Cholesterol levels: What numbers should you aim for?

People at high risk of heart disease may need even lower targets for their cholesterol numbers than other adults do.

It's important to keep your cholesterol levels within healthy limits. But if you have other risk factors for developing heart disease, you need to be even more vigilant — especially with your low-density lipoprotein (LDL), or "bad," cholesterol levels.

Types of cholesterol

LDL cholesterol can build up on the inside of artery walls, contributing to artery blockages that can lead to heart attacks. Higher LDL cholesterol levels mean higher risk. High-density lipoprotein (HDL) cholesterol is known as "good" cholesterol because it helps prevent arteries from becoming clogged. Higher HDL cholesterol levels generally mean lower risk.

A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:

Total cholesterol
HDL cholesterol
LDL cholesterol
Triglycerides, a type of fat often increased by sweets and alcohol

For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.

Interpreting the numbers

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. But what are the optimal levels of these various lipids? Consider these general guidelines.

Total cholesterol
Below 200 mg/dL	Desirable
200-239 mg/dL	Borderline high
240 mg/dL and above	High

LDL cholesterol
Below 70 mg/dL	Optimal for people at very high risk of heart disease
Below 100 mg/dL	Optimal for people at risk of heart disease
100-129 mg/dL	Near optimal
130-159 mg/dL	Borderline high
160-189 mg/dL	High
190 mg/dL and above	Very high

HDL cholesterol
Below 40 mg/dL	Poor
40-59 mg/dL	Better
60 mg/dL and above	Best

Triglycerides
Below 150 mg/dL	Desirable
150-199 mg/dL	Borderline high
200-499 mg/dL	High
500 or above	Very high

LDL targets differ

Because LDL cholesterol has a major association with heart disease, it's the main focus of cholesterol-lowering treatment. But it's not as simple as the chart may appear. Your target LDL number can vary, depending on your underlying risk of heart disease.

Most people should aim for an LDL level below 130 mg/dL. If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL. If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL.

So who's considered very high risk? You might be if you've had a heart attack or if you have diabetes. In addition, two or more of the following risk factors might also place you in the very high risk group:

Smoking
High blood pressure
Low HDL cholesterol
Family history of early onset heart disease
Age older than 45 if you're a man, or older than 55 if you're a woman

Lifestyle changes

If your LDL cholesterol is too high, the first thing your doctor will probably suggest is lifestyle changes. Eating more soluble fiber and less saturated fat and cholesterol can improve your cholesterol levels.

Being overweight and inactive tends to increase your LDL cholesterol and lower your HDL cholesterol, exactly the opposite of what you want. Exercise and weight loss can help reverse this trend. This is especially important for people who have large waist measurements — more than 40 inches for men and more than 35 inches for women — because people with this body shape are more likely to develop heart disease.

Medications may be needed

When lifestyle changes aren't enough to reach your cholesterol targets, your doctor may prescribe medications to help lower your cholesterol. These drugs are not a replacement for lifestyle changes. You'll still need to eat properly and exercise.

A hidden disorder

High cholesterol has no symptoms, but your genetic makeup — reflected in family history of high cholesterol or heart disease — might make you more prone to the condition, even if you eat right and exercise. That's why it's so important to have your cholesterol checked at least once every five years. Finding the problem early allows you to take action before it's too late.