What Is Borderline Cholesterol?

Medically Reviewed by Jabeen Begum, MD on May 17, 2023
7 min read

Has your doctor told you that you have "borderline" high cholesterol? That means your cholesterol level is above normal but not quite in the "high" range.

You have borderline high cholesterol if your total cholesterol is between 200 and 239 milligrams per deciliter (mg/dL).

Your doctor will also consider other things, like how much of your total cholesterol is LDL ("bad") cholesterol and how much of it is HDL ("good") cholesterol.

Making simple changes in your lifestyle is often enough to bring borderline cholesterol levels down to the normal range. Some people may also need to take medicine for it. And keep in mind that other things, like diabetes, high blood pressure, and smoking, also affect your heart health; it's not just about cholesterol.

If you have borderline cholesterol, your doctor will decide whether you need treatment by looking at these and other risk factors for heart disease. They may ask you to get an imaging test of your heart called a coronary artery calcium (CAC) scan. This test reveals whether dangerous plaque has built up in your heart's arteries.

You won't know you have borderline cholesterol unless you get a cholesterol blood test. You should do that every 5 years.

The average American has a total cholesterol level of 200, which is in the borderline range.

You can turn it around before you get high cholesterol. Start with these steps.

Why Do I Need a Cholesterol Test?

Cholesterol is a waxy, fat-like substance. Your liver makes all the cholesterol your body needs. But you take in more cholesterol from certain foods, such as those from animals. If you have too much cholesterol in your body, it can build up in the walls of your arteries (as "plaque") and eventually harden. This process, called atherosclerosis, actually narrows the arteries, making it harder for blood to travel through them. 

Unfortunately, high cholesterol doesn't cause symptoms. In later stages of atherosclerosis, though, you may have angina – severe chest pain from lack of blood flow to the heart. If an artery gets totally blocked, a heart attack results. A routine blood cholesterol test is a far better way of finding out what your cholesterol level is.

What Does a Cholesterol Test Measure?

In addition to measuring the total cholesterol in your blood, the standard cholesterol test (called a "lipid panel") measures three specific kinds of fat:

Low-density lipoproteins (LDL). This is the "bad cholesterol," the main cause of plaque buildup, which increases your risk of heart disease. In general, the lower the number, the better. But LDL cholesterol is only one part of a larger equation that measures a person’s overall risk of having a heart attack or stroke. 

For years, guidelines focused on specific target numbers for people to achieve to lower their risk. The most recent guidelines focus on a person’s overall risk and, based on that risk, recommend a certain percentage of LDL reduction as one part of a way to prevent serious heart and blood vessel problems.

High-density lipoproteins (HDL). This is the "good cholesterol." It transports bad cholesterol from the blood to the liver, where it is excreted by the body. Your HDL is another part of the equation that identifies the risk of a cardiovascular event. In general, the higher the number the better, although, as with LDL, the emphasis has shifted from specific target numbers to ways to reduce the overall risk.

Triglycerides. Another type of fat in the bloodstream, triglycerides are also linked to heart disease. They are stored in fat cells throughout the body.

What Do Cholesterol Test Numbers Mean?

If you have a lipoprotein profile, it's important to look at all the numbers from the cholesterol test, not just the total cholesterol number. That's because LDL and HDL levels are two top signs of potential heart disease. Use the information below to interpret your results (with the help of your doctor, of course). This will help you get a better idea about your risk for heart disease.

Total blood cholesterol level:

  • High risk: 240 mg/dL and above
  • Borderline high risk: 200-239 mg/dL
  • Desirable: Less than 200 mg/dL

LDL cholesterol levels:

190 mg/dL and above represents a high risk for heart disease and is a strong sign that you can benefit from intensive treatment, including lifestyle changes, diet, and statin therapy for reducing that risk.

For LDL levels that are equal to or less than 189 mg/dL, the guidelines recommend strategies for lowering LDL by 30% to 50%, depending on what other risk factors you have that can affect the health of your heart and blood vessels.

