Understanding Your Cholesterol Numbers: LDL, HDL, Triglycerides and What Comes Next
A cholesterol test, also called a lipid panel, is one of the most common blood tests in primary care. The results arrive as a list of numbers that can be confusing. This guide from South Florida Heart and Vascular Institute (SFHVI), the Boca Raton primary care and heart health practice of Bruce Wishnov, DO, explains what each number means, how doctors interpret them in the context of your overall risk, and what you can do to improve them.
Why cholesterol matters
Cholesterol is a waxy substance your body needs to build cells and make hormones. Problems arise when too much of certain types of cholesterol circulate in the blood. Over time, cholesterol can build up in artery walls as plaque, narrowing arteries and raising the risk of heart attack, stroke and peripheral artery disease. High cholesterol usually causes no symptoms, so testing is the only way to know your levels.
The numbers on a standard lipid panel
Results in the United States are usually reported in milligrams per deciliter (mg/dL). The ranges below are general reference points used for many adults; your own target depends on your health history and risk.
LDL cholesterol ("bad" cholesterol)
LDL carries cholesterol to the tissues and is the main contributor to plaque buildup. Lower is generally better. For many adults without heart disease, an LDL below 100 mg/dL is considered optimal, while 160 mg/dL or higher is considered high. People with existing heart disease, diabetes or other high-risk conditions are often treated to lower targets.
HDL cholesterol ("good" cholesterol)
HDL helps carry cholesterol away from the arteries. Low HDL, generally below 40 mg/dL for men and below 50 mg/dL for women, is associated with higher risk. Raising HDL with medication has not been shown to prevent heart attacks, so doctors focus mainly on LDL and overall risk.
Triglycerides
Triglycerides are a type of fat in the blood. Levels below 150 mg/dL are considered normal; 150 to 199 is borderline high; 200 to 499 is high; and 500 or above is very high. Very high triglycerides also raise the risk of pancreatitis. Triglycerides are strongly affected by recent meals, alcohol, blood sugar control and weight.
Total cholesterol and non-HDL cholesterol
Total cholesterol below 200 mg/dL is generally considered desirable. Non-HDL cholesterol (total minus HDL) captures all of the cholesterol carried by particles that can contribute to plaque and is increasingly used alongside LDL.
Numbers are only part of the picture
Two people with the same LDL can have very different risk. That is why current guidelines focus on your overall chance of developing cardiovascular disease, not just a single number. Your clinician will consider:
- Age and sex
- Blood pressure and whether it is treated
- Diabetes and blood sugar
- Smoking
- Family history of early heart disease
- Kidney disease and inflammatory conditions
For many adults between 40 and 75, doctors use a risk calculator to estimate 10-year risk. Additional tests, such as lipoprotein(a) or a coronary artery calcium scan, can help in some cases when the decision about treatment is uncertain. An LDL of 190 mg/dL or higher at any age usually prompts a closer look for an inherited cholesterol disorder.
Do you need to fast before the test?
Many people no longer need to fast for a routine cholesterol test. Fasting may still be recommended if your triglycerides were high before or if your clinician orders it for a specific reason. Follow the instructions you receive with your lab order.
How often to check
Healthy adults are often tested every four to six years, while people with risk factors or who are on treatment are checked more often, commonly a few months after starting or changing medication and then periodically. Your clinician will recommend a schedule that fits your situation. If you have Medicare, cholesterol screening may be part of the preventive services discussed at your annual wellness visit.
Lowering cholesterol: lifestyle first, medication when needed
Healthy habits help everyone, whether or not medication is needed:
- Eat for your heart. Emphasize vegetables, fruits, beans, whole grains, nuts, fish and olive oil. Limit saturated fat from fatty meats and full-fat dairy, and avoid trans fats.
- Add soluble fiber. Oats, barley, beans and lentils can modestly lower LDL.
- Move regularly. Aim for about 150 minutes a week of moderate activity, such as brisk walking, if your clinician agrees it is safe for you.
- Manage weight and blood sugar. Even modest weight loss can lower triglycerides.
- Limit alcohol and stop smoking. Quitting smoking improves HDL and lowers overall heart risk.
When lifestyle changes are not enough or your risk is high, medications such as statins are well studied and widely used to lower LDL and reduce the risk of heart attack and stroke. Other medications are available when needed. Do not start, stop or change a cholesterol medication without talking with your clinician.
When cardiology gets involved
Most cholesterol care happens in primary care. A cardiology evaluation may be recommended if you have very high cholesterol, a strong family history of early heart disease, symptoms such as chest discomfort with exertion, or known heart or vascular disease. At SFHVI, primary care in Boca Raton and cardiology in Boca Raton are coordinated, so the next step does not mean starting over. SFHVI is part of the Advanced Health Cardiology network and the broader Advanced Health Associates group.
Schedule a visit
SFHVI offers hypertension and cholesterol management, diabetes care and heart-health screening on State Road 7 in Boca Raton. See our services or request an appointment at 561-488-4847.
This article is for general education only and is not medical advice. Target ranges vary by individual; talk with your health care provider about your results and treatment. In an emergency, call 911.
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