Understanding Your Cholesterol Report

A lipid profile is a blood test that measures the amount of cholesterol and fats called triglycerides in the blood. These measurements give the doctor a quick snapshot of what's going on in your blood. Cholesterol and triglycerides in the blood can clog arteries, making you more likely to develop heart disease. Thus, these tests can help predict your risk of heart disease and allow you to make early lifestyle changes that lower cholesterol and triglycerides.

How to Read Your Lipid Panel

A report typically contains the following items, in this order:

  • Total cholesterol: An estimate of all the cholesterol in the blood (good HDL plus bad LDL, for example). Thus, a higher total cholesterol may be due to high levels of HDL, which is good, or high levels of LDL, which is bad. So knowing the breakdown is important.
  • Triglycerides: A type of blood fat.
  • High-density lipoprotein (HDL): Good cholesterol that helps protect against heart disease.
  • Low-density lipoprotein (LDL): Bad cholesterol and a major contributor to clogged arteries.

Some reports also include:

  • Total cholesterol to HDL ratio: The amount of total cholesterol divided by HDL. This number is useful in helping doctors predict the risk of developing atherosclerosis (plaque build-up inside the arteries).
  • Very low-density lipoprotein (VLDL): Another type of bad cholesterol that builds up inside the arteries.

Total Blood (Serum) Cholesterol

In general, doctors recommend that you try to keep this number under 200 mg/dL. Levels over 200 mg/dL -- depending on the breakdown of LDL versus HDL -- may mean you are at higher risk for heart disease.

  • Desirable: Less than 200 mg/dL
  • Borderline high: 200-239 mg/dL
  • High: Over 240 mg/dL

Having a total cholesterol level over 240 mg/dL may double the risk of heart disease.

Low-density lipoprotein (LDL)

Low-density lipoprotein is bad cholesterol. Think of the "L" in LDL as "lousy." High LDL levels increase the risk of heart disease.

Your actual LDL goal depends on whether or not you have existing risk factors for heart disease, such as diabetes or high blood pressure. But in general, LDL results are as follows:

  • Optimal: Less than 100 mg/dL
  • Near optimal: 100-129 mg/dL
  • Borderline high: 130-159 mg/dL
  • High: 160-189 mg/dL

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Based on your risk for heart disease, your doctor will discuss with you strategies for lowering your LDL by a certain percentage. Those strategies will include lifestyle changes -- including dietary changes and exercise -- as well as the use of cholesterol lowering medication. Together, you and your doctor will decide on the appropriate strategies for your particular situation.

High-Density Lipoprotein (HDL)

High-density lipoprotein (HDL) is good cholesterol. Think of the "H" in HDL as "healthy" to remember this cholesterol type as the good kind.

HDL helps carry bad cholesterol out of the bloodstream and arteries. It plays a very important role in preventing clogged arteries. So, the higher the HDL number, the better.

In general, HDL levels of 60 mg/dL or higher are considered to be good. Likewise, levels below 40 mg/dL are considered a risk factor for heart disease. But it's important to discuss with your doctor what level is best in your particular case.

Certain medications, including steroids, blood pressure drugs known as beta blockers, and some ‘water pills’ can interfere with HDL levels. Make sure your doctor always knows about all the medications you are taking.

Triglycerides

Triglycerides are a type of blood fat that has been linked to heart disease and diabetes. If you have high triglycerides, your total cholesterol and LDL levels may be high, as well.

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

Lifestyle plays a large role in your triglyceride level. Smoking, excessive drinking, uncontrolled diabetes, and medications such as estrogen, steroids, and some acne treatments can contribute to high triglyceride levels. However, in some cases, genes or an underlying disease can be the cause.

Total Cholesterol to HDL Ratio

This number is not always listed on a cholesterol report. Some doctors use this instead of the total cholesterol level to help decide on an approach to lowering cholesterol. However, the American Heart Association recommends that focussing on actual values rather than ratios is more useful in determining treatment.

Very Low-Density Lipoprotein (VLDL)

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This is a type of bad cholesterol that contains the highest amount of triglycerides. The higher your VLDL level, the more likely you are to have a heart attack or stroke.

The VLDL level is not always included in cholesterol reports. There is no simple or direct way to measure VLDL. Most labs estimate it by dividing the triglyceride level by 5. However, this is not valid if the triglyceride level is over 400.

Normal VLDL levels range from 5 - 40 mg/dL.

What's Your Goal?

Keep in mind your cholesterol report offers a general guideline only. What's normal for you may not be OK for someone else. Your doctor will look at all your cholesterol numbers together with your other risk factors to develop a specific strategy for you.

Your goal depends on your age, family history of heart disease, and whether or not you have other risk factors for heart disease, such as diabetes, high blood pressure, and weight problems. Results may even vary depending on the lab a doctor uses. Always ask your doctor to help you interpret test results.

Adults aged 20 and older should have their cholesterol and triglyceride levels checked once every five years. However, your doctor may suggest doing this more often if you have certain risk factors such as diabetes, high blood pressure, obesity, or a family history of heart disease.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on September 5, 2018

Sources

SOURCES:

Lab Tests Online: "Cholesterol: The Test."

National Cholesterol Education Program: "High Blood Cholesterol, What You Need to Know."

National Heart, Lung, and Blood Institute: "What is High Blood Cholesterol?"

American Heart Association: "What Your Cholesterol Levels Mean."

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