HDL cholesterol:

  • High risk: Less than 40 mg/dL for men and less than 50 mg/dL for women


  • Very high risk: 500 mg/dL and above
  • High risk: 200-499 mg/dL
  • Borderline high risk: 150-199 mg/dL
  • Normal: Less than 150 mg/dL

Use your diet to help lower your LDL cholesterol and raise your HDL cholesterol.

For the biggest impact, choose foods that are low in saturated fats and trans fats, and high in fiber, antioxidants, and omega-3 fatty acids. Whole grains, beans, apples, pears, oatmeal, salmon, walnuts, and olive oil are excellent heart-healthy choices.

Here are some more diet tips to help you lower your cholesterol:

Make meat lean. Cut back on red meats that are high in saturated fat and cholesterol, and choose only lean meats with very little visible fat. Examples of lean beef include London broil, eye of round, and filet mignon. Avoid processed meats like bacon and sausage, which are linked to higher odds of heart disease and diabetes.

Remove skin from poultry. That's where much of the fat is.

Eat more seafood. It usually has less fat than other meat. The American Heart Association recommends eating two servings of fatty fish (like salmon, tuna, or mackerel) each week for heart health. Those fish are good sources of omega-3 fatty acids, which are good for you.

Limit saturated fat. These are found in whole-fat dairy products, mayonnaise, and hydrogenated or partially hydrogenated oils or fats (such as stick margarine). These products may also contain trans fats, which can raise your cholesterol level.

Go liquid. For cooking, replace saturated fats that are solid at room temperature (such as butter and shortening) with liquid monounsaturated fats such as olive, canola, and flaxseed oils. There’s evidence that eating moderate amounts of monounsaturated fat – found in such foods as nuts, seeds, and avocados – may lower LDL cholesterol.

Add fiber with plant foods. Good sources include grapefruit, apples, beans and other legumes, barley, carrots, cabbage, and oatmeal.

Get two daily servings of plant sterol-rich foods. These foods, such as nuts, can help lower cholesterol. Plant sterols are also added to some soft margarines, granola bars, yogurts, and orange juice.

You need to know how much saturated fat, trans fat, and cholesterol are in your favorite foods. That can help you make better choices.

Too much saturated fat can drive up your cholesterol level. It's found mostly in animal products. Cholesterol also is found in animal products. Your doctor or a dietitian can let you know what your daily limit should be.

Artificial trans fats can raise your LDL ("bad") cholesterol. They're in packaged foods, like some crackers, cookies, pastries, and microwave popcorn.

Check the nutrition label. And because products marked "0 grams" of trans fats per serving can have up to a gram of trans fats, check the ingredients label, too. Anything marked "partially hydrogenated" is trans fat.

Exercise helps you get your cholesterol down from the borderline range.

Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, per day (150 minutes each week). You can also do a more intense workout for 75 minutes a week.

Taking a walk, riding your bike, playing a team sport, or taking a group fitness class will increase your heart rate while raising HDL ("good") cholesterol. Push yourself, if you can, but keep in mind that moderate exercise is better than none at all.

You can have borderline high cholesterol and be at a healthy weight. But if you're overweight, losing those extra pounds can help bring your cholesterol level back down.

Losing as little as 5% of your body weight can lower your cholesterol levels. One study found that adults who took part in a 12-week exercise program lowered their LDL by 18 points, and their total cholesterol dropped 26 points.

With a combination of weight loss and a healthy diet, it’s possible to lower LDL levels up to 30% – results that are similar to taking cholesterol-lowering drugs.

If you're not sure whether your weight is in a healthy place, ask your doctor to check your body mass index (BMI). A normal BMI is 18 to 25. If your BMI is 25 or higher, ask your doctor for advice on the best types of physical activity for you.

If you smoke, kicking the habit can help raise your HDL ("good") cholesterol up to 10%.

Have you tried to quit smoking before? For many people, it takes a couple of tries. Keep trying until it sticks. It's worth it, for your whole body's health.

During regular screening appointments, your doctor will check your cholesterol levels to see if the changes you’ve made have gotten you to your cholesterol goal.

If lifestyle changes aren’t enough to lower borderline high cholesterol, your doctor may talk to you about medication.