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Key takeaways
High cholesterol, a major risk factor for heart disease, affects over 94 million Americans, with LDL being the “bad” cholesterol and HDL the “good” cholesterol.
Cholesterol tests, recommended for everyone over the age of 20 at least once every five years, measure HDL, LDL, total cholesterol, and triglyceride levels to assess heart disease risk.
Preparation for a cholesterol test may require fasting, and results categorize cholesterol and triglyceride levels into healthy, at-risk, and dangerous ranges.
Lowering cholesterol can involve lifestyle changes such as diet, exercise, quitting smoking, and possibly medication like statins for those at high risk of heart disease.
What is a cholesterol test? | Who needs to be tested? | How to prepare | Cholesterol levels charts | How to lower cholesterol
Your healthcare provider ordered cholesterol tests, and you’ve just received the results but are unsure how to interpret them. Your HDL is high, but your LDL levels are low. What do your results mean?
Cholesterol is a waxy, fat-like substance. It can accumulate in all cells in your body. While your body needs some cholesterol to function properly, too much blood cholesterol increases your risk of heart disease. If your cholesterol is too high, it can cause build up on the walls of your arteries. This build up is called atherosclerosis and causes arteries to narrow. When this process occurs within the coronary arteries, it reduces blood flow to your heart.
High cholesterol affects more than 94 million Americans and is a major risk factor for heart disease, the leading cause of death in the United States. You’ve probably heard that high cholesterol is not good for your health, but it’s important to keep in mind that not all cholesterol is created equal.
“Not all cholesterol is bad,” says Ruth Brocato, MD, a primary care provider at Mercy Personal Physicians in Lutherville, Maryland. LDL is the “bad” cholesterol while HDL is the “good.” Dr. Brocato suggests thinking of LDL as “lousy” and HDL as “happy” to remember which is which.
What is a cholesterol test?
A cholesterol blood test, also called a lipid panel or lipid profile,measures the amount of cholesterol and certain types of fats in your blood. The test is used to assess your risk of heart disease. A cholesterol test is often part of a routine annual physical. “It’s typically a test offered to adults, but children and teens can also have high cholesterol,” says Janice Johnston, MD, the chief medical officer and cofounder of Redirect Health in Phoenix, Arizona.
A cholesterol test measures the following types of cholesterol:
- High density lipoprotein (HDL) levels: This “good” cholesterol can lower your risk of heart attack.
- Low density lipoprotein (LDL) levels: This “bad” cholesterol can cause plaque buildup in your arteries and blood vessels, and lead to cardiovascular disease including coronary artery disease (CAD), cerebrovascular disease, and peripheral artery disease (PAD)—the leading causes of heart attacks, stroke, and lower limb amputations.
- Total blood (or serum) cholesterol level: This measures the total amount of cholesterol in your blood, including high-density lipoprotein (HDL) and low-density lipoprotein (LDL).
- Triglyceride levels: This is another form of fat in your blood that can raise your risk of heart disease, especially in women.
You’ve probably heard that high blood cholesterol is not good for your health, but it’s important to keep in mind that not all cholesterol is created equal.
Who needs a cholesterol test?
Cholesterol tests are recommended for everyone over the age of 20, at least once every five years if normal. Screening for high cholesterol in children can also be considered. “High cholesterol doesn’t cause any symptoms, so it can be easy to ignore,” Dr. Johnston says. “It’s important to get regular cholesterol screenings in order to understand your risk of heart disease and to take measures to protect your health.” A blood test is the only way to determine your cholesterol levels.
“Many doctors and patients prefer to have annual lab tests for cholesterol, that way if there are problems, we can address them early,” Dr. Brocato says. “Those at a high-risk of heart disease, or who already have heart disease may be tested more often.”
There are now at-home cholesterol test kits if you can’t make it to a lab. If you use an at-home cholesterol test kit, ensure that it’s labeled “CDC Certified,” which means it’s been approved by the Cholesterol Reference Method Laboratory Network, a group that works with the Centers for Disease Control and Prevention (CDC) to ensure tests are accurate.
RELATED: Why you should monitor your cholesterol
How to prepare for your cholesterol test and what to expect
You may be instructed to not eat or drink anything other than water for 12 hours before taking a cholesterol test. However, some cholesterol tests don’t require fasting, so it’s important to ask your physician if and how long to fast before your cholesterol test.
Drinking plenty of water before a cholesterol test can ensure you receive accurate results. Dehydration can affect the accuracy of a cholesterol test, and so can certain medications such as corticosteroids and beta blockers.
