Cholesterol plays a major role in a person’s heart health. High blood cholesterol is a major risk factor for coronary heart disease and stroke. That’s why it’s important for all people to know their cholesterol level. They should also learn about their other risk factors for heart disease and stroke. The American Heart Association recommends that everyone age 20 and older have a fasting “lipoprotein profile” every five years. This test is done after a 9-12-hour fast without food, liquids or pills. It gives information about total cholesterol, low-density lipoprotein (LDL) or “bad” cholesterol, high-density lipoprotein (HDL) or “good” cholesterol, and triglycerides (blood fats).

Total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease. 200-239 mg/dL puts you at the borderline-high risk level. If your total cholesterol falls between 200 and 239 mg/dL, your doctor will evaluate your levels of LDL (bad) cholesterol and HDL (good) cholesterol and triglycerides. It’s possible to have borderline-high total cholesterol numbers with normal levels of LDL (bad) cholesterol balanced by high HDL (good) cholesterol. Work with your doctor to create a prevention and treatment plan that’s right for you. Depending on your LDL (bad) cholesterol levels and your other risk factors, you may also need medication. 240 mg/dL and over is considered high risk. People who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (200 mg/dL).

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. 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.

The lower your LDL cholesterol, the lower your risk of heart attack and stroke. In fact, it’s a better gauge of risk than total blood cholesterol. In general, LDL levels fall into these categories:

Less than 70 mg/dL – optimal for very high risk patient
Less than 100 mg/dL – optimal
100 to 129 mg/dL – Above Optimal
130 to 159 mg/dL – Borderline High
160 to 189 mg/dL – High
190 mg/dL and above – Very High

Triglyceride is a form of fat. People with high triglycerides often have a high total cholesterol level, including high LDL (bad) cholesterol and low HDL (good) cholesterol levels. Your triglyceride level will fall into one of these categories:

Normal: less than 100 mg/dL
Normal: less than 150 mg/dL
Borderline-High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 mg/dL

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% or more of calories). High triglycerides are a lifestyle-related
risk factor; however, underlying diseases or genetic disorders can be the cause.

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. 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.