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Tests and diagnosis
By Mayo Clinic staffA blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Triglycerides — a type of fat in the blood
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 in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your lipid panel (cholesterol test) results back to see if your cholesterol falls in ideal levels.
| Total cholesterol (U.S. and some other countries) | Total cholesterol* (Canada and most of Europe) | |
|---|---|---|
| Below 200 mg/dL | Below 5.2 mmol/L | Best |
| 200-239 mg/dL | 5.2-6.2 mmol/L | Borderline high |
| 240 mg/dL and above | Above 6.2 mmol/L | High |
| LDL cholesterol (U.S. and some other countries) | LDL cholesterol* (Canada and most of Europe) | |
|---|---|---|
| Below 70 mg/dL | Below 1.8 mmol/L | Best for people with heart disease |
| Below 100 mg/dL | Below 2.6 mmol/L | Best for people at risk of heart disease |
| 100-129 mg/dL | 2.6-3.3 mmol/L | Near ideal |
| 130-159 mg/dL | 3.4-4.1 mmol/L | Borderline high |
| 160-189 mg/dL | 4.1-4.9 mmol/L | High |
| 190 mg/dL and above | Above 4.9 mmol/L | Very high |
| HDL cholesterol (U.S. and some other countries) | HDL cholesterol* (Canada and most of Europe) | |
|---|---|---|
| Below 40 mg/dL (men) Below 50 mg/dL (women) |
Below 1 mmol/L (men) Below 1.3 mmol/L (women) |
Poor |
| 50-59 mg/dL | 1.3-1.5 mmol/L | Better |
| 60 mg/dL and above | Above 1.5 mmol/L | Best |
| Triglycerides (U.S. and some other countries) | Triglycerides* (Canada and most of Europe) | |
|---|---|---|
| Below 150 mg/dL | Below 1.7 mmol/L | Best |
| 150-199 mg/dL | 1.7-2.2 mmol/L | Borderline high |
| 200-499 mg/dL | 2.3-5.6 mmol/L | High |
| 500 mg/dL and above | Above 5.6 mmol/L | Very high |
The American Heart Association (AHA) recommends that a triglyceride level of 100 mg/dL (1.3 mmol/L) or lower is considered "optimal." The AHA says this optimal level would improve your heart health. However, the AHA doesn't recommend drug treatment to reach this level. Instead, for those trying to lower their triglycerides to this level, lifestyle changes such as diet, weight loss and physical activity are encouraged. That's because triglycerides usually respond well to dietary and lifestyle changes.
*Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.
LDL targets differ
Because LDL cholesterol is a major risk factor for heart disease, it's the main focus of cholesterol-lowering treatment. 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 (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L). In general, the lower your LDL cholesterol level is, the better.
You're considered to be at a high risk of heart disease if you:
- Have had a previous heart attack or stroke
- Have artery blockages in your neck (carotid artery disease)
- Have artery blockages in your arms or legs (peripheral artery disease)
- Have known diabetes that requires treatment
In addition, two or more of the following risk factors might also place you in the high-risk group:
- Smoking
- High blood pressure
- Low HDL cholesterol
- Family history of early heart disease
- Age older than 45 if you're a man, or older than 55 if you're a woman
- Elevated lipoprotein (a), another type of fat (lipid) in your blood
Children and cholesterol testing
Children as young as age 2 can have high cholesterol, but not all children need to be screened for high cholesterol. The American Academy of Pediatrics (AAP) recommends a cholesterol test (fasting lipid panel) for all children between the ages of 9 and 11. The AAP also recommends screening for children as young as 1 who have a known family history of high cholesterol or premature coronary artery disease. Your child's doctor may recommend retesting if your child's first test shows he or she has normal cholesterol levels.
The American Academy of Pediatrics also recommends testing if the child's family history for high cholesterol is unknown, but the child has risk factors for high cholesterol, such as obesity, high blood pressure or diabetes.
- Why cholesterol matters. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Why-Cholesterol-Matters_UCM_001212_Article.jsp. Accessed Dec. 13, 2012.
- What is cholesterol? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbc/. Accessed Dec. 13, 2012.
- Third report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/cholesterol. Accessed Dec. 13, 2012.
- Arsenault BJ, et al. Beyond low-density lipoprotein cholesterol: Respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. Journal of the American College of Cardiology. 2009;55:35.
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary report. Pediatrics. 2011;128:S213.
- Drug therapy for cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp. Accessed Dec. 13, 2012.
- Creider JC, et al. Niacin: Another look at an underutilized lipid-lowering medication. Nature Reviews Endocrinology. 2012;8:517.
- Samuel S, et al. Estimating health and economic benefits from using prescription omega-3 fatty acids in patients with severe hypertriglyceridemia. American Journal of Cardiology. 2011;108:691.
- Cooking for lower cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cooking-for-Lower-Cholesterol_UCM_305630_Article.jsp. Accessed Dec. 13, 2012.
- Huffman KM, et al. Exercise effects on lipids in persons with varying dietary patterns - does diet matter if they exercise? American Heart Journal. 2012;164:117.
- Chapman MJ, et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: Evidence and guidance for management. European Heart Journal. 2011;32:1345.
- Natural medicines in clinical management of hyperlipidemia. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Dec. 13, 2012.
- Red yeast rice. University of Maryland Medical Center. http://www.umm.edu/altmed/articles/red-yearice-000323.htm. Accessed Dec. 13, 2012.
- Miller M, et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2011;123:2292.
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