Interpreting cholesterol test results
Your cholesterol results will typically be ready within a day or two. At-home cholesterol tests either offer immediate results via a monitor or come with a mailer that you use to send a blood sample to a lab in order to receive your results. Your test results will show your cholesterol levels in milligrams per deciliter of blood (mg/dL).
Total cholesterol levels |
|
|---|---|
| Total cholesterol range | Meaning |
| < 200 mg/dL | Healthy |
| 200-239 mg/dL | At risk |
| > 240 mg/dL | Dangerous |
LDL cholesterol levels |
|
|---|---|
| LDL cholesterol range | Meaning |
| < 100 mg/dL | Healthy |
| 100-159 mg/dL | At risk |
| > 160 mg/dL | Dangerous |
HDL cholesterol levels |
|
|---|---|
| HDL cholesterol range | Meaning |
| < 40 mg/dL | Dangerous |
| 41-59 mg/dL | At risk |
| > 60 mg/dL | Healthy |
The CDC notes that men tend to have higher LDL and lower HDL cholesterol than women, but after menopause, LDL cholesterol levels in women increase.
Triglyceride levels |
|
|---|---|
| Triglyceride range | Meaning |
| < 150 mg/dL | Healthy |
| 150-499 mg/dL | At risk |
| > 500 mg/dL | Dangerous |
“Your doctor will review your cholesterol results with you and look at your risk factors for heart disease that go beyond just cholesterol,” says Dr. Johnston, who adds this includes your weight, physical activity levels, and diet.
Sometimes high cholesterol is the result of diet and lifestyle. “Inactivity, lack of fiber in your diet, excessive animal fats and simple carbs, aging, diabetes, and smoking, can all cause high cholesterol,” Dr. Brocato says. For others, genetics can also play a big part in cholesterol levels. Some people who are young, slim, exercise frequently, and eat healthy meals have high cholesterol levels because of an inherited condition that is passed down through families. When examining a patient’s cholesterol results, providers also take the following factors under consideration:
- Risk factors such as uncontrolled high blood pressure, high blood sugar, and smoking
- Lifetime risk calculation
- Length of time cholesterol has been elevated
- Family history of heart disease or high cholesterol
- Age and gender
- Body mass index (BMI) and obesity
How to lower cholesterol levels
Depending on your test results, your doctor may first recommend diet and lifestyle changes including:
- Quitting smoking. The habit raises your risk for heart disease.
- Exercising daily for 30 minutes. Even a 30-minute walk at a moderate pace can lower triglycerides and boost HDL cholesterol.
- Eating more fruits and vegetables, whole grains, lean meats, fish, poultry, and low-fat dairy—as well as foods that are low in calories, saturated fat, and cholesterol.
- Consuming more fiber. The American Heart Association (AHA) recommends a daily intake of 25 to 30 grams of fiber, but most people only get a third of that. Fiber helps with weight loss, and high-fiber foods have been associated with a lower risk of heart disease. If you’re not getting enough fiber, talk to your doctor about taking a fiber supplement.
- Eliminating refined sugars, white breads, and starches.
- Losing five to 10 pounds, especially if you’re carrying weight around your midsection, which can raise your cardiovascular risk.
- Learning to de-stress. Whether you take up yoga, practice meditating, or walk in nature, those with good coping skills have high HDL levels, while those with poor coping skills have worse LDL and high triglyceride levels.
- Sleeping better. It may be helpful to get six to eight hours of sleep each night.
RELATED: The best diet for high cholesterol
“Lifestyle modifications can make a big difference,” Dr. Brocato says. If your provider determines you’re at high risk of developing heart disease, or if diet and lifestyle changes haven’t proven to be effective, you may be prescribed a statin, such as Lipitor (atorvastatin) or Crestor (rosuvastatin), that can effectively lower your cholesterol levels. “Statins are the go-to medication for high cholesterol,” says Dr. Johnston. “They’ve been around a long time and are well-tolerated by most patients.”
Dr. Johnston recommends talking with a healthcare professional about taking a Coenzyme Q10 (CoQ10) supplement. CoQ10 is an antioxidant that your body produces naturally. Some studies have shown that C0Q10 levels are lower in people with heart disease and those who take statins.
“If you have high cholesterol, your doctor will work with you to create an individualized treatment plan to maintain good heart health,” Dr. Johnston says. Most people can manage cholesterol through a combination of lifestyle changes and medication.