Understanding Cholesterol: Diagnosis and Treatment

Depending on your risk factors, you may be told to have your cholesterol checked every 4 to 6 years starting at age 20. It's a simple blood test.

Your doctor may ask you to not eat or drink overnight before the test, so they can check your total cholesterol, your HDL (“good”) cholesterol, and your LDL ("bad”) cholesterol.

What the Numbers Mean

What levels to expect can vary, depending on whether you smoke, have diabetes or high blood pressure, are overweight, or are at risk for heart disease for other reasons. But here are the general guidelines:

Total Cholesterol Levels

Desirable: Below 200

Borderline high: Between 200 and 239

High: 240 or more

HDL (‘Good’) Cholesterol Levels

Excellent: 60 and above

Normal: 40 to 59

Too low: Below 40

LDL (‘Bad’) Cholesterol Levels

Optimal: Less than 100.

Near optimal/Above optimal: 100-129

Borderline high: Between 130 and 159

High: Above 160 tp 189

Very high: 190 and above

Getting High Cholesterol Under Control

If you have high cholesterol or want to prevent it, most doctors and dietitians agree that changing your habits is your first line of defense.


That means eating a diet low in saturated fat and simple carbohydrates, avoiding trans fats, getting more fiber, keeping your weight healthy, exercising regularly, and not smoking.

Keep these tips in mind:

  • Cut saturated fat to less than 7% of your total calories.
  • Avoid trans fat completely. Check the ingredients label for "partially hydrogenated" oils. Those are trans fats. Even if a product says "0 grams trans fat," it can have a small amount of trans fat (less than half a gram per serving), and that adds up.
  • Read food labels. Products that say "low cholesterol" or "no cholesterol" could be too high in saturated fats or sugar.

Your doctor may also recommend that you start taking prescription drugs to help your cholesterol level. They include:

Statins. These are among the most widely used drugs to lower total and LDL cholesterol. Statins available in the U.S. are atorvastatin (Lipitor). fluvastatin (Lescol), lovastatin (altoprev, Mevacor), pitavastatin (Livalo), pravastatin (Flolipid, Pravachol), rosuvastatin calcium (Crestor), or simvastatin (Zocor). These drugs block the liver's ability to make cholesterol. Though they usually don't cause problems, in rare instances, they can damage the liver and muscle. Because of this, your doctor will do blood tests to check your liver function after you start treatment and if there are any signs of problems. There have also been reports of memory loss and a small increase in the risk of getting type 2 diabetes. The benefits may outweigh the risks, so talk with your doctor about that.


Niacin. Doctors may prescribe this to help raise HDL ("good") cholesterol. To be effective, it must be taken in large doses. Unfortunately, in these amounts it often causes skin flushing and upset stomach. Newer versions of niacin made to minimize these side effects may be easier to take. Despite its effects on cholesterol levels, an important scientific study recently found that adding niacin to statin therapy did not lower the risk of future heart problems.

Bile acid binders. Also known as cholestyramine and colestipol, these may lower total and LDL cholesterol in some people. Side effects include bloating, gas, and constipation. If your cholesterol level can't be controlled by using medication, your doctor may try to combine a bile acid binder and a statin.

Fibric acid derivatives. Doctors occasionally prescribe these to raise HDL cholesterol and lower triglyceride levels. They also mildly lower LDL.

Ezetimibe (Zetia). This drug limits the amount of cholesterol the small intestine can absorb. People who take it also usually take a statin, which can reduce cholesterol another 25%. Zetia is controversial, however, because of less evidence that it lowers the risk of heart attack or death from heart disease.


LDL apheresis. This isn't a drug. It's a blood-cleansing procedure that may help with severe, genetic cholesterol disorders. Over several hours, blood is removed from the body, chemically cleansed of LDL cholesterol, and then returned to the body. Treatments every 2 to 3 weeks can cut average LDL cholesterol by 50% to 80%, but they’re costly in both time and money.

Proprotein convertase substilisin kexin type 9 (PCSK9) inhibitors. This is a newer class of cholesterol-lowering drugs which is used in patients who cannot control their cholesterol through diet and statin treatments in heterozygous familial hypercholesterolemia. It is also used in those with clinical atherosclerotic heart disease. The drugs alirocumab (Praluent) or evolocumab (Repatha) have been found to block the liver protein PCSK9, which hinders the liver’s ability to remove LDL-cholesterol from the blood. By doing so, it reduces the amount of bad cholesterol in the bloodstream. Evolocumab in particular, has proven to be effective in lowering the risk of heart attack and strokes in people who have cardiovascular disease.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on May 28, 2020



American Heart Association.

Heart Center Online.

National Cholesterol Education Program.

News release, FDA.

FDA: "Trans Fat at-a-Glance."

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