Normal and high cholesterol values
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Specific target levels or the recommended cholesterol values you should try to maintain, are established only for LDL or "bad" cholesterol. This is because LDL cholesterol is the most important indicator for your risk of atherosclerosis or a hardening of the arteries, and eventually heart disease or stroke. However, the total cholesterol and HDL cholesterol values are often the only ones monitored because they are easy and inexpensive to measure. This is acceptable for an initial assessment of your risk of heart disease.
Table Of Cholesterol Values
| mg/dL: | mmol/L: |
Total cholesterol | ||
desirable | < 200 | < 5.1 |
borderline high | 200 - 239 | 5.1 - 6.1 |
high | > 239 | > 6.1 |
LDL cholesterol - the "bad" cholesterol | ||
optimal | < 100 | < 2.6 |
near/above optimum | 100 - 129 | 2.6 - 3.3 |
borderline high | 130 - 159 | 3.3 - 4.1 |
high | 160 - 189 | 4.1 - 4.8 |
very high | > 189 | 4.8 |
HDL cholesterol - the "good" cholesterol | ||
low (undesirable!)* | < 40 | < 1.0 |
high (desirable!) | > 60 | > 1.5 |
Serum triglycerides | ||
normal | < 150 | 1.7 |
borderline high | 150 - 199 | 1.7 - 2.2 |
high | 200 - 499 | 2-2 - 5.6 |
very high | > 499 | > 5.6 |
The values in the above table are indicated in milligrams per deciliter blood (mg/dL) and millimole/liter (mmol/L). The unit mg/dL is common in the US, whereas mmol/L is generallly used in the rest of the world. Please use our unit converter if you would like to convert your values.
If you are interested in "real" cholesterol levels actually measured in individuals such as the US population, please have a look here.
LDL Cholesterol Targets: It All Depends On Your Risk Category
Anyone with a higher heart attack risk should lower their LDL cholesterol more than individuals with a lower risk. The National Cholesterol Education Program defines three risk categories with different LDL cholesterol targets for each:
| Risk Categories & LDL Targets | |
| 1. Highest Risk Category | |
| Presence of: coronary artery disease and/or diabetes mellitus and/or 10 year risk of heart attack > 20% | LDL-target: < 100 mg/dL |
| 2. Medium Risk Category | |
| Presence of: 2 or more risk factors and 10 year risk of heart attack <20% | LDL-target: < 130 mg/dL |
| 3. Lowest Risk Category | |
| Presence of: less than 2 risk factors and 10 year risk of heart attack <10% | LDL-target: < 160 mg/dL |
Risk factors include:
- Cigarette smoking
- Hypertension (blood pressure over 140/90)
- Low HDL or "good" cholesterol (< 40 mg/dL)
- Family history of premature coronary heart disease (CHD): CHD in male first-degree relative younger than 55 or in a female first-degree relative younger than 65
- Advanced age (Men 45 years and older & women 55 years and older)
To determine your number of risk factors, count the above items that apply to you. However, you must subtract one from your count if you have a HDL or "good" cholesterol level higher than 60 mg/dL. HDL cholesterol above 60 mg/dL is called a "negative" risk factor which is positive for your health.
You can easily calculate your individual LDL cholesterol target, your risk category and your 10-year risk of a heart attack using our risk calculator.
British RecommendationsThe Joint British Societies also issue cholesterol recommendations, but only for individuals at high cardiovascular risk. This includes anyone with one or more of the following:
- Atheroscleriotic disease such as:
- Coronary heart disease (CHD)
- Stroke
- Peripheral arterial disease (PAD)
- Diabetes mellitus
- Cardiovascular disease risk of 20% or higher over 10 years (can be determined by a risk calculator).
The latest set of guidelines released in 2005 recommend a total cholesterol level of less than 4.0 mmol/L (156 mg/dL) and LDL cholesterol of less than 2.0 mmol/L (78 mg/dL). These figures are lower than the 1998 guidelines, when total cholesterol of less than 5.0 mmol/L (195 mg/dL) and LDL cholesterol of less than 3.0 mmol/L (117 mg/dL) was recommended. Triglyceride targets are not explicitly set, although triglyceride levels greater than 1.7 mmol/L (150 mg/mL) are considered high.
The Joint British Societies, including the British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, and The Stroke Association, have published their guidelines here. (free registration required)
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Which Cholesterol Values Are Most Important?
Let's put those values into perspective by determining which factors are especially important and which are less important:
- Excess LDL or "bad cholesterol" in your blood signifies "high" cholesterol. This is probably the most important indicator for your risk of atherosclerosis or a hardening of the arteries and heart disease. The primary goal of lipid-lowering therapy is generally to lower the levels of LDL cholesterol.
- Total cholesterol is a less precise predictor of heart disease risk than LDL because it includes many kinds of cholesterol, including the beneficial HDL or "good" cholesterol. Nonetheless, a high total cholesterol level usually indicates a high level of LDL.
- A very low level of HDL is just as important a risk factor for developing heart disease as a high LDL value. On the other hand, a high level of HDL or "good" cholesterol can compensate for a high level of "bad" LDL cholesterol.
- Elevated triglyceride or fat levels are also associated with an increased risk, especially in combination with obesity and other factors.
- You may notice Lipoprotein(a) or Lp(a) on your medical chart. Lp(a) is a subtype of LDL, and individuals with high levels of Lp(a) or "very bad" LDL, appear to be at higher risk for heart disease. Researchers can't seem to agree on the exact level of "high" Lp(a), but most specialists consider a value of approximately 30 mg/dL (0.8 mmol/l) to be high.
The Cholesterol Ratio
1) LDL Cholesterol/HDL CholesterolSince both high LDL cholesterol or high total cholesterol and low HDL cholesterol are used for predicting coronary artery disease, combining both factors to one number is helpful. LDL cholesterol is usually divided by HDL cholesterol, resulting in the cholesterol ratio or cholesterol risk ratio for predicting coronary heart disease:
- Optimal Risk Ratio (LDL/HDL): lower than 3.5
- Average Risk Ratio (LDL/HDL): approximately 4.5
- Increased Risk Ratio (LDL/HDL): higher than 5.0
Example 1: Anyone with a borderline high LDL cholesterol of 230 mg/dL and an average to low HDL value of 45 mg/dL has a risk ratio of 5.1 or an increased risk.
Example 2: Anyone with a high total cholesterol of 270 mg/dL and a high HDL level of 70 mg/dL has a risk ratio of approximately 3.9 or a lower than average risk.
Use of the risk ratio may predict coronary artery disease more accurately than with LDL levels alone.
2) Total Cholesterol/HDL CholesterolThe ratio of total cholesterol to HDL cholesterol is sometimes calculated. Although the total cholesterol/HDL ratio is not as accurate or pure as the LDL/HDL ratio, the former is more commonly obtained because total cholesterol is easier and cheaper to measure than LDL cholesterol levels.
Reports from the Framingham Heart Study suggest the following influence of total cholesterol to HDL cholesterol ratios on male heart disease risk:
- Half the average heart disease risk at a ratio of 3.4
- Average heart disease risk at a ratio of 5.9
- Double the average heart disease risk at a ratio of 9.6
- Half the average heart disease risk at a ratio of 3.3
- Average heart disease risk at a ratio of 4.4
- Double the average heart disease risk at a ratio of 7.0
For an even more precise measurement of coronary heart disease risk, please use the risk calculator and take into account additional factors such as gender, age, smoking, blood pressure levels and diabetes.
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