How to Read Your Scary Cholesterol Blood Test

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Nothing gets your attention quite like your doctor asking you to sit down for a heart-to-heart about your cholesterol numbers.

Danger signs

Regardless of the reason (high cholesterol can be from genetics, inactivity, excess weight or from eating certain foods), a high blood cholesterol reading — typically 200 mg/dL (milligrams per deciliter) or more — can signal danger.

Too much cholesterol in the bloodstream is linked to hardening or clogging of arteries and increases the risk of a heart attack or stroke. So when your blood test reveals changes, changes for the better or for the worse, you want to know what they mean. What follows is a cheat sheet for understanding those numbers.

First, though, a brief explanation of what cholesterol is and why these numbers matter.

A little cholesterol goes a long way

Cholesterol is a fat produced in our bodies, particularly in the liver. It’s in all the cells, but too much causes problems. Factors affecting cholesterol numbers can include a recent heart attack, prescription medicines, exercise, diet and pregnancy.

Many people find help from a popular class of drugs, statins, that lower cholesterol and reduce systemic inflammation. But statins can have side effects, including muscle pain, liver damage, skin rash, higher blood sugar or even memory loss or confusion, this Mayo Clinic article says. Many of us want to try lowering cholesterol numbers naturally before getting on a lifetime regimen of medicine.

Whether you use drugs or lifestyle changes, act soon if you have high cholesterol. According to an article in Time:

Among a group of 1,478 people aged 55 years old from the Framingham Heart Study’s Offspring Cohort, those who had higher cholesterol levels for 11 to 20 years (beginning when they were about 35 years old) had a 16.5% higher risk of having a heart attack about 15 years later, compared to a 4.4% risk for those whose cholesterol levels never veered beyond the normal range during middle age.

Know your numbers

Dr. Antonio M. Gotto Jr., a cholesterol expert at Weill Medical College of Cornell University, tells WebMD that people under 40 should get a blood test (“lipid panel”) every three years and those over 40 should get tested annually.
Here’s what to know about your test results (< means “less than”, > means “more than”):

Total cholesterol

Ideal: <200 mg/dL

This measures all cholesterol, good and bad. Levels over 200 may require treatment. Your true risk, however, is revealed in the ratio of your HDL to total cholesterol.

Total-cholesterol-to-HDL ratio

Ideal: <3.5-to-1

Find your ratio: Divide your HDL number (more on that number below) into your total cholesterol. The higher the ratio, the higher the risk. For example, your total cholesterol might be 214, but if your HDL is 71, your ratio is a nice, low 3-to-1. “Most health care providers want the ratio to be below 5:1,” says the University of Rochester Medical Center.

HDL — ‘good’ cholesterol

Ideal: >40-59 mg/dL

Higher is better with HDL, a type of cholesterol that soothes inflammation in the arteries and may help break up cholesterol there, sending it to the liver for removal, WebMD says. High HDL lowers risk of heart and artery disease. For men, 40 mg/dL or higher is ideal. Women should aim for 60 or higher.

LDL — ‘bad’ cholesterol

Ideal: <100-130 mg/dL

Low LDL is good. High LDL can cause cholesterol to build up in arteries. The National Heart, Lung and Blood Institute puts it bluntly:

The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease.


Ideal: < 150 mg/dL

Triglycerides are another fat whose levels can raise cardiovascular disease risk. Lower numbers are better.

Armed with your understanding of these numbers, you now have a baseline for comparison as you work to improve your cholesterol — whether through diet, medication or both — or to celebrate how well you are doing and keep it that way.

Are you aware of your cholesterol levels and whether you need to take action? Share with us in comments below or on our Facebook page.

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