Cholesterol Numbers and What They Mean

Understanding cholesterol

Cholesterol is a substance that helps your body produce hormones, digestive substances, and vitamin D. Molecules called lipoproteins carry cholesterol around your body through your bloodstream. These lipoproteins are made of lipid (fat) on the inside and protein on the outside.

Your liver makes all the cholesterol your body needs to function. Some foods—including meat, liver, poultry, and full-fat dairy products—provide extra cholesterol. Eating foods high in saturated fats and trans fats may also stimulate your liver to make more cholesterol than it normally would.

Excess cholesterol can combine with fat, calcium, and other substances in your blood to form a fatty deposit called plaque. Over time, plaque can build up inside your arteries and impede the flow of blood. When this occurs in an artery to the heart, it may lead to angina (chest pain) or a heart attack. When it occurs in an artery to the brain, it may lead to a stroke.

To help prevent such problems, you need to be aware of your cholesterol levels by getting tested. If levels are out of the recommended range, you can take steps to improve them. The World Heart Federation recommends that all adults ages 20 and older get a cholesterol test every five years. Some people may need to have their cholesterol checked more often. Meet with your doctor to review your personal and family medical history and discuss the most appropriate plan for testing.

Parts of a lipoprotein profile

A blood test called a lipoprotein profile provides the most complete information about your cholesterol levels. If your doctor recommends this test, you may need to fast for several hours beforehand. The test report will show four numbers:

LDL (“bad”) cholesterol. This form of cholesterol is the main contributor to plaque build-up in your arteries. The lower your LDL level is, the better.

HDL (“good”) cholesterol. This form of cholesterol carries excess LDL away from your arteries and to your liver, which clears it from your body. The higher your HDL level is, the better.

Triglycerides. This type of blood fat is often measured along with cholesterol. Research indicates that high triglycerides may increase the risk for heart disease, particularly in women.

Total cholesterol. This number is calculated from your LDL, HDL, and triglyceride levels.

If you didn’t fast before your blood test, the lab may only be able to measure HDL and total cholesterol levels.

Cholesterol by the numbers

Health care professionals have moved away from setting one-size-fits-all cholesterol goals for patients. They now look at cholesterol numbers in the context of your overall risk for cardiovascular disease. Ask your health care professional to help you interpret the results of your cholesterol test. Traditionally, these numbers have been considered ideal:

LDL cholesterol: less than 100 mg/dL (2.6 mmol/L), or less than 70 mg/dL (1.8 mmol/L) for people with heart disease or diabetes

HDL cholesterol: 60 mg/dL and above (1.5 mmol/L)

Total cholesterol: less than 200 mg/dL (5.2 mmol/L)

Triglycerides: less than 150 mg/dL (1.7 mmol/L)

Numbers vary depending on your region, so check with your health care professional in your country what is ideal for you.

Globally, raised total cholesterol affects approximately 39% of adults. In 2019, the number of DALYs (disability-adjusted life years) due to high non-HDL cholesterol reached 98.6 million. It also caused an estimated 4.4 million deaths. From a regional perspective, the death toll has decreased in high-income western countries. Conversely, it has more than doubled in southeast Asia and even tripled in east Asia. As a result, by 2017, half of the deaths attributable to high non-HDL cholesterol were recorded in east, southeast, and south Asia, compared with a quarter in 1990. This demonstrates a global shift of the disease burden from high-income countries in north-western Europe, North America, and Australasia to middle-income countries in east and southeast Asia, as well as some countries in Oceania and central Latin America.

Doctors in the United Arab Emirates are warning about a rise in young people suffering from cardiovascular disease, with half of heart attack patients aged under 50. Cardiovascular disease (CVD) is a leading cause of mortality worldwide and contributes to 40 percent of all deaths in the UAE. The high incidence of heart disease is due to multiple risk factors, including abdominal obesity, diabetes, smoking, hypertension and high cholesterol levels, found increasingly in younger adults in the country, according to physicians at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health.

Reducing your risk with medication

If your cholesterol numbers are not optimal or if you have a history of a heart attack, stroke, angina, peripheral artery disease, transient ischemic attack (TIA, or “mini-stroke”), or certain cardiovascular procedures, cholesterol-lowering medication may be indicated.

Other factors may also come into play, including age, family history, and other medical conditions. It’s best to talk with your health care professional about treatment options, including the pros and cons of cholesterol-lowering medication.

Lowering your risk with lifestyle changes

These healthy habits can have a positive impact on your cholesterol numbers:

Be physically active. Aim for at least 150 minutes of moderate physical activity every week. Getting regular physical activity helps lower LDL (“bad”) cholesterol, decrease triglycerides, and raise HDL (“good”) cholesterol.

Make smart food choices. Eating wisely is another way to improve LDL, triglyceride, and HDL levels. Limit saturated fats, trans fats, and foods high in cholesterol (such as fatty meats and liver). Emphasise fruits, vegetables, and foods high in fibre (such as oatmeal and beans).

Maintain a healthy weight. If you are in the overweight or obese BMI range, losing weight can help prevent or control high cholesterol.

Drink alcohol in moderation, or not at all. Excessive alcohol use can raise triglyceride levels.

Don’t smoke. Smoking compounds your risk for heart disease, and it can also reduce HDL (“good”) cholesterol.

Eating Right

It is important to eat right, keep a healthy weight, and exercise, even if:

• You do not have heart disease or diabetes.
• Your cholesterol levels are in the normal range.

These healthy habits may help prevent future heart attacks and other health problems.

Eat foods that are low in fat. These include whole grains, fruits, and vegetables. Using low-fat toppings, sauces, and dressings will help.

Look at food labels. Avoid foods that are high in saturated fat. Eating too much of this type of fat can lead to heart disease.

• Choose lean protein foods, such as soy, fish, skinless chicken, very lean meat, and fat-free or 1% dairy products.
• Look for the words “hydrogenated”, “partially hydrogenated”, and “trans fats” on food labels. Do not eat foods with these words in the ingredients lists.
• Limit how much fried food you eat.
• Limit how many prepared baked goods (donuts, cookies, and crackers) you eat. They may contain a lot of fats that are not healthy.
• Eat fewer egg yolks, hard cheeses, whole milk, cream, ice cream, and cholesterol and lifestyle.
• Eat less fatty meat and smaller portions of meat, in general.
• Use healthy ways to cook fish, chicken, and lean meats, such as broiling, grilling, poaching, and baking.
• Eat foods that are high in fiber. Good fibers to eat are oats, bran, split peas and lentils, beans (kidney, black, and navy beans), some cereals, and brown rice.

Learn how to shop for, and cook, foods that are healthy for your heart. Learn how to read food labels to choose healthy foods. Stay away from fast foods, where healthy choices can be hard to find.

Get plenty of exercise. And talk with your provider about what kinds of exercises are best for you.