Understanding cholesterol levels

Some health problems are more noticeable than others. You can feel a sprained ankle. You can see a rash. You know when the flu knocks you down.

But some early signs of heart disease risk, including high blood pressure or unhealthy cholesterol levels, can be harder to detect. You may feel fine and still have cholesterol levels that increase your risk for heart disease, heart attack or stroke.

That’s one reason cholesterol screening matters. A simple blood test can help your doctor understand your cholesterol numbers and your overall heart disease risk. From there, you can talk about whether lifestyle changes, medication or both may help.

So, what exactly is cholesterol, and what can you do about it? 

What is cholesterol?

Cholesterol is a waxy, fat-like substance in your body. Your liver makes the cholesterol your body needs. Cholesterol is also found in some foods, particularly animal-based foods such as meat, dairy products and eggs.

Cholesterol gets a bad rap, but your body needs it to function. It helps your body make cells, hormones and vitamin D. But too much cholesterol in your blood can contribute to plaque buildup inside your arteries. Over time, that buildup can raise your risk for heart attack, stroke or blockages in the arteries of your legs.

Cholesterol is only one part of your heart disease risk. Your doctor may also look at other factors, such as your blood pressure, diabetes status, smoking history, age, family history and overall health.

What is good cholesterol and bad cholesterol?

You may have heard cholesterol described as “good” or “bad.” That can be confusing. Your body needs cholesterol, but the type and amount of cholesterol in your blood matter.

Cholesterol can’t travel through your blood on its own. It moves through your body in particles called lipoproteins. Two important types are high-density lipoprotein (HDL), often called “good” cholesterol, and low-density lipoprotein (LDL), often called “bad” cholesterol.

LDL cholesterol makes up most of the cholesterol in your body. When LDL cholesterol is too high, it can contribute to plaque buildup in your arteries.

HDL cholesterol helps carry some cholesterol away from the arteries and back to the liver, where your body can remove it. In general, higher HDL cholesterol is better, but HDL is only one piece of your overall cholesterol picture.

What do cholesterol levels mean?

Cholesterol levels are measured with a blood test called a lipid panel. Your results may include total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

There isn’t one perfect cholesterol number for everyone. Your target levels can depend on your age, health history and overall risk for heart disease. For many adults, doctors generally look for:

HDL cholesterol

Optimal: 60 mg/dL or above 
Low: Under 40 mg/dL for men; under 50 mg/dL for women

LDL cholesterol

For many people: Below 100 mg/dL 
For people at high risk: Below 70 mg/dL 
For people at very high risk or with existing atherosclerotic cardiovascular disease: Below 55 mg/dL

Total cholesterol

Optimal: Under 200 mg/dL 
Borderline high: 200–239 mg/dL 
High: 240 mg/dL or above

Triglycerides

Optimal: Under 150 mg/dL 
Borderline high: 150–199 mg/dL 
High: 200–499 mg/dL 
Very high: 500 mg/dL or above

Your doctor can help you understand what your results mean for you. For example, someone who has already had a heart attack may need a lower LDL cholesterol goal than someone with few heart disease risk factors.

You and your doctor can also decide how often you need cholesterol screening based on your age, results, family history and other risk factors.

Do cholesterol levels change by age?

Cholesterol levels can change over time, and your risk for heart disease often increases as you get older. But cholesterol goals aren’t based on age alone.

Instead of using a simple “cholesterol levels by age” chart, your doctor will likely look at your full heart disease risk. That may include your age, blood pressure, cholesterol numbers, family history, diabetes status, smoking history and whether you’ve already had a heart attack, stroke or other heart-related condition.

This risk-based approach helps your doctor recommend a cholesterol goal and treatment plan that fits your health.

How can you improve your cholesterol levels?

Daily habits can affect LDL cholesterol levels and your overall heart health. To help support healthier cholesterol levels, you might focus on:

• Avoiding tobacco
• Being physically active
• Getting a healthy amount of sleep, usually 7–9 hours a night for adults
• Limiting foods high in saturated fat and avoiding trans fats
• Maintaining a healthy weight

Some people have high cholesterol because of genetics or other factors they can’t control. If lifestyle changes aren’t enough, medication may be part of your treatment plan. Your doctor can talk with you about your options and help you decide what makes sense for your health.