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How Low Must Your Cholesterol Go?

Who does -- and doesn't -- need cholesterol-lowering drugs.
By
WebMD Feature
Reviewed by Louise Chang, MD

The newest dance: the cholesterol limbo.

  • Step one: You get your bad LDL cholesterol down to normal levels. Whew! You're under the bar.
  • Step two: Your doctor says normal levels aren't low enough and sets the bar lower.
  • Step three: You get your cholesterol way down. You're under the bar again!
  • Step four: New research shows that even lower LDL cholesterol levels are better. The bar drops again.

How low must you go?

Recommended Related to Cholesterol Management

Triglyceride-Friendly Meals

Fries or fruit? Ribeye or tuna steak? Soda or water? Every time you decide what to eat, you either increase or decrease your chance of having a heart attack or stroke. Let that inspire you to choose triglyceride-friendly meals. “Changing the diet can have dramatic effects on triglyceride levels,” says Robert Bonow, MD, former president of the American Heart Association and professor of Medicine at Northwestern University. In fact, a healthy diet -- plus exercise and weight loss if you’re overweight...

Read the Triglyceride-Friendly Meals article > >

If you're starting to get obsessed with cholesterol, you aren't alone. Ernst J. Schaefer, MD, is director of the lipid metabolism laboratory at Boston's Tufts University. He's also head of the heart disease prevention clinic and the lipid research laboratory at New England Medical Center.

"My wife complains that all I do is dream about these particles," Schaefer tells WebMD.

That's because Schaefer's job is to keep people from dying of heart disease. This means improving the condition of people who already have heart disease. And it means preventing heart disease in people who don't yet have it.Bad Cholesterol

When we talk about cholesterol, we're usually talking about bad cholesterol: low-density lipoprotein or LDL. A little too much LDL starts the heart-disease ball rolling.

When a person's blood is loaded with LDL cholesterol, the stuff builds up inside the walls of the large blood vessels known as arteries. This plaque irritates the blood vessel walls. The immune system gets involved and this only makes things worse. The blood vessel lining becomes fragile and unstable -- what doctors call inflammation. The artery narrows, and blood flow is restricted. And if the inflamed area of plaque bursts through the artery wall, the resulting clot can cause a fatal heart attack or stroke.

This is why your doctor's focus is on your LDL cholesterol level.

Everybody, Schaefer says, should get their cholesterol level below 160 mg/dL -- at the very least. An LDL level below 130 is much better. And many of us -- especially those who have heart disease -- should have much lower LDL levels than that.

A report, released July 12, 2004 by the National Cholesterol Education Program (NCEP), reduces target LDL levels from 100 mg/dL to 70 mg/dL for those at the very highest risk for heart disease. For people at high risk for heart disease, the target for LDL lowering remains the same. In this group medical therapy with statins should lower LDL to a target of less than 100 mg/dl, the report shows.

But LDL it isn't the whole story. Good Cholesterol

You also have a kind of cholesterol called high-density lipoprotein, or HDL. HDL is the good guy.

"HDL is responsible for pulling LDL cholesterol out of the artery wall," Schaefer notes. Too little HDL -- less than 40 mg/dL -- raises heart disease risk . Plenty of HDL -- at least 60 mg/dL --- greatly lowers heart disease risk.

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Is This Normal? Get the Facts Fast!

Is Your Cholesterol Level Heart Healthy?
What is your LDL (low-density lipoprotein) level?

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or
Answer:
Desirable
0-199
Borderline
200-239
High
240+

Your level is currently

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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