Triglycerides (U.S. and some other countries) |
Triglycerides* (Canada and most of Europe) |
|
|---|---|---|
| Below 150 mg/dL | Below 1.7 mmol/L | Desirable |
| 150-199 mg/dL | 1.7-2.2 mmol/L | Borderline high |
| 200-499 mg/dL | 2.3-5.6 mmol/L | High |
| 500 mg/dL and above | Above 5.6 mmol/L | Very high |
*Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.
LDL targets differ
Because LDL cholesterol has a major association with heart disease, it's the main focus of cholesterol-lowering treatment. But it's not as simple as the chart may appear. Your target LDL number can vary, depending on your underlying risk of heart disease.
Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L).
So who's considered at very high risk? If you've had a heart attack or if you have diabetes or carotid or peripheral vascular disease, you're at very high risk. In addition, two or more of the following risk factors might also place you in the very high risk group:
- Smoking
- High blood pressure
- Low HDL cholesterol
- Family history of early heart disease
- Age older than 45 if you're a man, or older than 55 if you're a woman
- Elevated lipoprotein (a)
Types of cholesterol
LDL cholesterol can build up on the inside of artery walls, contributing to artery blockages that can lead to heart attacks. Higher LDL cholesterol levels mean higher risk. High-density lipoprotein (HDL) cholesterol is known as "good" cholesterol because it helps prevent arteries from becoming clogged. Higher HDL cholesterol levels generally mean lower risk.
A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:
- Total cholesterol
- HDL cholesterol
- LDL cholesterol
- Triglycerides, a type of fat often increased by sweets and alcohol
For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.
Lifestyle changes
If your LDL cholesterol is too high, the first thing your doctor will probably suggest is lifestyle changes. Eating more soluble fiber, found in oatmeal, beans, fruits and vegetables, and less saturated fat and cholesterol can improve your cholesterol levels.
Being overweight and inactive tends to increase your LDL cholesterol and lower your HDL cholesterol, exactly the opposite of what you want. Exercise and weight loss can help reverse this trend. This is especially important for people who have large waist measurements — more than 40 inches (101.6 centimeters) for men and more than 35 inches (88.9 centimeters) for women — because people with this body shape are more likely to develop heart disease.
Medications may be needed
When lifestyle changes aren't enough to reach your cholesterol targets, your doctor may prescribe medications to help lower your cholesterol levels. These drugs, such as statins, aren't a replacement for lifestyle changes. You'll still need to eat properly and exercise.
A hidden risk factor
High cholesterol has no symptoms, but your genetic makeup — reflected in family history of high cholesterol or heart disease — might make you more prone to the condition, even if you eat right and exercise. That's why it's so important to have a baseline cholesterol test at age 20 and have follow-up tests at least once every five years. Finding the problem early allows you to take action before it's too late. Your doctor may recommend more frequent cholesterol tests if your total cholesterol level or LDL cholesterol level is high.
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