Cholesterol Levels: What You Need to Know

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk of coronary artery disease and other heart diseases.

How do you measure cholesterol levels?

A blood test called a lipoprotein or lipid panel can measure your cholesterol levels. Before the test, you'll usually need to fast (not eat or drink anything but water) for 9 to 12 hours. Follow the instructions your health care provider gives you.

The test gives information about your:

• Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
• HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
• Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein). It gives a better picture of all the "bad" types of cholesterol that can raise your heart risk.
• Triglycerides. This is another type of fat in your blood that can raise your risk of heart disease, especially in women.

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Talk with your provider about what your cholesterol numbers should be. The numbers that are best for you may depend on your age, race, blood pressure, weight, family history, and more. However, here are some general guidelines showing the desirable levels (levels that are healthy for most people):

Anyone age 19 or younger:

Men age 20 or older:

Women age 20 or older:

Triglycerides are not a type of cholesterol, but they are also measured in this test. A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

What are risk-based LDL goals?

If you have heart disease, or your provider thinks you might be at higher risk, they may use your LDL cholesterol level to help you set goals for your LDL cholesterol levels.

Your provider may use a new risk estimator tool called PREVENT, which stands for Predicting Risk of Cardiovascular Disease EVENTs, to guide these goals and estimate your risk of heart disease. It looks at factors like your age, health history, and family history, and puts you in a risk group.

LDL goal by risk level

How often should I get a cholesterol test?

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 21 or younger:

• Children should be screened at least once between ages 9 to 11 and again once between ages 17 and 21
• Some children may have this test starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

For people who are ages 21 to 65:

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people older than 65:

• They should be tested every year

Additional testing may include:

• A lipoprotein(a) blood test once as an adult, and an apolipoprotein B or "apo B" test if you have certain health conditions. These special blood tests help your provider understand your heart risk.
• A coronary calcium scan may be done to help determine if you need cholesterol medicines. This is an imaging test which checks to see if you have calcium built up in your heart arteries.

What affects my cholesterol levels?

Many factors can affect your cholesterol levels. Some of them are things you can change:

• Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include red meats, full-fat dairy products, chocolate, some baked goods, and many deep-fried and processed foods.
• Weight. Being overweight or having obesity are risk factors for heart disease. They also tend to increase your cholesterol. If you have high cholesterol and are overweight, it's recommended that you lose at least 5% of your body weight, which would be 10 pounds for a 200-pound person.
• Lack of physical activity. Not being physically active is a risk factor for heart disease.
• Smoking. Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove cholesterol from your arteries, having a lower HDL level can contribute to a higher cholesterol level.

Some factors that you cannot change can also affect your cholesterol levels, such as

• Age. Your cholesterol levels tend to rise as you get older. Even though it is less common, younger people, including children and teens, can also have high cholesterol.
• Sex. Between ages 20 and 39, men have a greater risk of high total cholesterol than women. But after menopause, a woman's risk goes up. This happens because menopause lowers levels of female hormones that may protect against high blood cholesterol.
• Family history. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families.
• Ethnicity. Your ethnicity may increase your risk of high cholesterol.

How can I lower my cholesterol?

You can lower your cholesterol through heart-healthy lifestyle changes: They include a heart-healthy eating plan, weight management, and regular physical activity.

If the lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. You may need a statin if you:

• Are age 30 or older and have an LDL cholesterol of 160 mg/dL or higher
• Have a strong family history of heart disease

If you take medicines to lower your cholesterol, you still should continue with the lifestyle changes.

NIH: National Heart, Lung, and Blood Institute