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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 at high risk of heart disease |
| Below 100 mg/dL | Below 2.6 mmol/L | Best for people at risk for 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)
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
- Diabetes
- 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 recommends a cholesterol test (fasting lipid panel) for children between the ages of 2 and 10 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.
- Cholesterol. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4488. Accessed April 20, 2010.
- High blood cholesterol: What you need to know. National Cholesterol Education Program. http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.pdf. Accessed April 20, 2010.
- Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf. Accessed April 19, 2010.
- 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.
- Daniels SR, et al. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122:198.
- Ford ES, et al. Concentrations of low density lipoprotein cholesterol and total cholesterol among children and adolescents in the United States. Circulation. 2009;119:1108.
- Cholesterol lowering drugs. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=163. Accessed April 19, 2010.
- Guyton JR, et al. Safety considerations with niacin therapy. Journal of the American College of Cardiology. 2007;99:22C.
- Koski RR. Omega-3-acid ethyl esters (Lovaza) for severe hypertriglyceridemia. Pharmacy and Therapeutics. 2008;33:271.
- Cooking for lower cholesterol. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=515. Accessed April 26, 2010.
- Kodama S, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol. Archives of Internal Medicine. 2007;167:999.
- Poli A, et al. Non-pharmacological control of plasma cholesterol levels. Nutrition and Metabolism in Cardiovascular Diseases. 2008;18:1.
- Natural medicines in clinical management of hyperlipidemia. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed April 23, 2010.
- FDA warns consumers to avoid red yeast rice products promoted on internet as treatments for high cholesterol products found to contain unauthorized drug. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108962.htm. Accessed April 26, 2010.
- Miller M, et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. In press. Accessed April 27, 2011.
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