Cholesterol Counts: Knowing Your Numbers
High cholesterol, also known as hypercholesterolemia, is a health condition that puts people at greater risk for heart attack and stroke. Cholesterol is a waxy substance in the blood that is made by the liver and also obtained from food. Cholesterol has several important functions in the body, which include making vitamin D and some hormones, building cell walls, and creating bile salts which assist in digesting fat. Too much cholesterol circulating in the blood leads to a buildup of plaque on the artery walls, known as atherosclerosis. This plaque buildup leads to a narrowing of the arteries and therefore restricts blood flow to the heart. If the plaque completely restricts blood from getting to the heart, a heart attack results. In addition, if an artery supplying blood to the brain becomes too narrow, a stroke occurs. Factors like age, gender, race, family health history, smoking, high blood pressure, diabetes, and diet can have an impact on a person’s cholesterol level and are considered when determining their risk. For those who are 40 through 79 years of age, the American Heart Association’s Cardiovascular Risk Calculator is available to determine a person’s 10-year risk for a heart attack or stroke.
If you have your cholesterol tested, the doctor will likely order a lipid panel. These results will be shown as four different numbers:
- Total Cholesterol
- LDL Cholesterol
- HDL Cholesterol
It's important to understand what the numbers mean and how to interpret them.
Your total blood cholesterol is a measure of LDL cholesterol, HDL cholesterol, and triglycerides. Total cholesterol is calculated using the equation below:
Total cholesterol = LDL + HDL + 20% of your triglyceride level
Ranges for Total Cholesterol:
|Less than 180 mg/dL||Optimal|
|180-200 mg/dL||Near Optimal|
|200-239 mg/dL||Borderline High-Risk|
|240 mg/dL and above||High-Risk|
LDL cholesterol, also known as low-density lipoprotein or "bad" cholesterol, is the main source of the cholesterol buildup that occurs in the artery walls. It is important to aim for a low LDL cholesterol level but it is no longer the main factor for preventing a heart attack or stroke.
Ranges for LDL Cholesterol:
|Less than 100 mg/dL||Optimal|
|100 to 129 mg/dL||Near Optimal|
|130 to 159 mg/dL||Borderline High|
|160 to 189 mg/dL||High|
|190 mg/dL and above||Very High|
HDL cholesterol, also known as high-density lipoprotein or "good" cholesterol, helps prevent buildup of plaque on artery walls. HDL cholesterol carries cholesterol away from the arteries to the liver, where it is then passed from the body. HDL cholesterol has a protective effect against heart disease and low HDL cholesterol is associated with an increased risk of heart disease.
Ranges for HDL Cholesterol:
|Men||> 40 mg/dL||Optimal|
|Women||> 50 mg/dL||Optimal|
Total to HDL Ratio
The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting atherosclerosis and heart disease risk. The number is obtained by dividing total cholesterol by HDL cholesterol. A high ratio indicates a higher risk of heart attack while a low ratio indicates a lower risk. The recommendation is to keep this ratio below 5:1, with the ideal being below 3.5:1.
Triglycerides are a type of lipid that makes up the majority of fat in our diets. They are either made in the liver or consumed in the form of food and then absorbed into the body through the small intestine.
It is not proven that high triglycerides are a direct risk factor for heart disease. However, high triglycerides are often part of a group of conditions called metabolic syndrome, which is the combination of high blood pressure, high blood sugar, an increased waist circumference, low HDL cholesterol, and high triglycerides. Metabolic syndrome increases the risk for heart disease, diabetes, and stroke.
Ranges for Triglycerides:
|Less than 150 mg/dL||Normal|
|500 mg/dL||Very High|
Preventing and Treating High Cholesterol
Whether you are preventing or treating high cholesterol, committing to healthy lifestyle changes is an important step in reducing your risk for heart attack or stroke. The following lifestyle changes are recommended by the American Heart Association:
- Heart-Healthy Diet: A diet pattern emphasizing fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. Limiting red meat and sugary foods and beverages. For more information on a heart-healthy diet, check out these NCHPAD links:
- Exercise: 40 minutes of aerobic exercise of moderate to vigorous intensity 3-4 times a week or at least 30 minutes of moderate physical activity most days of the week. Examples of aerobic exercise include swimming, bicycling, dancing, and brisk walking. These workouts can be broken up into a number of 10 minute sessions that can be done throughout the day. Visit NCHPAD’s video page to see if there are any workouts that could work for you!
- Quit smoking: Cigarette and tobacco smoke are 1 of 7 major independent risk factors for coronary heart disease. If you are a smoker and think that it is too later for you to quit, the good news is that your lungs can start to heal themselves as soon as you stop smoking!