Keeping your cholesterol levels healthy is a great way to keep your heart healthy – and lower your chances of getting heart disease or having a stroke.
Cholesterol can be tricky to understand, though, because not all is bad for you. Some is actually good for you.
The most important thing you can do as a first step is to know your cholesterol numbers by getting your cholesterol tested.
Here are some easy ways for you to understand what the testing involves, how it can help you and ways to improve your health by improving your cholesterol.
All adults age 20 or older should have a fasting lipoprotein profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides — once every five years. This test is done after a nine- to 12-hour fast without food, liquids or pills. It gives information about total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.
1. Total Cholesterol:
|Total Cholesterol Level||Category|
|Less than 200 mg/dL||Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.|
|200 to 239 mg/dL||Borderline high|
|240 mg/dL and above||High blood cholesterol. A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL.|
|HDL Cholesterol Level||Category|
|Less than 40 mg/dL|
Less than 50 mg/dL
|Low HDL cholesterol. A major risk factor for heart disease.|
|60 mg/dL and above||High HDL cholesterol. An HDL of 60 mg/dL and above is considered protective against heart disease.|
With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease. The mean level of HDL cholesterol for American adults age 20 and older is 54.3 mg/dL.
Smoking, being overweight and being sedentary can all result in lower HDL cholesterol. To raise your HDL level, avoid tobacco smoke, maintain a healthy weight and get at least 30-60 minutes of physical activity more days than not.
People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL cholesterol levels. Female sex hormones raise HDL cholesterol levels.
|LDL Cholesterol Level||Category|
|Less than 100 mg/dL||Optimal|
|100 to 129 mg/dL||Near or above optimal|
|130 to 159 mg/dL||Borderline high|
|160 to 189 mg/dL||High|
|190 mg/dL and above||Very high|
Your other risk factors for heart disease and stroke help determine what your LDL level should be, as well as the appropriate treatment for you. A healthy level for you may not be healthy for your friend or neighbor. Discuss your levels and your treatment options with your doctor to get the plan that works for you. The mean level of LDL cholesterol for American adults age 20 and older is 115.0 mg/dL.
Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes have high triglyceride levels. Normal triglyceride levels vary by age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery walls). Atherosclerosis increases the risk for heart attack and stroke.
|Less than 100 mg/dL||Optimal|
|Less than 150 mg/dL||Normal|
|150–199 mg/dL||Borderline high|
|500 mg/dL and above||Very high|
Many people have high triglyceride levels due to being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent or more of calories). High triglycerides are a lifestyle-related risk factor; however, underlying diseases or genetic disorders can be the cause. The mean level of triglycerides for American adults age 20 and older is 144.2 mg/dl. People with high triglycerides should substitute monounsaturated and polyunsaturated fats —such as those found in canola oil, olive oil or liquid margarine —for saturated fats, limit added sugars, eat complex carbohydates and reduce fructose intake.
The main therapy to reduce triglyceride levels is to change your lifestyle. This means control your weight, eat a heart-healthy diet, get regular physical activity, avoid tobacco smoke, limit alcohol to one drink per day for women or two drinks per day for men and limit beverages and foods with added sugars. Visit your healthcare provider to create an action plan that will incorporate all these lifestyle changes. Sometimes, medication is needed in addition to a healthy diet and lifestyle.
A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic syndrome increases the risk for heart disease and other disorders, including diabetes.
VLDL (very low density lipoprotein) transports cholesterol and triglycerides within the body. It is made in the liver in response to a high-carbohydrate meal. Conditions known to increase levels include diabetes, obesity, and acute hepatitis. It is thought to play a role in atherosclerosis as well. Lifestyle changes and medications are often successful in reducing levels in the blood.
An elevated level of VLDL cholesterol (>30 mg/dL or >0.77 mmol/L), like elevated LDL cholesterol, is considered a risk factor for heart disease and stroke. The presence of high VLDL in addition to high LDL may affect the choice of therapy used to lower cholesterol.
Since high triglycerides and high VLDL cholesterol are often associated with such conditions as diabetes, alcohol consumption, overweight and obesity, these may be lowered by lifestyle changes as well as drug treatment aimed at lowering triglyceride and cholesterol levels.
Low levels of VLDL cholesterol are not generally a concern.
6. Direct LDL Cholesterol
Direct LDL-C is ordered whenever calculation of LDL cholesterol will not be accurate because the person’s triglycerides are significantly elevated. It may be ordered by a doctor when prior test results have indicated high triglycerides. In some laboratories, this direct LDL test will automatically be performed when the triglyceride levels are too high to calculate LDL-C. This saves the doctor time by not needing to order another test, saves the patient time by not needing to have a second blood sample drawn, and speeds up the time to provide the test result.
Elevated levels of LDL, as measured with the direct LDL-C test, indicate a greater risk of developing heart disease. Decreasing levels show a response to lipid-lowering lifestyle changes and/or drug therapies and indicate a decreased risk of heart disease.
Low levels of LDL are not generally a concern and are not monitored. They may be seen in people with an inherited lipoprotein deficiency and in those with hyperthyroidism, infection, and inflammation.
7. Cholesterol Ratios
Some lipid panel results will include ratios, such as the total cholesterol to HDL cholesterol ratio (total/HDL) and the low density lipoprotein/high density lipoprotein (LDL/HDL) ratio. These ratios may provide useful information on gauging a person’s health. However, researchers and doctors are divided on the effectiveness of using these ratios for predicting the chances of developing heart disease.
a. Total/HDL ratio
b. LDL/HDL ratio
c. HDL/LDL ratio
a. Total Cholesterol/HDL Cholesterol
Total cholesterol to HDL ratios (or total/HDL ratios) are determined by dividing the HDL cholesterol into the total cholesterol. If a person has a total cholesterol of 200 mg/dL and an HDL cholesterol of 40 mg/dL, his or her total/HDL ratio would be 5:1. The goal is to keep these ratios of cholesterol below 5:1, with the ideal being below 3.5:1.
Scientists and doctors are divided on the effectiveness of these ratios for predicting the chances of developing heart disease. At this point, the American Heart Association recommends using the absolute numbers for total blood cholesterol and HDL cholesterol instead of the total/HDL cholesterol ratio. They believe that the absolute cholesterol numbers are more useful to plan treatment than this cholesterol ratio.
b. LDL/HDL Cholesterol
Another ratio that certain labs determine is the LDL to HDL ratio. These cholesterol ratios are sometimes used to help predict the chances of developing heart disease. Such ratios compare levels of bad cholesterol (LDL) to good cholesterol (HDL). For LDL/HDL ratios, the goal is to keep it below 3.5:1, with the ideal being under 2.5:1.
However, similar to the total/HDL ratio, the medical community is divided on whether the LDL/HDL ratio is better than absolute total cholesterol or LDL cholesterol levels in predicting a person’s risk for heart disease. For treatment of high cholesterol, using the absolute numbers for LDL and HDL is recommended.
c. HDL/LDL Cholesterol
HDL/LDL ratios compare the level of good cholesterol (HDL) to bad cholesterol (LDL). In the case of HDL/LDL ratios, the goal is to keep this ratio above .3:1, with the ideal being above .4:1.
If you have not got your lipid profile done in past 5 years, be ready to get your cholesterol levels soon by lipid panel.